Abstract
BackgroundEthnic disparities have been associated with injury and mortality. The impact of ethnicity on head and neck injury (HNI), traumatic brain injury (TBI), in-hospital mortality and resource utilization following a motorcycle crash (MCC) is undetermined. This study explored the influence of ethnicity in these aspects and the effect of helmet use on HNI and TBI following a MCC.MethodsThe National Trauma Registry provided hospitalization data on motorcycle riders and passengers between 2008 and 2017. Ethnicity was classified as Jews or Arabs, the two major ethnic groups in Israel. Univariate followed by multivariable logistic models were applied to examine ethnic disparities. Mediation effect was tested by structural equation modeling.ResultsAmong 6073 MCC casualties, Arabs had increased odds of HNI (OR = 1.37,95% CI = 1.12–1.65) and TBI (OR = 1.51,95%CI = 1.12–1.99), and a six-fold decreased odds of helmet use (OR = 0.16,95%CI = 0.12–0.22). The HNI and TBI associations with ethnicity were mediated by helmet use. Arabs had significantly higher odds for admission to intensive care unit (OR = 1.36,95%CI = 1.00–1.83), and lower odds for ambulance evacuation (OR = 0.73,95%CI = 0.61–0.89) and discharge to rehabilitation (OR = 0.55,95%CI = 0.39–0.7). In-hospital mortality was not associated with ethnicity.ConclusionsHelmet non-use is an important etiologic factor associated with motorcycle-related HNI and TBI among Arabs. While in Israel, ethnic equality exists in in-hospital health care, disparities in ambulance and rehabilitation utilization was found. Intervention programs should target the Arab population and focus on helmet compliance.
Highlights
Motorcycle crashes (MCCs) are a significant cause of traumatic injury and mortality, resulting in approximately 88,000 casualties and 5029 deaths in the United States in 2015
head and neck injury (HNI) Head and neck injury, traumatic brain injury (TBI) Traumatic brain injury Numbers are odds ratios [ORs] and 95% confidence interval [CI] Model I: Unadjusted Model II: Adjusted for age, gender and motorcyclist position Model III: adjusted for helmet use *p < 0.05 **p < 0.01***p < 0.001 ****p < 0.0001
In-hospital mortality was not associated with ethnicity
Summary
Motorcycle crashes (MCCs) are a significant cause of traumatic injury and mortality, resulting in approximately 88,000 casualties and 5029 deaths in the United States in 2015. Head injury is most common among fatally injured motorcyclists [2]. Helmet use has been reported to reduce fatalities by 37% [3] and brain injuries by 67% [4], as well as to reduce hospitalization costs [5]. Ethnic disparities associated with traumatic injuries [6,7,8,9,10] and health care resource utilization [11] are well documented. The impact of ethnicity on head and neck injury (HNI), traumatic brain injury (TBI), in-hospital mortality and resource utilization following a motorcycle crash (MCC) is undetermined.
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