Social Determinants of Severe Injury among Pediatric Patients During the COVID-19 Pandemic: an Exploratory Study.

Introduction: This study sought to identify social determinants of health (SDH) patterns associated with severe pediatric injuries. Method: We used cross-sectional data from children (<= 18 years) admitted to a pediatric trauma center between March and November 2021 (n = 360). We used association rule mining (ARM) to explore SDH patterns associated with severe injury. We then used ARM -identified SDH patterns in multivariable logistic regressions of severe injury, controlling for patient and caregiver demographics. Finally, we compared results to naive hierarchical logistic regressions that consid-ered SDH types as primary exposures rather than SDH patterns. Results: We identified three SDH patterns associated with severe injury: (1) having child care needs in combination with neighbor-hood violence, (2) caregiver lacking health insurance, and (3) care-giver lacking social support. In the ARM-informed logistic regression models, the presence of a child care need in combination with neighborhood violence was associated with an increased odds of severe injury (aOR, 2.77; 95% CI, 1.01-7.62), as was caregiver lacking health insurance (aOR, 2.29; 95% CI, 1.02-5.16). In the naive hierarchical logistic regressions, no SDH type in isolation was associated with severe injury. Discussion: Our exploratory analyses suggest that considering the co-occurrence of negative SDH that families experience rather than isolated SDH may provide greater insights into prevention strategies for severe pediatric injury. J Pediatr Health Care. (2022) 36, 549-559