Race/Ethnic and Socioeconomic Disparities in the Use of Helmets in Children Involved in Bicycle Accidents
Methods A review of all pediatric patients involved in bicycle-related accidents from the Los Angeles County database from 2006-2011 was performed. The main outcome measure was helmet use and its association with age, gender, insurance status, and race/ethnicity. An exploratory analysis was also performed to assess whether helmet use was associated with the need for emergency surgery, morbidity, mortality, and LOH (length of hospital stay), after adjusting for injury severity score (ISS), age, insurance status, and race/ethnicity.
Results 1,248 patients were identified; median age = 13 (IQR 10-15) years and 64% were male. Overall, 11.3% of patients wore helmets with differences noted based on race/ethnicity (Whites = 35.2%, Asians = 7.0%, Blacks = 6.0%, Hispanics = 4.2%, p<0.0001) and socioeconomic status (Private Insurance = 15.2%, Public Insurance = 7.6%, p<0.0001). Children over the age of 12 were less likely to wear helmets (odds ratio 0.7, 95%CI 0.5-0.9, p=0.03). Overall, 5.9% required an emergency operation, 34.1% returned to their pre-injury capacity, and mortality was 0.7% (9 patients, 8 did not wear a helmet). Median LOS was 2 days (IQR1-3), and median ISS was 5 (IQR 2-10). On multivariable analysis, for the outcomes of the need for emergency surgery, mortality, and LOH; only higher ISS increased the risk of these outcomes.
Conclusion Only 11.3% of children involved in bicycle-related accidents wore helmets, and there was a significantly lower use of helmets among children older than 12, and children of minority background and lower socioeconomic status. Thus, targeting low-income middle and high schools and minority communities with education and prevention strategies may help improve the use of helmets in children in Los Angeles County.