V. E. Chong1, W. S. Lee1, G. P. Victorino1 1UCSF-East Bay,Surgery,Oakland, CA, USA
Introduction: Measures of individual socioeconomic status, such as income, educational attainment, employment level, and insurance status, are known to correlate with violent injury recidivism. Accordingly, tertiary violence prevention programs at many trauma centers target these areas to help violently injured patients avoid recurrent violent victimization. A person’s environment may also influence their risk of being involved in violence, and as such, neighborhood socioeconomic status may impact the likelihood of recurrent injury. As this potential link has yet to be completely studied, we conducted a review of victims of interpersonal violence treated at our trauma center, hypothesizing that the median income of their neighborhood of residence predicts recurrent violent victimization.
Methods: We conducted a retrospective analysis of our urban trauma center’s registry, identifying patients who were victims of interpersonal violence from 2005-2010. We included patients ages 12-24, as this is the age of eligibility for our hospital’s violence intervention program. We focused on this age group because we currently have the resources to further address their needs. Patients who died from their trauma were excluded. Recurrent episodes of violent injury were identified, with follow-up through 2012. Median income for the patient’s zip code of residence was derived from US census estimates and divided into quartiles. Multivariate logistic regression was conducted to evaluate predictors of violent injury recidivism.
Results: During the study period, 1,888 patients presented to our trauma center as a result of interpersonal violence. Mechanism of injury included blunt assault (n=451; 24%), stabbing (n=266; 14%), and gunshot wound (n=1171; 62%). We identified 162 recidivist events (8.6%). Neighborhood median income ranged from $25,818 to $137,770. Univariate analysis was performed, and multivariate logistic regression confirmed the following factors as independent predictors of violent injury recidivism: male gender (OR=2.54 [1.33, 4.86]; p=0.005), black race (OR=2.14 [1.16, 3.93]; p=0.01), and the two lowest neighborhood median income quartiles, < $37,609 (OR=1.7 [1.15, 2.51]; p=0.008) and $37,609 to $40,062 (OR=1.85 [1.13, 3.02]; p=0.01).
Conclusion: For young patients that present with violent injury, the median income of their neighborhood of residence is independently correlated with their risk of recidivism. Low neighborhood socioeconomic status may be associated with a patient’s disrupted sense of safety after violent injury, and may represent a shortage of resources necessary to help patients avoid future violence. As such, tertiary violence prevention programs aimed at reducing violent injury recidivism should include services at both the individual level, examples of which include job training and educational support, and the neighborhood level, including advocacy efforts focused on community safety and social justice.