To achieve health equity, injury disparities must be better understood

To achieve health equity, injury disparities must be better understood

By: Kelsie Cleboski Date: December 19th, 2019

A new study from Harborview Injury Prevention & Research Center and the University of Washington School of Social Work identified trends and gaps in current injury disparities research. After reviewing ten years of published studies, the authors are calling for more researchers to collaborate with impacted communities and study prevention policies and programs.

“An important step toward achieving health equity is understanding current injury disparities,” said lead author on the study and HIPRC core member Megan Moore, Ph.D., MSW. “One of the most important gaps we identified was limited prevention and intervention strategies. The experiences and knowledge of impacted communities are vital to understanding and addressing these problems, and community engagement as well as community-based participatory research will be key to achieving health equity in injury.”

The authors identified a second notable gap in the lack of policy research, with only six studies focused on this area.

The scoping review, published in Health Equity in October, identified more than 600 studies published between 2007 and 2017 that explicitly examined injury disparity. HIPRC researchers reviewed each study’s design and data to draw larger conclusions.

Much of the existing disparity research compares injury rates and outcomes between different demographic groups. Race was the most common factor compared in the studies, followed by residential location, insurance status, and gender. Few studies examined factors such as sexual orientation, language, disability, or incarceration, the review authors noted. Studies on injury disparities among older adults were also rare. Disparities were noted in all of the categories included in studies.

Co-author and doctoral student Kelsey Conrick, MPH, noted that injury disparities research would also benefit from greater nuance in categorizing demographic differences.

“Most studies over-simplify populations who likely are impacted differently by injury. For example, thirty-eight studies created a white/non-white race binary, which potentially overlooks differences between the racial groups within those categories,” she said. “When we over-simplify, we risk losing critical information about how different communities experience injury, and we risk developing ineffective interventions.”

While studying demographic differences is useful for understanding the state of injury disparities, Moore noted, it’s also important to look deeper to work on solutions.

“We need to step back and begin to think about systematic strategies to address the noted disparities,” said Moore, who is also the Sidney Miller Endowed Associate Professor in Direct Practice at the UW School of Social Work. “We need better data, more community engagement, and a strong commitment to begin to make changes at different points of care – from prevention, to acute care, to rehabilitation and on to outpatient care and thriving in the community.

Most of the studies also defined injury broadly and did not compare disparities across different types of injuries. Such comparisons could help lead to new priorities and solutions for prevention and care.

Moore helms the Injury-Related Health Equity Across the Lifespan initiative, or iHeal, at HIPRC, and the idea for the scoping review grew out of the national iHeal Symposium hosted by the center in 2017. iHeal’s mission is to promote health equity by improving injury disparities research nationwide, and the scoping review is an important step in achieving that goal.

Other co-authors on the study include HIPRC associate member Molly Fuentes, M.D., M.S.; core member Ali Rowhani-Rahbar, M.D., Ph.D.; Washington State University associate professor Janessa Graves, Ph.D., MPH; UW Department of Epidemiology alumna Divya Patil, MPH; former INSIGHT intern Madeline Herrenkohl, Research Scientist Brianna Mills, Ph.D.; core member Fred Rivara, M.D., MPH; core member Beth Ebel, M.D., MPH; and HIPRC Director Monica Vavilala, M.D.

Funding for the study came from the National Center for Advancing Translational Sciences of the National Institutes of Health.