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Abstract
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Pino et al1 explore the associations between neighborhood context and likelihood of violence perpetration or reinjury after a violent injury. Using the Index of Concentration at the Extremes (ICE), the authors conducted a retrospective review of patients who had a nonfatal violent injury and presented to Boston Medical Center, a level 1 trauma center treating 70% of individuals with firearm and stab wounds in Boston. The authors found that increasing neighborhood racialized economic segregation, measured at the census tract level, was associated with increased risk of police-reported violence perpetration at 1 year. Notably, they did not find an association between neighborhood deprivation and risk of violent reinjury at 1 year.1
Social determinants of health, including poverty, lack of economic opportunity, and exposure to adverse childhood experiences, are associated with worse health outcomes in a number of domains, particularly injury. This study adds to the growing body of literature assessing the association of neighborhood context with risk of injury, particularly violent injury. There are number of key, unique methodological considerations used in this work that are worth highlighting. First, Pino et al1 used a unique methodology linking hospital, state, and police data to better understand the trajectory of individuals within environments of deprivation. Second, the authors chose to use ICE, 1 of many area-based socioeconomic deprivation indices, because this measure assesses the association of long-standing structural racism with health outcomes and is better able to quantify privilege and deprivation at the extremes. This measure allows for an assessment of the complexity of neighborhood context and intersectionality between race and ethnicity and deprivation in US cities. Third, using geospatial methods to assess deprivation at the census tract level with ICE, the authors were able to carefully elucidate the way in which neighborhood built environment and context are associated with outcomes among individuals after injury. The use of census tract-level data rather than zip code-level data is an important method in this study given that variation at the census tract level may disappear at the more heterogeneous zip code level.2 Lastly, the authors used Kaplan-Meier survival curves to estimate timing of violence perpetration, finding that the greatest occurrence of violence perpetration was within the first year after injury. This methodology allows for understanding when key support and interventions to survivors of injury may be most needed and effective. These findings highlight that injury-prevention efforts focusing on the individual are necessary but perhaps insufficient to address the underlying context in which individuals live and that may be associated with increased risk for injury...
Language: en |