Racial/ethnic and socioeconomic disparities in the use of helmets in children involved in bicycle accidents Veronica F. Sullins, Arezou Yaghoubian, Julien Nguyen, Amy H. Kaji, Steven L. Lee PII: DOI: Reference:
S0022-3468(14)00047-5 doi: 10.1016/j.jpedsurg.2014.01.038 YJPSU 56669
To appear in:
Journal of Pediatric Surgery
Received date: Accepted date:
25 January 2014 27 January 2014
Please cite this article as: Sullins Veronica F., Yaghoubian Arezou, Nguyen Julien, Kaji Amy H., Lee Steven L., Racial/ethnic and socioeconomic disparities in the use of helmets in children involved in bicycle accidents, Journal of Pediatric Surgery (2014), doi: 10.1016/j.jpedsurg.2014.01.038
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ACCEPTED MANUSCRIPT
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Racial/Ethnic and Socioeconomic Disparities in the Use of Helmets in Children Involved in Bicycle Accidents
Department of Surgery, Harbor-UCLA Medical Center, Los Angeles, CA 90509, USA
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Veronica F Sullinsa, Arezou Yaghoubianb, Julien Nguyenc, Amy H Kajid, Steven L Leea*
Department of Surgery, Division of Plastic Surgery, University of California, Los Angeles, Los
University of California, Los Angeles, Los Angeles, CA 90095, USA
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Angeles, CA 90095, USA
Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA 90509,
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USA
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Corresponding Author:
Steven L. Lee Division of Pediatric Surgery Harbor-UCLA Medical Center 1000 West Carson Street Box 25, Bldg 1-E Torrance, CA 90509, USA Telephone: +1 310 222 2706 Fax: +1 310 782 1562 E-mail:
[email protected] ACCEPTED MANUSCRIPT Abstract Purpose: While bicycle helmet use reduces bicycle-related head injury, few children wear them
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regularly. We aimed to describe racial/ethnic and socioeconomic differences in pediatric helmet use in Los Angeles County (LAC) to help target groups for injury prevention programs.
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Methods: A retrospective review of all pediatric patients involved in bicycle-related accidents in
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LAC between 2006 and 2011 was performed. Our primary analysis examined the association between helmet use and age, gender, insurance status, and race/ethnicity. We also evaluated the
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association between helmet use and the need for emergency surgery, mortality, and length of hospital stay (LOH), after adjusting for injury severity score (ISS), age, insurance status, and
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race/ethnicity.
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Results: Of 1,248 patients, 11.3% wore helmets with decreased use among children 12 years and older, minorities, and those without private insurance. Overall, 5.9% required an emergency
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operation, 34.1% returned to their pre-injury capacity, and mortality was 0.7%. On multivariable
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analysis, higher ISS increased LOH, the risk for emergency surgery, and mortality. Conclusion: Nearly 90% of children involved in bicycle-related accidents were not wearing helmets. Helmet use was lower among older children, minorities, and those from a low socioeconomic status. Injury prevention programs targeting low-income middle and high schools and minority communities may help increase helmet use in children in LAC.
Keywords: Bicycle Helmet; Bicycle Accidents; Helmet Use; Racial Disparities; Ethnic Disparities
ACCEPTED MANUSCRIPT According to the CDC, an estimated 33 million children ride bicycles nearly 10 billion hours each year. Unfortunately, nearly 200 children die each year from bicycle crashes, and bicycle-
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related injuries account for over 250,000 emergency department related visits [1]. While helmet
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use is a proven intervention that reduces bicycle-related head injury by 63-88% [2] only 18% of
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the population and 15% of children under 15 years of age wear helmets all or most of the time [3]. Although California has had a mandatory bicycle helmet law for those less than 18 years old
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since 1994, the state had the second highest number of bicyclist fatalities in 2011 [4]. The problem of ethnic and racial disparities has recently received significant attention in both the
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media and the literature; yet there are little data regarding racial/ethnic and socioeconomic differences in the use of helmets among injured patients. Thus, the aim of this study was to
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describe racial/ethnic and socioeconomic differences in pediatric helmet use in Los Angeles
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County to delineate target groups for developing and disseminating injury control
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recommendations.
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1. Materials and Methods
This study was approved by the Human Subjects Committee of the Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center. We evaluated all bicycle-related trauma patients