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Research article
Racial disparities in pedestrian-related injury hospitalizations in the United States
Corinne Peek-Asa
University of Iowa College of Public Health
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9472-2538
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Public Health.
Background
Racial/ethnic disparity has been documented in a wide variety of health outcomes, and environmental components are contributors. For example, food deserts have been tied to obesity rates. Pedestrian injuries are strongly tied to environmental factors, yet no studies have examined racial disparity in pedestrian injury rates. We examine a nationally-representative sample of pedestrian-related hospitalizations in the United States to identify differences in incidence, severity, and cost by race/ethnicity.
Methods
Patients with ICD diagnosis E-codes for pedestrian injuries were drawn from the United States Nationwide Inpatient Sample (2009-2016). Rates were calculated using the United States Census. Descriptive statistics and generalized linear regression were used to examine characteristics (age, sex, severity of illness, mortality rates, hospital admissions, length of stay, total costs) associated with hospitalizations for pedestrian injuries.
Results
The burden of injury from pedestrian-related hospitalizations was higher among Black, Hispanic, and Multiracial/Other groups in terms of admission rates, costs per capita, proportion of children injured, and length of stay compared to Whites and Asian or Pacific Islander race/ethnicities. Compared to Whites, hospital admission rates were 1.92 (95% CI: 1.89-1.94) and 1.20 (95% CI: 1.19-1.21) times higher for Multiracial/Other and Blacks, respectively. Costs per capita ($USD) were $6.30, $4.14, and $3.22 for Multiracial/Others, Blacks, and Hispanics, compared to $2.88 and $2.32 for Whites and Asian or Pacific Islanders. Proportion of lengths of stay exceeding one week were larger for Blacks (26.4%), Hispanics (22.6%), Asian or Pacific Islanders (23.1%), and Multiracial/Other (24.1%), compared to Whites (18.6%). Extreme and major loss of function proportions were also highest among Black (34.5%) and lowest among Whites (30.2%).
Conclusions
Results from this study show racial disparities in pedestrian injury hospitalization rates and outcomes, particularly among Black, Hispanic, and Multiracial/Other race/ethnicity groups and support population and system-level approaches to prevention. Access to transportation is an indicator for health disparity, and these results indicate that access to safe transportation also shows inequity by race/ethnicity.
Keywords
walking, race, mortality, health status disparities, epidemiology
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CURRENT STATUS: Published
Version 4
Posted 09 Sep, 2020
Published
On 25 Sep, 2020
No community comments so far
Editorial decision: Accept
On 07 Sep, 2020
Editor assigned
On 06 Sep, 2020
Submission checks complete
On 05 Sep, 2020
Editor invited
On 05 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 27 Aug, 2020
Editor assigned
On 18 Aug, 2020
Submission checks complete
On 17 Aug, 2020
Editor invited
On 17 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 11 Aug, 2020
Review #2 received
Received 31 Jul, 2020
Reviewer #2 agreed
On 29 Jul, 2020
Review #1 received
Received 12 Jul, 2020
Reviewer #1 agreed
On 06 Jul, 2020
Reviewers invited
Invitations sent on 26 Jun, 2020
Editor assigned
On 23 Jun, 2020
Submission checks complete
On 22 Jun, 2020
Editor invited
On 22 Jun, 2020
No comments provided
Editorial decision: Major revision
On 16 Apr, 2020
Review #2 received
Received 04 Mar, 2020
Reviewer #3 agreed
On 26 Feb, 2020
Reviewer #2 agreed
On 19 Feb, 2020
Review #1 received
Received 06 Feb, 2020
Reviewer #1 agreed
On 07 Jan, 2020
Reviewers invited
Invitations sent on 04 Jan, 2020
Editor assigned
On 20 Dec, 2019
Submission checks complete
On 19 Dec, 2019
Editor invited
On 19 Dec, 2019
First submitted
On 08 Dec, 2019
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This preprint is under consideration at BMC Public Health. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research article
Racial disparities in pedestrian-related injury hospitalizations in the United States
Corinne Peek-Asa
University of Iowa College of Public Health
Corresponding Author
ORCiD: https://orcid.org/0000-0001-9472-2538
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 4
Posted 09 Sep, 2020
Published
On 25 Sep, 2020
No community comments so far
Editorial decision: Accept
On 07 Sep, 2020
Editor assigned
On 06 Sep, 2020
Submission checks complete
On 05 Sep, 2020
Editor invited
On 05 Sep, 2020
No comments provided
Editorial decision: Minor revision
On 27 Aug, 2020
Editor assigned
On 18 Aug, 2020
Submission checks complete
On 17 Aug, 2020
Editor invited
On 17 Aug, 2020
No comments provided
Editorial decision: Minor revision
On 11 Aug, 2020
Review #2 received
Received 31 Jul, 2020
Reviewer #2 agreed
On 29 Jul, 2020
Review #1 received
Received 12 Jul, 2020
Reviewer #1 agreed
On 06 Jul, 2020
Reviewers invited
Invitations sent on 26 Jun, 2020
Editor assigned
On 23 Jun, 2020
Submission checks complete
On 22 Jun, 2020
Editor invited
On 22 Jun, 2020
No comments provided
Editorial decision: Major revision
On 16 Apr, 2020
Review #2 received
Received 04 Mar, 2020
Reviewer #3 agreed
On 26 Feb, 2020
Reviewer #2 agreed
On 19 Feb, 2020
Review #1 received
Received 06 Feb, 2020
Reviewer #1 agreed
On 07 Jan, 2020
Reviewers invited
Invitations sent on 04 Jan, 2020
Editor assigned
On 20 Dec, 2019
Submission checks complete
On 19 Dec, 2019
Editor invited
On 19 Dec, 2019
First submitted
On 08 Dec, 2019
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at BMC Public Health.
Background
Racial/ethnic disparity has been documented in a wide variety of health outcomes, and environmental components are contributors. For example, food deserts have been tied to obesity rates. Pedestrian injuries are strongly tied to environmental factors, yet no studies have examined racial disparity in pedestrian injury rates. We examine a nationally-representative sample of pedestrian-related hospitalizations in the United States to identify differences in incidence, severity, and cost by race/ethnicity.
Methods
Patients with ICD diagnosis E-codes for pedestrian injuries were drawn from the United States Nationwide Inpatient Sample (2009-2016). Rates were calculated using the United States Census. Descriptive statistics and generalized linear regression were used to examine characteristics (age, sex, severity of illness, mortality rates, hospital admissions, length of stay, total costs) associated with hospitalizations for pedestrian injuries.
Results
The burden of injury from pedestrian-related hospitalizations was higher among Black, Hispanic, and Multiracial/Other groups in terms of admission rates, costs per capita, proportion of children injured, and length of stay compared to Whites and Asian or Pacific Islander race/ethnicities. Compared to Whites, hospital admission rates were 1.92 (95% CI: 1.89-1.94) and 1.20 (95% CI: 1.19-1.21) times higher for Multiracial/Other and Blacks, respectively. Costs per capita ($USD) were $6.30, $4.14, and $3.22 for Multiracial/Others, Blacks, and Hispanics, compared to $2.88 and $2.32 for Whites and Asian or Pacific Islanders. Proportion of lengths of stay exceeding one week were larger for Blacks (26.4%), Hispanics (22.6%), Asian or Pacific Islanders (23.1%), and Multiracial/Other (24.1%), compared to Whites (18.6%). Extreme and major loss of function proportions were also highest among Black (34.5%) and lowest among Whites (30.2%).
Conclusions
Results from this study show racial disparities in pedestrian injury hospitalization rates and outcomes, particularly among Black, Hispanic, and Multiracial/Other race/ethnicity groups and support population and system-level approaches to prevention. Access to transportation is an indicator for health disparity, and these results indicate that access to safe transportation also shows inequity by race/ethnicity.
Figure 1
Figure 2