Race/Ethnic and Socioeconomic Disparities in the Use of Helmets in Children Involved in Bicycle Accidents

Saturday, October 26, 2013: 8:15 AM
Windermere Ballroom W (Hyatt Regency Orlando, formerly the Peabody)
Veronica F. Sullins, MD1, Arezou Yaghoubian, MD2, Julien Nguyen3, Amy Kaji, MD, PhD4 and Steven L. Lee, MD3, (1)University of California Los Angeles and Harbor-UCLA Medical Center, Los Angeles, CA, (2)Surgery, UCLA, Los Angeles, CA, (3)UCLA, Los Angeles, CA, (4)Emergency Medicine, Harbor-UCLA, Torrance, CA

Purpose According to the CDC, an estimated 33 million children ride bicycles nearly 10 billion hours each year. Unfortunately, nearly 400 children die each year from bicycle crashes, and bicycle-related head injuries account for over 150,000 emergency department related visits. While helmet use is a proven intervention that reduces bicycle-related head injury by 80%, only 19% of adults and 15% of children wear helmets all or most of the time. There are little data regarding racial/ethnic and socioeconomic differences in the use of helmets. The aim of this study was to describe race/ethnicity and socioeconomic differences in pediatric helmet use in Los Angeles County to help delineate target groups for developing and disseminating injury control recommendations.

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.