SCIENTIFIC REVIEW

Open Access

The influence of socioeconomic status on management and outcomes in major trauma: A systematic review and meta-analysis

Corresponding Author

Amanda Koh

[email protected]

orcid.org/0000-0003-4757-2869

Gastrointestinal Surgery, Nottingham Digestive Diseases Centre and National Institute for Health Research (NIHR) Biomedical Research Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

Correspondence

Amanda Koh, Nottingham Digestive Diseases Centre, National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.

Email: [email protected]

Contribution: Conceptualization, Data curation, Formal analysis, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing

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Alfred Adiamah,

Alfred Adiamah

orcid.org/0000-0002-0624-6197

East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

Contribution: Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing

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Georgia Melia,

Georgia Melia

orcid.org/0000-0001-8886-509X

East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

Contribution: Project administration, Resources, Software, Writing - original draft, Writing - review & editing

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Lauren Blackburn,

Lauren Blackburn

orcid.org/0000-0002-6129-8790

East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

Contribution: Conceptualization, Investigation, Methodology, Validation, Writing - original draft, Writing - review & editing

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Adam Brooks,

Adam Brooks

East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

Contribution: Conceptualization, Investigation, Methodology, Resources, Supervision, Writing - original draft, Writing - review & editing

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Amanda Koh,

Corresponding Author

Amanda Koh

[email protected]

orcid.org/0000-0003-4757-2869

East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

Correspondence

Email: [email protected]

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Alfred Adiamah,

Alfred Adiamah

orcid.org/0000-0002-0624-6197

East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

Contribution: Conceptualization, Formal analysis, Investigation, Methodology, Supervision, Validation, Visualization, Writing - original draft, Writing - review & editing

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Georgia Melia,

Georgia Melia

orcid.org/0000-0001-8886-509X

East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

Contribution: Project administration, Resources, Software, Writing - original draft, Writing - review & editing

Search for more papers by this author

Lauren Blackburn,

Lauren Blackburn

orcid.org/0000-0002-6129-8790

East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

Contribution: Conceptualization, Investigation, Methodology, Validation, Writing - original draft, Writing - review & editing

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Adam Brooks,

Adam Brooks

East Midlands Major Trauma Centre, Queen's Medical Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK

Contribution: Conceptualization, Investigation, Methodology, Resources, Supervision, Writing - original draft, Writing - review & editing

Search for more papers by this author

First published: 09 October 2024

https://doi.org/10.1002/wjs.12372

Citations: 2

This paper has been accepted for presentation to the annual congress of the Association of Surgeons in Great Britain and Ireland (ASGBI), Belfast, May 2024. The abstract has been published in the British Journal of Surgery.

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Abstract

Background

Major trauma is a leading cause of death and disability in younger individuals and poses a significant public health concern. There is a growing interest in understanding the complex relationships between socioeconomic deprivation and major trauma. Anecdotal evidence suggests that deprivation is associated with more violent and debilitating injuries. There remains a paucity in literature evaluating major trauma outcomes in relation to socioeconomic deprivation.

Methods

A comprehensive search of MEDLINE, Embase, and CENTRAL databases was performed to identify studies from 1947 to March 2024. The primary outcome was to establish the distribution of injuries based on deprivation, with secondary outcomes evaluating surgical intervention rates, length of stay, and mortality. Quantitative pooling of data was based on the random-effects model.

Results

Fourteen studies and 878,872 trauma patients were included. A substantial proportion (28%) of trauma incidents occurred in the most deprived group. Patients from the lowest socioeconomic group were considerably younger (weighted mean difference [WMD] −9.85 years and 95% confidence intervals [CI] −9.99 to −9.70) and more likely to be male (odds ratio [OR] 1.36 and 95% CI 1.14–1.63). There were no differences in surgical intervention (OR 1.74 and 95% CI 0.97–3.13), length of stay (WMD 1.15 days and 95% CI −0.32−2.62), and mortality (OR 1.04 and 95% CI 0.95–1.14) regardless of background.

Conclusion

Major trauma is prevalent in deprived areas and in younger individuals, with an increasing trend of deprivation in male patients. Although the rates of surgery, length of stay, and mortality did not differ between groups, planning of public health interventions should target areas of higher deprivation.

1 INTRODUCTION

Major trauma poses a significant public health concern and is the leading cause of death and disability globally.^{1, 2} Despite advances in trauma care and development of major trauma pathways, trauma remains a common cause of death in the younger population globally. The UK National Audit Office² estimates that there are 20,000 cases of major trauma annually with 5400 subsequent deaths. Although data on the outcomes of trauma and its pattern of mechanisms have increasingly been described in recent years,³ little is known about the association between socioeconomic status (SES) and patient outcomes.

The injury burden from major trauma is not shared equally among all patients, with previous studies indicating that those of lower socioeconomic backgrounds being overrepresented in trauma populations.⁴ Social deprivation, or low SES, can be described as a limitation of access to resources due to poverty, discrimination, finances, and lack of education and is often linked to poorer health outcomes. Recent studies from the United States^5-8 have indicated that social deprivation increases the likelihood of experiencing more severe and violent trauma. In addition to the increased likelihood that vulnerable patients have to suffer from traumatic injury, disparities can also exist in trauma care received and subsequent mortality.⁵ The reason for this is likely to be multifactorial. Patients from low SES backgrounds are less likely to have financial access to healthcare for treatment and are less likely to have access to tools for health promotion.^9-11 Chronic stressors and lack of access to preventative care for comorbid conditions in patients from low SES backgrounds can also contribute to deleterious outcomes following the trauma.¹²

Understanding the association between SES and the management and outcomes of major trauma can be useful in the planning and provision of public health prevention programs. This systematic review and meta-analysis aims to investigate these complex associations.

2 METHODS

This systematic review and meta-analysis was performed in accordance with the guidance of the PRISMA and MOOSE statements, and the protocol was registered with the PROSPERO database (registration number: CRD42024519267).

2.1 Search strategy

A comprehensive and systematic search of the Medline, Embase, CENTRAL, and ClinicalTrials.gov databases was undertaken to identify relevant studies from database inception to March 19, 2024. Relevant MeSH terms and keywords relating to SES were combined with terms relating to major trauma [“socioeconomic status” odds ratio (OR) “social deprivation”] AND [“major trauma”]. The reference list of all studies that met the inclusion criteria were hand-searched for any additional suitable articles to ensure comprehensive study inclusion. The detailed search strategy can be found in Table S1.

2.2 Eligibility criteria

Eligible study types are observational studies evaluating the effects of socioeconomic deprivation on outcomes in major trauma patients. Letters, case reports, case series with less than 20 participants, and systematic reviews were excluded. Studies that did not report the primary outcome measure were also excluded. The studies had to be in human subjects 18 years of age or older. There was no limitation to language of publication, sex, geographic location, or publication status.

Major trauma was defined using the UK NICE guidelines definition¹³ which is accepted by all the UK national trauma centers as an injury or combination of injuries that are life-threatening and could be life changing because it may result in long-term disability. For the purpose of this review, studies which included solely head and neck or orthopedic injuries were excluded from analysis as their management varies greatly. Only studies that categorized SES with a discrete or numerical value were included in this review.

2.3 Study selection and data extraction

Studies identified from the database search were screened based on their titles and abstracts by two independent reviewers (AK and GM), and studies that meet the eligibility criteria were read in full text. Duplicate studies were excluded. Any discordance was resolved by consensus with the other authors. Where multiple reports describing the study were identified, data from all reports were used if required, ensuring no duplicate counting of study participants.

A standardized data extraction form was used to document study characteristics and outcomes. This included information regarding the study design, country of origin, years conducted, patient population, and a description of the measurement of SES used by individual studies.

The primary outcome of interest is to establish the proportion of patients with a low SES that present as a major trauma. The secondary outcomes included a comparison of the age, sex, injury severity score (ISS), rate of surgical intervention, length of hospital stay, and mortality rates between the lowest and highest SES groups. The longer-term disability was also explored where reported by the level of social deprivation. The lowest SES group describes participants with the greatest level of socioeconomic deprivation.

2.4 Risk of bias assessment

The risk of bias for each study was assessed using the Newcastle–Ottawa scale (NOS) for cohort studies. A modified NOS was used to assess the risk of bias for this systematic review. The selection criteria was rated from 1–3 stars instead of 4, as the “demonstration that outcome of interest was not present at start of study” is not applicable for this review. An overall risk of bias score was given to each study: low, moderate, and high risk of bias.

2.5 Statistical analysis

Meta-analyses of the pooled data and creation of forest plots were performed using StataMP version 14.1 (Stata Corp., https://www.stata.com/news/14-1/). Prevalence data were presented as the prevalence rates with their respective 95% confidence intervals (CIs). A pooled estimation was computed using a random-effects model to allow for variation between studies. Effects summary comparing the secondary outcomes between the lowest and highest SES groups were presented as OR with their respective 95% CI for categorical data and weighted mean difference (WMD) and 95% CI for continuous data. Publication bias was assessed as per the methods described by Egger et al.¹⁴ using the visual inspection for asymmetry of the funnel plot. Statistical heterogeneity was assessed using the I² statistic with the following interpretation of values as outlined in the Cochrane Handbook¹⁵:

0%–40% might not be important,
30%–60% may represent moderate heterogeneity,
50%–90% may represent substantial heterogeneity,
75%–100% considerable heterogeneity.

3 RESULTS

3.1 Study selection

A total of 3999 studies were retrieved from the database search (Figure 1). After excluding duplicates, 2901 abstracts were screened and 154 full-text articles were identified as being potentially eligible for analysis. After a critical appraisal of the full-texts, 140 were excluded from this review. Table S2 lists potentially eligible studies that were excluded along with reasons.

Details are in the caption following the image — **FIGURE 1**
Open in figure viewer PowerPoint

PRISMA flow diagram.

Finally, 14 studies^16-29 with a total of 878,872 participants met the eligibility criteria and were assessed qualitatively and quantitatively. There were 253,158 participants from the lowest socioeconomic backgrounds (most deprived) and 227,756 from the highest socioeconomic backgrounds (least deprived).

3.2 Study characteristics

The included studies were published between 2000 and 2024 (Table 1). Eight studies were from Europe,^{17-20, 22, 24, 26, 28} four from North America,^{16, 23, 27, 29} one from Australia,²¹ and one from the Middle East.²⁵ Ten of the studies were multicenter studies^{17-24, 26, 28} and four were single-center studies.^{16, 25, 27, 29} The included studies had varying ways of determining their study participants' SES; however, the majority used their respective government's official deprivation index tools. Of the 14 studies, 8 assigned their participants into 1 of 5 levels of deprivation (quintiles), 2 into quartiles, 2 into tertiles, and 2 into low and high SES groups.

TABLE 1. Characteristics of the included studies.

Author	Study design	Country and year(s) of study	Population	Subjects (n)	Determination of SES
Henry et al. (2024)	Retrospective	United States, 2012–2021	Single center (regional adult trauma center)	1044	SES determined by area of deprivation index (ADI) tool and official United States Census Bureau.
Henry et al. (2024)	Retrospective	United States, 2012–2021	Single center (regional adult trauma center)	1044	Study subjects are assigned one of 5 SES quintiles.
Snell et al. (2023)	Retrospective	United Kingdom, 2014–2019	Multicenter	7666	SES determined by English official index of multiple deprivation 2019 (IMD) stool.
Snell et al. (2023)	Retrospective	United Kingdom, 2014–2019	Multicenter	7666	Study subjects are assigned one of 5 SES quintiles.
Moksnes et al. (2023)	Prospective	Norway, 2020	Two regional trauma centers	601	SES determined by Norwegian Centrality Index (NCI) tool.
Moksnes et al. (2023)	Prospective	Norway, 2020	Two regional trauma centers	601	Study subjects are assigned one of 3 tertiles.
Madsen et al. (2022)	Retrospective	Norway, 2008–2014	Multicenter	177,663	SES determined by education, income, and occupation (calculation and assignment of index performed by the study investigators).
Madsen et al. (2022)	Retrospective	Norway, 2008–2014	Multicenter	177,663	Study subjects are assigned one of 5 quintiles.
Popal et al. (2021)	Retrospective	Netherlands, 2015–2017	Two regional trauma centers (level 1)	967	SES determined by statistics Netherlands (CBS) and The Dutch Institute for Social Research (SCP).
Popal et al. (2021)	Retrospective	Netherlands, 2015–2017	Two regional trauma centers (level 1)	967	Study subjects are assigned one of 5 quintiles.
Giummarra et al. (2021)	Retrospective	Australia, Jan 2009–Jun 2017	Multicenter	1003	SES determined by the index of relative socio-economic advantage and disadvantage (IRSAD) tool.
Giummarra et al. (2021)	Retrospective	Australia, Jan 2009–Jun 2017	Multicenter	1003	Study subjects are assigned one of 5 quintiles.
Bege et al. (2019)	Retrospective	France, 2016	Multi-center	137,944	SES determined by the French area-level deprivation index (FDep99 index) tool.
Bege et al. (2019)	Retrospective	France, 2016	Multi-center	137,944	Study subjects are assigned one of 4 quartiles.
Sall et al. (2018)	Retrospective	United States, 2006–2014	Multi-center	407,553	SES determined by the United States Census Bureau.
Sall et al. (2018)	Retrospective	United States, 2006–2014	Multi-center	407,553	Study subjects are assigned one of 4 quartiles.
McHale et al. (2018)	Retrospective	United Kingdom, 2015	Multicenter (using the national trauma database, TARN)	48,658	SES determined by English official index of multiple deprivation 2019 (IMD) stool.
McHale et al. (2018)	Retrospective	United Kingdom, 2015	Multicenter (using the national trauma database, TARN)	48,658	Study subjects are assigned one of 5 SES quintiles.
Abedzadeh-Kalahroudi. (2018)	Retrospective	Iran, 2014–2015	Single center	570	SES determined on asset index (by performing principal component analysis by the study investigators).
Abedzadeh-Kalahroudi. (2018)	Retrospective	Iran, 2014–2015	Single center	570	Study subjects are assigned one of 3 tertiles.
Devos et al. (2017)	Retrospective	Belgium, 2009–2011	Multicenter	64,304	SES determined by entitlement to reduced payments for healthcare services.
Devos et al. (2017)	Retrospective	Belgium, 2009–2011	Multicenter	64,304	Study subjects are assigned either low or high SES.
Mikhail et al. (2016)	Retrospective	United States, 2000–2009	Single center	4007	SES determined by the United States Census Bureau.
Mikhail et al. (2016)	Retrospective	United States, 2000–2009	Single center	4007	Study subjects are assigned either low or high SES.
Corfield et al. (2016)	Retrospective	Scotland, 2011–2012	Multicenter (using the national trauma database)	9238	SES determined by the Scottish Index of Multiple Deprivation (IMD) 2012 tool.
Corfield et al. (2016)	Retrospective	Scotland, 2011–2012	Multicenter (using the national trauma database)	9238	Study subjects are assigned one of 5 quintiles.
Zarzaur et al. (2010)	Retrospective	United States, 1996–2005	Single center	17,658	SES determined by the United States Census Bureau.
Zarzaur et al. (2010)	Retrospective	United States, 1996–2005	Single center	17,658	Study subjects are assigned one of 5 quintiles.

3.3 Meta-analysis

3.3.1 Demographics

Fourteen studies reported on the SES of patients presenting as a major trauma, with 28% (95% CI 24%–31%) of all patients coming from the most deprived backgrounds (Figure S1a). There was a considerable statistical heterogeneity across studies (I² = 99.86%).

Five studies^{16, 18, 20, 23, 29} reported on the average age of patients from each socioeconomic group. Major trauma patients from the lowest socioeconomic group were considerably younger compared to the highest (WMD −9.85 years, 95% CI −9.99 to −9.70, see Figure S1b). However, there was, a considerable statistical heterogeneity (I² = 99%).

Seven studies^{16, 18, 20, 22-24, 29} reported on the sex of patients across all socioeconomic groups. Male patients were more likely to derive from the lowest socioeconomic backgrounds (OR 1.36, 95% CI 1.14–1.63, and I² = 98%; see Figure S1c).

Four studies^{16, 20, 23, 29} reporting on ISS across patients from all socioeconomic backgrounds found that there were no significant differences between the most- and least-deprived groups (WMD −0.85, 95% CI −2.38 to 0.69, and I² = 96%; see Figure S1d).

3.3.2 Patient outcomes

Two studies^{16, 18} reported on the rate of surgical intervention across major trauma (Figure 2A). There were no statistically significant differences between the most- and least-deprived groups (OR 1.74, 95% CI 0.97–3.13, and I² = 0%).

Three studies^{16, 18, 23} reporting on the length of hospital stay found that there were no significant differences between the two socioeconomic groups (WMD 1.15 days and 95% CI −0.32 to 2.62; see Figure 2B).

Eight studies^{16, 20, 22-25, 27, 28} reporting on mortality rates found that there were no significant differences in mortality between the most and least deprived groups (OR 1.04, 95% CI 0.95–1.14, and I² = 64%; see Figure 2C).

3.4 Disability

Two studies^{21, 25} reported post-trauma disability, one²¹ at 6-, 12- and 24-months and another²⁵ at 1- and 3-months. One²¹ study reported that there was a trend of increasing disability (problems with pain, anxiety and depression, mobility, self-care, and activities of daily living) with lower SES groups. Another study²⁵ did not report any differences in disability across SES groups. Pooled analysis was not possible due to the lack of data.

3.5 Risk of bias

The risk of bias was evaluated using the NOS (Table 2). Overall, 8 studies had a low risk of bias,^{20-24, 27-29} whereas 4 studies had a medium risk of bias^{16, 19, 25, 26} and 2 studies had a high risk of bias.^{17, 18}

TABLE 2. Risk of bias assessment.

Study	Risk of bias assessment
Study	Selection	Comparability	Outcome	Overall score
Henry et al. (2024)	***	-	**	5
Snell et al. (2023)	***	-	-	3
Moksnes et al. (2023)	***	-	-	3
Madsen et al. (2022)	***	**	-	5
Popal et al. (2021)	***	**	**	7
Giummarra et al. (2021)	***	*	***	7
Bege et al. (2019)	***	-	*******	6
Sall et al. (2018)	***	**	**	7
McHale et al. (2018)	***	**	***	8
Abedzadeh-Kalahroudi et al. (2018)	***	-	**	5
Devos et al. (2017)	***	*	-	4
Mikhail et al. (2016)	***	**	**	7
Corfield et al. (2016)	***	**	***	8
Zarzaur et al. (2010)	***	**	**	7

Note: Risk of bias: 6 or above, low risk; 4 or 5, medium risk; and 1–3, high risk.

4 DISCUSSION

This meta-analysis of 14 studies found that a considerable proportion of major trauma incidents occurred in younger individuals from low socioeconomic backgrounds, with an increasing trend of deprivation in male patients. Importantly, there were no differences in the rate of surgical intervention, length of hospital stay, and mortality between the most and least deprived population. There was considerable statistical heterogeneity across the meta-analysis for the outcomes of proportion of significant socioeconomic deprivation, age, sex, ISS, and mortality. This was not unexpected as the population and methodology used to determine the participants' SES varied across the 14 studies.

Historical epidemiological data have described that major trauma is predominantly a disease of young men,^{30, 31} but recent studies^{32, 33} have suggested that the trauma population may gradually be changing to reflect an aging population due to improvements in healthcare and consequently prolonging life expectancies. Despite this, thirteen of the fourteen studies included within this systematic review were published within the last decade and still showed an ongoing trend of young male patients from low socioeconomic backgrounds. In the United Kingdom, young males are substantially more likely to be involved in violence and knife crime, both as perpetrators and victims.^34-36 Exposure to violence increases the risk of alcohol and drug abuse³⁷ and consequently injuries requiring a major trauma admission. These risks increase further with increasing levels of deprivation.^{9, 38-40} This supports the findings of this present study, where majority of the patients were young, male, and from low socioeconomic backgrounds.

In recent years, there has been a growing interest in understanding the complex relationships between SES and major trauma admissions. Deprivation-related stressors, unemployment, homelessness, inadequate access to community resources, including sporting opportunities in youth, and social isolation all create a disparity in trauma rates. Previous studies^{17, 41} have demonstrated that socioeconomically deprived individuals are more likely to participate in high-risk behaviors, which increases the risk for injuries. Despite a disparity in the demographics of major trauma patients, this present review has importantly highlighted that the management and mortality rates do not differ across different socioeconomic groups. Previous studies have demonstrated that acquired in-hospital complications, preexisting chronic conditions, and lack of access to care for comorbid conditions in patients from deprived backgrounds can also worsen outcomes following major trauma.^{12, 42} The NHS healthcare model in the United Kingdom means that all healthcare is free at the point of use, which reduces inequalities of access to healthcare found in several other countries. In England, the majority of trauma is attended to by a trauma team and specialist trauma centers; evidence suggests that this model has led to improvements in outcomes.⁴³ Better access to healthcare is also associated to reductions in inequalities of mortality across Europe.⁴³

Patients who have suffered moderate and severe traumatic injuries often face challenges in the post-discharge recovery, including anxiety, depression, post-traumatic stress disorder (PTSD), pain, cognition issues, other physical disability, and failed return to work.^44-47 These issues are often compounded in individuals from deprived backgrounds due to stigma and reduced social and financial support. There is growing evidence to show that improved access to work is associated with better health and quality of life.⁴⁸ Improved access to early and continued rehabilitation and involvement of a multidisciplinary team can support patients recover with adequate psychological, emotional, and physical support.

This is the first systematic review and meta-analysis examining the association between SES and the management and outcomes of patients presenting as a major trauma, which has highlighted the discrepancies in the demographics of patients between the lowest and highest SES groups. Despite this, the present analysis has some limitations. While this systematic review included 14 studies and over eight hundred thousand patients, some studies had smaller sample sizes (three studies had less than 1000 patients). Post-injury disability was only reported in 2 studies, of which only one²¹ reported long-term disability at 24 months. There was a significant heterogeneity in the data across all outcome measures. This is likely due to the diversity in the population and methodology used across the 14 studies. The criteria for determining levels of socioeconomic deprivation varied between the studies. Although most study investigators relied on official and recognized government index of multiple deprivation tools, three performed their own calculations to assign participants into a socioeconomic group. For the purposes of the present analyses, outcomes were compared between the lowest and highest SES groups. Although majority of the study investigators presented their patients' SES as quintiles (five equal groups), others presented SES as either two, three, or four groups. Therefore, this variation in the determination of participants' SES may explain the heterogeneity in the data across all outcome measures.

Information on functional outcomes is crucial to evaluate the full impact of trauma including disability, quality of life, lost income, social care, and direct healthcare costs. However, there is a lack of available data on functional outcomes following major trauma from the included studies. Future research should focus on long-term outcomes of the different socioeconomic groups following major trauma. There is a need to explore functional outcomes to understand how individuals from different socioeconomic backgrounds recover from injury in order to understand the long-term burden of trauma. Further larger studies are required to explore the impact of SES on the mechanism of action, management, in-hospital, and long-term outcomes of major trauma. Finally, identifying those at the highest risk of injury and subsequent poor outcomes can help develop and prioritize key issues in public health policies and strategies that could help prevent major trauma.

5 CONCLUSION

Major trauma is more prevalent in deprived areas; younger males, from lower socioeconomic backgrounds, are more likely to be presenting with blunt or penetrating trauma injuries. However, there was, no difference in the rates of surgery, length of stay, and mortality between the most and least deprived groups following presentation—a likely beneficial effect of level 1 trauma units with centralized expertise. Nonetheless, the currently available literature remains sparse regarding the longer-term disability and outcomes following major trauma injuries based on levels of deprivation.

In future, the planning of public health interventions should be targeted at areas of higher deprivation to diminish the impact of avoidable traumatic injuries especially in younger males.

AUTHOR CONTRIBUTIONS

Amanda Koh: Conceptualization; data curation; formal analysis; investigation; methodology; project administration; resources; software; supervision; validation; visualization; writing—original draft; writing–review & editing. Alfred Adiamah: Conceptualization; formal analysis; investigation; methodology; supervision; validation; visualization; writing - original draft; writing—review & editing. Georgia Melia: Project administration; resources; software; writing - original draft; writing—review & editing. Lauren Blackburn: Conceptualization; investigation; methodology; validation; writing—original draft; writing—review & editing. Adam Brooks: Conceptualization; investigation; methodology; resources; supervision; writing—original draft; writing—review & editing.

ACKNOWLEDGMENTS

There was no external funding.

CONFLICT OF INTEREST STATEMENT

The authors declare that they have no conflicts of interest.

ETHICS STATEMENT

Ethical approval was not necessary as this was a systematic review.

PROTOCOL REGISTRATION

The protocol was registered with the PROSPERO database (registration number: CRD42024519267).

Supporting Information

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Citing Literature

Volume48, Issue11

November 2024

Pages 2783-2792

The influence of socioeconomic status on management and outcomes in major trauma: A systematic review and meta-analysis