Abstract
BackgroundTrauma remains a leading cause of morbidity and mortality in the UK and throughout the world. Socioeconomic deprivation has been linked with many types of ill-health and previous studies have shown an association with injury in other parts of the world. The aim of this study was to investigate the association between socioeconomic deprivation and trauma incidence and case-fatality in Scotland.MethodsThe study included nine thousand two hundred and thirty eight patients attending Emergency Departments following trauma across Scotland in 2011-12. A retrospective cohort study was conducted using secondary data extracted from the national trauma registry. Postcode of residence was used to generate deciles using the Scottish Index of Multiple Deprivation. The incidence rate ratio (IRR) was calculated to allow comparison of incidence of trauma across SIMD deciles. For mortality, observed: expected ratios were obtained using observed mortality in the cohort and expected deaths using probability of survival based on Trauma and Injury Severity Score (TRISS) method.ResultsCompared with the most deprived decile, the least deprived had an incidence rate ratio (IRR) for all trauma of 0.43 (95 % CI 0.32–0.58, p < 0.001). The association was stronger for penetrating trauma (IRR 0.07, 95 % CI .01–0.56, p = 0.011). There was a significant interaction between age, gender and SIMD. For case fatality, multivariate logistic regression showed that, severity of trauma (ISS > 15) OR 18.11 (95 % CI 13.91 to 23.58) and type of injury (Penetrating versus blunt injury) OR 2.07 (95 % CI 1.15 to 3.72) remain as independent predictors of case fatality in this dataset.DiscussionOur data shows a higher incidence of trauma amongst a socioeconomically deprived population, in keeping with other areas of the world. In our dataset, outcome, as measured by in-hospital mortality, does not appear to be associated with socioeconomic deprivation.ConclusionIn Scotland, populations living in socioeconomically deprived areas have a higher incidence of trauma, especially penetrating trauma, requiring hospital attendance. Case fatality is associated with more severe trauma and penetrating trauma, but not socioeconomic deprivation.Electronic supplementary materialThe online version of this article (doi:10.1186/s13049-016-0275-7) contains supplementary material, which is available to authorized users.
Highlights
Trauma remains a leading cause of morbidity and mortality in the UK and throughout the world
Case fatality is associated with more severe trauma and penetrating trauma, but not socioeconomic deprivation
The dedicated audit staff review all admissions to participating hospital Emergency Departments (ED) and Intensive Care Units (ICU) with any traumatic injury to assess if they are eligible for inclusion in the trauma registry
Summary
Trauma remains a leading cause of morbidity and mortality in the UK and throughout the world. Socioeconomic deprivation has been linked with many types of ill-health and previous studies have shown an association with injury in other parts of the world. The aim of this study was to investigate the association between socioeconomic deprivation and trauma incidence and case-fatality in Scotland. Injuries due to trauma remain a major cause of morbidity and mortality in the UK and throughout the world [1]. It is the leading cause of death in the 15–44 year age-group worldwide, [2] and a major cause of disability and loss of earnings [3]. Direct health costs in the UK are estimated at £400 million per annum, and the total economic cost has been estimated to be of the order of £3.5 billion per annum [7]
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