K. L. McCord1, C. A. Annesi5, M. Zhu1, A. Zhuang1, P. Jalihal1, S. Morris1, A. K. Buck2,4, L. Allee3,4 1Boston University, Chobanian And Avedisian School Of Medicine, Boston, MA, USA 2Boston University, Chobanian And Avedisian School Of Medicine – Department Of Graduate Medical Education, Boston, MA, USA 3Boston University, Chobanian And Avedisian School Of Medicine – Department Of Surgery, Boston, MA, USA 4Boston Medical Center, Department Of Surgery, Boston, MA, USA 5University Of Alabama at Birmingham, Department Of Surgery, Birmingham, Alabama, USA
Introduction: Firearm violence disproportionately impacts neighborhoods of high socioeconomic disadvantage. Area Deprivation Index (ADI) is a composite social deprivation score calculated for each nine digit zip code in the United States. This study aims to understand the relationship between firearm injury outcomes in Massachusetts (MA) and neighborhood disadvantage, using Area Deprivation Index (ADI).
Methods: Retrospective single institution study of MA residents (≥18 years) who presented to a level 1 trauma center with a gunshot injury from 2015-2021. 2020 MA state ADI values were assigned based on patient address and grouped into quartiles. Ascending order of quartiles reflects increasing levels of social disadvantage. Univariate analyses and multivariable logistic regression were performed to assess association between ADI quartile and discharge mortality, 30-day emergency department (ED) visits, and 30-day readmissions.
Results: There were 948 subjects; 369 patients in quartile 1, 159 in quartile 2, 260 in quartile 3, and 160 in quartile 4. More males were in higher ADI quartiles (P=0.02). Remaining demographic factors and comorbidities were similar among quartiles. After controlling for demographic factors and comorbidities, quartile 4 was associated with a lower rate of mortality on discharge (OR 0.23, 95% CI 0.1–0.8). Rate of ED visits and readmission within 30-days post-discharge were not significantly different between ADI quartiles on univariate and multivariable analysis. After controlling for ADI, Hispanic/Latino ethnicity (OR 1.9, 95% CI 1.1-3.3) was associated with increased ED visits within 30 days and Black race (OR 0.29, 95% CI 0.1-0.7) was associated with decreased hospital admissions within 30 days.
Conclusion: Fourth quartile ADI score, Hispanic/Latino ethnicity, and Black race were associated with differences in firearm injury outcomes, suggesting complex interactions between community-level access to care and individual racial and ethnic background. Larger studies are necessary to inform community level funding against firearm violence.