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Socioeconomic factors influence on traumatic brain injury
Position du problème et objectif(s) de l’étude
In France, traumatic brain injury (TBI) is a leading cause of death and disability in individuals under 40, mainly due to road traffic accidents, falls, and violence. Its incidence in Europe was 262–326 per 100,000 in 2015, with 230 per 100,000 in France in 2016. TBI profiles differ by age, gender, and socioeconomic status. However, trends like increasing falls in the elderly and determinants such as violence in disadvantaged areas with high unemployment have not been thoroughly analyzed. In this study, we aim to explore mechanisms differences in Paris and its surroundings in relation to pre-injury professional status of the patients.
Matériel et méthodes
Data were extracted from a national data base (French National Trauma Registry, TraumaBase), which includes clinical and socio-demographic variables of 44,739 patients. For the selection of TBI cases, we selected patients based on three criteria: having a brain lesion on CT scan (ISS > 0) or having a score of Glasgow Coma Scale ≤8 and pupillary abnormality, yielding 20,344 cases. We analyzed six centers in Ile-de-France, focusing only on patients included in 2023. Patients were classified into four groups for each main variable: mechanism of accident (unintentional fall, RTA, aggression, suicide attempt) and professional status (employed, unemployed, senior/+65, student/minor). Classification was based on intentionality and mechanism of accident, with suicide attempts and aggressions categorized according to intentionality, while RTAs and unintentional falls were classified based on the mechanism of accident. Missing or unclassifiable data led to exclusion, resulting in a final sample of over 700 patients.
Résultats & Discussion
A total of over 700 patients had their accident between January 01, 2023, and December 31, 2023. Majority were men (79%) with a median age of 39 years old (IQR, 25-58) and women (21%) had a median age of 47 years old (IQR, 31-73). RTA accounted for 50% of all injuries behind falls (30%), aggressions (10%) and suicide attempt (9.6%). Regarding the employment status of the patients, 51% were employed (median age, 38 years old (IQR, 28-50), 84% of men), 17% were unemployed (median age, 33 years old (IQR, 27-47), 79% of men), 11% were students (or minor people, median age, 18 years old (IQR, 16-20), 82% of men) and 21% were senior (have more than 65 years old, median age, 75 years old (IQR, 69-81), 63% of men). Unemployed patients were younger than employed patients (p=0.04). A χ2 test of independence revealed a significant association between professional status and mechanism of accident, with a chi-squared value of 117.9, degrees of freedom (df) = 9, and a p-value of < 2.2e-16.
Conclusion
This study highlights a significant association between pre-injury professional status and the mechanism of traumatic brain injury in the Parisian area. Road traffic accidents were still the leading cause of TBI across all groups, but interestingly their distribution varied by employment status. Unemployed patients were younger than employed ones, and their TBI mechanisms differed significantly with more aggressions and suicide attempts. The strong statistical association confirms that socioeconomic factors is associated with injury patterns. These findings underscore the importance of targeted prevention strategies addressing specific risk profiles based on employment status. Further research is needed to explore underlying social determinants and their impact on trauma epidemiology.
Auteurs
Léa MEYER (1) , Arthur JAMES (2), Alice JACQUENS (2), Vincent DEGOS (2), Eleonore BAYEN (3) - (1)Laboratoire D'imagerie Biomédicale-Inserm U1146, Sorbonne University, Paris, France & Department Of Anesthesiology And Critical Care, Pitié-Salpêtrière Hospital, Aphp, Paris, France, Paris, France, (2)Department Of Anesthesiology And Critical Care, Pitié-Salpêtrière Hospital, Aphp, Paris, France & Sorbonne University, Grc 29, Groupe De Recherche Clinique En Anesthésie Réanimation Médecine Périopératoire, Arpe, Paris, France, Paris, France, (3)Laboratoire D'imagerie Biomédicale-Inserm U1146, Sorbonne University, Paris, France & Department Of Physical And Rehabilitation Medicine, Pitié-Salpêtrière Hospital, Aphp, Paris, France & Sorbonne University, Grc 24, Paris, France, Paris, France