Effect of Stay-at-Home orders and other COVID-related policies on trauma hospitalization rates and disparities in the USA: a statewide time-series analysis
Creators: name: Ko, Jamie S.
name: Bonilla, Jackie
name: Kinlaw, Alan C.
name: Quintero, Stephanie M.
name: Schiro, Sharon E.
name: Ponder, Madison
name: Strassle, Paula D.
name: Nápoles, Anna María
Publisher: name: Springer Nature
Year: 2022

description: <p>Background To combat the coronavirus pandemic, states implemented several public health policies to reduce infection and transmission. Increasing evidence suggests that these prevention strategies also have had a profound impact on non-COVID healthcare utilization. The goal of this study was to determine the impact of a statewide Stay-at-Home order and other COVID-related policies on trauma hospitalizations, stratified by race/ethnicity, age, and sex. Methods We used the North Carolina Trauma Registry, a statewide registry of trauma hospitalizations for 18 hospitals across North Carolina, including all North Carolina trauma centers, to calculate weekly rates of assault, self-inflicted, unintentional motor vehicle collision (MVC), and other unintentional injury hospitalizations between January 1, 2019, and December 31, 2020. Interrupted time-series design and segmented linear regression were used to estimate changes in hospitalization rates after several COVID-related executive orders, overall and stratified by race/ethnicity, age, and sex. Changes in hospitalization rates were assessed after 1) USA declaration of a public health emergency; 2) North Carolina statewide Stay-at-Home order; 3) Stay-at-Home order lifted with restrictions (Phase 2: Safer-at-Home); and 4) further lifting of restrictions (Phase 2.5: Safer-at-Home). Results There were 70,478 trauma hospitalizations in North Carolina, 2019&ndash;2020. In 2020, median age was 53 years old and 59% were male. Assault hospitalization rates (per 1,000,000 NC residents) increased after the Stay-at-Home order, but substantial increases were only observed among Black/African American residents (weekly trend change&thinsp;=&thinsp;1.147, 95% CI&thinsp;=&thinsp;0.634 to 1.662) and 18&ndash;44-year-old males (weekly trend change&thinsp;=&thinsp;1.708, 95% CI&thinsp;=&thinsp;0.870 to 2.545). After major restrictions were lifted, assault rates decreased but remained elevated compared to pre-COVID levels. Unintentional non-MVC injury hospitalizations decreased after the USA declared a public health emergency, especially among women&thinsp;&ge;&thinsp;65 years old (weekly trend change&thinsp;=&thinsp;-4.010, 95% CI&thinsp;=&thinsp;-6.166 to -1.855), but returned to pre-pandemic levels within several months. Conclusions Statewide Stay-at-Home orders placed Black/African American residents at higher risk of assault hospitalizations, exacerbating pre-existing disparities. Males 18&ndash;44 years old were also at higher risk of assault hospitalization. Fear of COVID-19 may have led to decreases in unintentional non-MVC hospitalization rates, particularly among older females. Policy makers must anticipate policy-related harms that may disproportionately affect already disadvantaged communities and develop mitigation approaches.</p>