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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.
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Details

1 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)
2 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)
3 Emory University, Department of Epidemiology, Rollins School of Public Health, Atlanta, USA (GRID:grid.189967.8) (ISNI:0000 0001 0941 6502)
4 University of North Carolina at Chapel Hill, Department of Epidemiology, Gillings School of Public Health, Chapel Hill, USA (GRID:grid.10698.36) (ISNI:0000000122483208)
5 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)