ABSTRACT
Background: Low neighbourhood socioeconomic status (N-SES) is associated with increased injury incidence. We examined the relationship between N-SES and nonaccidental trauma (NAT), defined as blunt and penetrating assaults, during the COVID-19 pandemic in a major Canadian city. Methods: Our institutional trauma registry data were retrospectively analyzed for all severely injured (Injury Severity Score [ISS] > 12) adult (> 18 yr) patients admitted between January 2016 and September 2020 with nonaccidental trauma (NAT). The period from Jan. 1, 2016, to Feb. 28, 2020, was defined as pre-COVID-19, and the period from Mar. 1 to Sept. 30, 2020, was defined as COVID-19. Addresses of patients sustaining NAT were geocoded and matched to 15 local geographic areas (LGAs), which were divided into quintiles on the basis of median household income. Changes in proportions of NAT during COVID-19 were mapped to LGA using geospatial analysis software. Correlation between quintile and NAT was performed using the Spearman rho. Results: In this study, 439 patients sustained NAT: 386 (88%) were injured during the pre-COVID-19 period, and 53 (12%) were injured during the COVID-19 period. Six of 15 LGAs experienced increases in NAT during the COVID-19 period, 2 of which were statistically significant. There was a strong and significant inverse correlation between income quintile and NAT (Spearman rho correlation coefficient -0.55, p = 0.035) in the pre-COVID-19 time frame. This correlation became more pronounced during the COVID-19 period (Spearman rho correlation coefficient -0.60, p = 0.018). Conclusion: Low N-SES was associated with increased incidence of NAT during the COVID-19 pandemic, highlighting the impact of income disparity on an already-vulnerable population. Further work is needed to determine whether other trauma-related health outcomes due to disparities in N-SES have been amplified during the pandemic.