Abstract

Background

To combat the coronavirus pandemic, states implemented several public health policies to reduce infection and transmission. Increasing evidence suggests that these prevention strategies also have had a profound impact on non-COVID healthcare utilization. The goal of this study was to determine the impact of a statewide Stay-at-Home order and other COVID-related policies on trauma hospitalizations, stratified by race/ethnicity, age, and sex.

Methods

We used the North Carolina Trauma Registry, a statewide registry of trauma hospitalizations for 18 hospitals across North Carolina, including all North Carolina trauma centers, to calculate weekly rates of assault, self-inflicted, unintentional motor vehicle collision (MVC), and other unintentional injury hospitalizations between January 1, 2019, and December 31, 2020. Interrupted time-series design and segmented linear regression were used to estimate changes in hospitalization rates after several COVID-related executive orders, overall and stratified by race/ethnicity, age, and sex. Changes in hospitalization rates were assessed after 1) USA declaration of a public health emergency; 2) North Carolina statewide Stay-at-Home order; 3) Stay-at-Home order lifted with restrictions (Phase 2: Safer-at-Home); and 4) further lifting of restrictions (Phase 2.5: Safer-at-Home).

Results

There were 70,478 trauma hospitalizations in North Carolina, 2019–2020. In 2020, median age was 53 years old and 59% were male. Assault hospitalization rates (per 1,000,000 NC residents) increased after the Stay-at-Home order, but substantial increases were only observed among Black/African American residents (weekly trend change = 1.147, 95% CI = 0.634 to 1.662) and 18–44-year-old males (weekly trend change = 1.708, 95% CI = 0.870 to 2.545). After major restrictions were lifted, assault rates decreased but remained elevated compared to pre-COVID levels. Unintentional non-MVC injury hospitalizations decreased after the USA declared a public health emergency, especially among women ≥ 65 years old (weekly trend change = -4.010, 95% CI = -6.166 to -1.855), but returned to pre-pandemic levels within several months.

Conclusions

Statewide Stay-at-Home orders placed Black/African American residents at higher risk of assault hospitalizations, exacerbating pre-existing disparities. Males 18–44 years old were also at higher risk of assault hospitalization. Fear of COVID-19 may have led to decreases in unintentional non-MVC hospitalization rates, particularly among older females. Policy makers must anticipate policy-related harms that may disproportionately affect already disadvantaged communities and develop mitigation approaches.

Details

Title
Effect of Stay-at-Home orders and other COVID-related policies on trauma hospitalization rates and disparities in the USA: a statewide time-series analysis
Author
Strassle, Paula D. 1   VIAFID ORCID Logo  ; Kinlaw, Alan C. 2 ; Ko, Jamie S. 1 ; Quintero, Stephanie M. 1 ; Bonilla, Jackie 3 ; Ponder, Madison 4 ; Nápoles, Anna María 1 ; Schiro, Sharon E. 5 

 National Institute on Minority Health and Health Disparities, National Institutes of Health, Division of Intramural Research, Bethesda, USA (GRID:grid.281076.a) (ISNI:0000 0004 0533 8369) 
 University of North Carolina School of Pharmacy, Division of Pharmaceutical Outcomes and Policy, Chapel Hill, USA (GRID:grid.10698.36) (ISNI:0000000122483208); University of North Carolina at Chapel Hill, Cecil G. Sheps Center for Health Services Research, Chapel Hill, USA (GRID:grid.10698.36) (ISNI:0000000122483208) 
 Emory University, Department of Epidemiology, Rollins School of Public Health, Atlanta, USA (GRID:grid.189967.8) (ISNI:0000 0001 0941 6502) 
 University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Public Health, Chapel Hill, USA (GRID:grid.10698.36) (ISNI:0000000122483208) 
 University of North Carolina at Chapel Hill, Division of General, Acute Care, and Trauma Surgery, Department of Surgery, Chapel Hill, USA (GRID:grid.10698.36) (ISNI:0000000122483208) 
Publication year
2022
Publication date
Dec 2022
Publisher
Springer Nature B.V.
e-ISSN
21971714
Source type
Scholarly Journal
Language of publication
English
ProQuest document ID
2738694268
Copyright
© This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply 2022. This work is published under http://creativecommons.org/licenses/by/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.