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Background Although there is a growing dependence on the immigrant workforce in many countries, recent trend analyses on the work-related health of immigrants are scarce. Thus, this study aims to fill this gap by comparing reported occupational injuries due to accidents (OIA) trends among native-born Swedes with first-generation immigrants arriving from different global regions now working in Sweden from 2003 to 2020. Methods A repeated cross-sectional registered-based study was conducted including the total working population (18 years or older) (approximately 3.5-4 million individuals annually). Information on OIA and migrant status was obtained from nationwide registers. The incidence rate (IR) of an OIA per 1000 workers with 95% confidence intervals (CI) was calculated for region of birth, the reason for immigration, and time since immigration for each year. Joinpoint analyses were employed to detect significant shifts in the trends. Results The IR of OIA among native-born workers demonstrated a relatively stable trend between 2003 and 2020. Immigrant workers had in general a higher IR of OIA compared to native-born workers across the study period. Among immigrant workers, a steeper downward trend in OIA was observed until 2008/2010. After 2010, the trends were relatively stable or slightly increasing, depending on the region of birth, reason for immigration, and time since immigration. The stratified analysis demonstrated varying patterns depending on sociodemographic and occupational factors. Conclusions Immigrant workers in Sweden have a higher incidence of occupational injuries than native Swedes. Despite a general downward trend since 2003, young immigrants from Africa and the Middle East show an upward trend, highlighting a concerning increase for an already vulnerable group and potentially worsening health inequalities.

Background Rates of suicide remain elevated among U.S. Veterans and have increased disproportionately among Asian American and Pacific Islander (AAPI) Veterans. Knowledge is limited regarding suicide prevention considerations for clinicians working with AAPI Veterans, yet culturally responsive strategies tend to be most effective. To address this gap, we sought to elucidate subject matter experts’ perspectives regarding suicide prevention considerations for AAPI Veterans. Methods Qualitative interviews were conducted with 14 key informants (e.g., clinicians, researchers) in 2023 to understand their experiences with, and recommendations for, preventing suicide among AAPI Veterans in the Continental U.S. Interview transcripts were analyzed through thematic analysis, with an inductive approach. Results Key informants discussed the heterogeneity of the AAPI population and emphasized the need to balance cultural sensitivity and cultural humility in suicide prevention with AAPI Veterans. Fear of bringing shame and dishonor upon one’s family was described as a factor which may prevent AAPI Veterans from disclosing mental health concerns and suicide risk and which may prevent them from accessing healthcare services for mental health and suicidality. Suicide risk among AAPI Veterans was viewed as being shaped by shame and the centrality of the family-collective, with family conferring both protection against and risk for suicide. Cultural norms and beliefs regarding suicide were considered pertinent to suicide among AAPI Veterans and included beliefs about perseverance in coping with distress to permittance of suicide in specific circumstances. Somatic idioms were described as a means by which AAPI Veterans may communicate distress and suicidality, with key informants discussing how this may impact treatment and outreach. Conclusion Key informant interviews provided crucial insights into cultural factors salient to conceptualizing and addressing AAPI Veterans’ risk for suicide. These findings can be utilized to inform tailored suicide prevention for this population, with emphasis on addressing mental health stigma, considering somatic idioms of distress, and considering the role of family in suicide risk and prevention.

Background Vulnerable populations at risk of injury include persons with intellectual and developmental disabilities (IDD), and persons who are deaf or hard of hearing (DHH). The purpose of this study was to describe and compare emergency department and inpatient hospitalization (ED + IP) injury rates and rate ratios by injury type among persons under age 65 with IDD or with DHH to those without IDD or DHH. Methods This is a descriptive population-based retrospective cross-sectional study of injuries among patients under the age of 65 with an IDD disability or a DHH disability using Kentucky ED + IP discharge datasets from 2019 to 2023. Injury rates and injury rate ratios were calculated for those under the age of 65 with an IDD or a DHH disability and without an IDD or a DHH disability, using number of persons under age 65 with or without the related disability as the denominator. Results The overall injury rate was lower for persons under age 65 with an IDD or DHH compared to those without those disabilities in 2023 (1 and 3 per 100,000 population, respectively). IDD or DHH disability types had significantly lower overall ED + IP injury rate ratios compared to those without those disabilities (IDD: 0.667 [95% CI: 0.640–0.694], DHH: 0.658 [95% CI: 0.633–0.683]). When ED + IP injury type rate ratios were compared, IDD or DHH persons had higher injury rate ratios for self-harm (IDD: 8.740 [95% CI: 7.783–9.815], DHH: 1.7846 [95% CI: 1.402–2.272]), assault (IDD: 1.386 [95% CI: 1.173–1.637], DHH: 1.310 [95% CI: 1.115–1.540]), unintentional falls (IDD: 1.540 [95% CI: 1.436–1.633], DHH: 1.283 [95% CI: 1.201–1.372]), and drug poisonings (IDD: 2.401 [95% CI: 2.103–2.740], DHH:1.620 [95% CI: 1.391–1.886]) compared to those without such disabilities. Those with IHH or DHH who were treated for injuries incurred triple the charges of patients without these conditions (~$17,086 IDD; $19,550 DHH; and $5,216 no IDD or DHH disabilities). Conclusions These findings have implications for health policy at the state and federal level. Clinical care interventions to reduce assault, self-harm, drug poisonings and unintentional injuries and healthcare utilization in persons with IDD or DHH should be publicly funded or covered by health insurance.

Background Firearms became the leading cause of death in the United States pediatric population in 2019 and have persisted as the leading cause through 2021, with widening racial and ethnic disparities. We aimed to examine recent trends in U.S pediatric firearm mortality, how they differ by intent, and identify which ages, and racial and ethnic groups have been most impacted over time. Methods The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research database was queried for mortalities in children aged 0–19 years from 2014–2023, and crude death rate was reported as number of deaths per 100,000 persons per year. Results Firearms continued to be the leading cause of death in patients aged 0–19 years from 2021 to 2023, firearm crude death rate decreased from 5.8 to 5.5. In patients aged 14–19, firearms became the leading cause of death in 2016. In patients aged 0–13 years, firearms continue to be the fourth leading cause of death. Firearm death rates for Black children decreased from 18.6 in 2022 to 17.6 in 2023 yet remained far higher than other races, and highest in all census regions. Crude firearm death rates for American Indian and Alaskan Native (AIAN) children remained the second highest. The firearm suicide rate in Black children (1.8) surpassed that of White children (1.6) in 2022 and was the highest of any ethnicity in 2023. NonCore (rural) regions had the highest firearm crude death rates in 2018–19, and AIAN children were disproportionately affected in these areas, while Large Central Metro areas surpassed this in 2020–2021. Conclusions Firearms remain the leading cause of death among children aged 14–19, and the fourth leading cause of death among children 13 and younger. Racial and ethnic disparities remain prominent, as Black and American Indian and Alaskan Native children continue to be disproportionately affected, particularly by firearm suicide. Prevention strategies should target these vulnerable populations and children at highest risk to prevent future firearm deaths.

Background Rural Australians have a higher age adjusted rate of both hospitalisation and death from injury, and this rate increases with increasing remoteness. However, it is uncertain if this is due to an increased incidence of injury or less access to treatment. The aim of this study is to examine the association of remoteness and in-hospital mortality in Major Trauma patients admitted to the Royal Melbourne Hospital. Methods This study was a retrospective cohort study of all persons aged 15 + years diagnosed with ‘major trauma’, (defined as Injury Severity Score, ISS > 12) from a Motor Vehicle Collision admitted to the Royal Melbourne Hospital from 2010 to 2021. The exposure of interest was remoteness as measured by the Accessibility/Remoteness Index of Australia (ARIA), the outcome of interest was in-hospital mortality. Logistic regression models were constructed looking at the odds of death by increasing remoteness adjusting for age, ISS, and comorbidity. Missing data were imputed using chained equations. A sensitivity analysis was performed for ARIA+ category, and a quantitative bias analysis performed for potential selection bias. All analyses were performed using Stata v17. Ethical approval was obtained from the Melbourne Health Human Research Ethics Committee (HREC2022_044). Results Eligibility was met for 2324 cases, of whom 53.3% were classified as major city, 36.1% inner regional, and 10.6% outer regional/remote. In-hospital mortality was 6.0% for those injured in major cities, 5.4% in inner regional and 4.1% for outer regional/remote. The median ISS was 19 and 18.3% had at least one limiting comorbidity. The adjusted odds of death were reduced by half for those injured in outer regional and remote compared with major city (OR = 0.51, 95%CI = 0.25–1.03). This result did not alter with the sensitivity analysis for postcode of injury. Quantitative bias analysis suggested the presence of severe selection bias, with the odds ratio showing an increased odds of death (OR = 1.83) for more remotely injured persons. Conclusion Persons injured remotely are not more likely to die in-hospital after major trauma once they arrive at hospital. Unexpectedly, there was some evidence to suggest that those injured most remotely had a survival advantage, despite similar injury severity Quantitative bias analysis suggested selection bias could be responsible for this apparent survival advantage for more remotely injured persons.

BackgroundIncorporating post-discharge data into trauma registries would allow for better research on patient outcomes, including disparities in outcomes. This pilot study tested a follow-up data collection process to be incorporated into existing trauma care systems, prioritizing low-cost automated response modalities.MethodsThis investigation was part of a larger study that consisted of two protocols with two distinct cohorts of participants who experienced traumatic injury. Participants in both protocols were asked to provide phone, email, text, and mail contact information to complete follow-up surveys assessing patient-reported outcomes six months after injury. To increase follow-up response rates between protocol 1 and protocol 2, the study team modified the contact procedures for the protocol 2 cohort. Frequency distributions were utilized to report the frequency of follow-up response modalities and overall response rates in both protocols.ResultsA total of 178 individuals responded to the 6-month follow-up survey: 88 in protocol 1 and 90 in protocol 2. After implementing new follow-up contact procedures in protocol 2 that relied more heavily on the use of automated modalities (e.g., email and text messages), the response rate increased by 17.9 percentage points. The primary response modality shifted from phone (72.7%) in protocol 1 to the combination of email (47.8%) and text (14.4%) in protocol 2.ConclusionsResults from this investigation suggest that follow-up data can feasibly be collected from trauma patients. Use of automated follow-up methods holds promise to expand longitudinal data in the national trauma registry and broaden the understanding of disparities in patient experiences.

Background Endemic levels of community firearm violence in United States cities disproportionately burden certain sociodemographic groups. Nonfatal injuries are an understudied aspect of firearm violence. Police data in a large and heterogenous place like New York City (NYC) provide the unique opportunity to use a single data source to measure fatal and nonfatal community firearm violence. Methods The study analyzed epidemiologic trends in fatal and nonfatal community firearm violence using the publicly available New York Police Department (NYPD) Shooting Incident Dataset from 2019 to 2023. The analyses tabulated shooting victims by sociodemographic variables (age group, race and ethnicity, and sex) and case fatality rates, mapped shootings by census tract, and described social determinants of health (SDOH)—poverty, educational attainment, unemployment—in the census tracts where shootings occurred. Results From 2019 to 2023, the annual average number of shooting victims in NYC was 1,578. Shootings doubled from 2019 to 2020 though trended downward from 2021 to 2022 to 2023. Four out of five shootings were nonfatal. Males, people ages 18-24, and non-Hispanic Black people in NYC experienced the greatest proportion of shootings. Shootings coincided with census tracts also experiencing above median percentages of adverse SDOH (i.e., highest levels of unemployment, poverty, and low educational attainment). Discussion Nonfatal injuries are an important component of community firearm violence to monitor. The findings identify inequities in community firearm violence by sex, age group, and race and ethnicity in NYC. One contributor to racial inequities in violence is the impact of place-based SDOH in certain NYC neighborhoods. Conclusions This study leverages NYPD data to estimate the full magnitude of violence by tracking nonfatal in addition to fatal injuries. The study emphasizes the need for researchers to go beyond individual demography and better understand the place-based social determinants of firearm violence.

Background Nearly 7,000 snakebite injuries are reported yearly in the United States, with almost one quarter of those in the pediatric population. Due to increased exposure to snakes, rural children may experience different clinical outcomes for snakebite injuries. The goal of this study was to examine differences in resource utilization of rural and urban pediatric patients with snakebite injuries. Methods This is a retrospective cross-sectional study of patients aged 21 years and under presenting with venomous snakebites in the United States from January 1, 2016, through March 31, 2023, using the Pediatric Hospital Information System database and ICD-10 codes indicating snakebites. Comparisons were conducted to evaluate demographic and clinical characteristics in association with resource utilization and complications between patients living in rural areas and patients living in urban areas. Results The study included 2,633 patients from 23 states. The median age was 9 years; 61% of patients were male. Most patients were in the South and over 70% resided in urban areas. 82% of the population was admitted to a hospital, with median length of stay 1.59 days. Compared to urban patients, rural patients were more likely to be admitted and receive antivenom but were less likely to have an intensive care unit admission and have abnormal coagulation studies. Conclusions Rural pediatric patients with snakebites had different resource utilization and clinical complications than urban patients.

Background Although health inequalities associated with ethnic disadvantage are of increasing concern to policymakers in the United Kingdom (UK), evidence on ethnicity and childhood unintentional injuries is unclear. Given that people from some minority ethnic communities face disproportionate disadvantage such as unemployment, poverty, and insecure and low-quality housing, children from these families might be expected to have higher risks of unintentional injuries compared to their White counterparts. Aims To determine whether the likelihood of unintentional childhood injuries vary among children from minority ethnic backgrounds and whether this variation can be explained by maternal migration status and variables relating to household composition, parenting attitudes and behaviours. Methods We used logistic regression to analyse data from 12,717 children using sweeps two (2003–2004) and three (2005–2006) of the Millennium Cohort Study. Unintentional childhood injuries were measured in the third sweep of data collection when the children were aged five. Exposure variables included socioeconomic information, ethnicity, housing, household composition, maternal migration status and variables relating to parenting, values, and behaviours. Results Children from some minority ethnic backgrounds (Pakistani, Bangladeshi, Black African, and ‘other’) were less likely to be injured than White children. Having a mother who was born outside the UK explained the relationship in Pakistani and Bangladeshi children. We observed differences in variables such as parenting style, values, household composition, and smoking and alcohol use among minority ethnic and migrant groups, but these variables did not statistically explain the differences in childhood injury. Conclusions Children from minority ethnic families in the UK are less likely to sustain unintentional injuries compared to their White peers, with this protective effect primarily evident among children whose mothers were born outside the UK. While cultural and behavioural differences were observed between ethnic groups, these did not statistically explain the injury variation. The findings emphasise the importance of disaggregating ethnicity and migrant status in injury prevention research and investigating the mechanisms underlying lower injury rates among first-generation migrant families.

Background Our pediatric tertiary care hospital sees a high rate of firearm injuries. Hospital-based violence intervention programs (HVIPs) reduce violent injury recidivism rates in victims. However, significant gaps exist in the delivery of trauma-informed services to families. Our specific aim was to increase our HVIP referral rate by 20% over a 12-month time frame for children seen for interpersonal violence in the emergency department (ED). Methods Our quality improvement study was done at a pediatric tertiary care hospital and encompassed patients 0 to 18 years of age who presented to our ED for assault-related concerns from December 26, 2021 to June 23, 2024. The primary outcome measure was percentage of HVIP-eligible patients who received a referral from the ED. We conducted a root cause analysis by interviewing stakeholders including HVIP staff, ED providers, nurses, and social workers to understand gaps in the referral process. Key drivers included electronic medical record (EMR) trigger tools for referral placement, accessibility of HVIP staff, and staff knowledge of HVIP eligibility and services. We integrated three main EMR-based interventions on June 15, 2023 that triggered referrals to the HVIP. Results Our ED HVIP referral rate during the pre-intervention period (December 26, 2021 to June 15, 2023) was 53.6%. During our post-intervention phase (June 15, 2023 to June 23, 2024), the referral rate reached and sustained at 93.5%, a 74.4% increase. Conclusions We identified a large percentage of missed HVIP-eligible referrals and developed interventions that significantly increased our referral rate. However, this did not translate into increased enrollment, indicating the need for additional efforts.