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Socioeconomic Status and Non-Fatal Adult Injuries in Selected Atlanta (Georgia USA) Hospitals

  • Erin Hulland (a1), Ritam Chowdhury (a2) (a3), Stefanie Sarnat (a4), Howard H. Chang (a1) and Kyle Steenland (a2) (a4)...

Injury mortality data for adults in the United States and other countries consistently show higher mortality for those with lower socioeconomic status (SES). Data are sparse regarding the role of SES among adult, non-fatal US injuries. The current study estimated non-fatal injury risk by household income using hospital emergency department (ED) visits.


A total of 1,308,892 ED visits at 10 Atlanta (Georgia USA) hospitals from 2001-2004 (347,866 injuries) were studied. The SES was based on US census-block group income, with subjects assigned to census blocks based on reported residence. Logistic regression was used to determine risk by SES for injuries versus all other ED visits, adjusting for demographics, hospital, and weather. Supplemental analyses using hospital data from 2010-2013, without data on SES, were conducted to determine whether earlier patterns by race, age, and gender persisted.


Risk for many injury categories increased with higher income. Odds ratio by quartiles of increasing income (lowest quartile as referent, 95% confidence interval [CI] given for upper most quartile) were 1.00, 1.23, 1.34, 1.40 (95% CI 1.36-1.45) for motor vehicle accidents; 1.00, 1.03, 1.11, 1.24 (95% CI 1.20-1.29) for being struck by objects; 1.00. 0.99, 1.04, 1.12 (95% CI 1.00-1.25) for suicide; and 1.00, 1.03, 1.05, 1.12 (95% CI 1.09-1.15) for falls. In contrast, decreased injury risk with increased household income was seen for assaults (1.00, 0.83, 0.73, 0.67 [95% CI 0.63-0.72], by increasing quartiles). These trends by income did not differ markedly by race and gender. Whites generally had less risk of injuries, with the exception of assaults and motor vehicle accidents. Males had higher risk of injury than females, with the exception of falls and suicide attempts. Patterns of risk for race, age, and gender were consistent between 2001-2004 and 2010-2013.


For most non-fatal injuries, those with higher income had more risk of ED visits, although the opposite was true for assault.

Hulland E , Chowdhury R , Sarnat S , Chang HH , Steenland K . Socioeconomic Status and Non-Fatal Adult Injuries in Selected Atlanta (Georgia USA) Hospitals. Prehosp Disaster Med. 2017;32(4):403413.

Corresponding author
Correspondence: Ritam Chowdhury, MBBS, MPH, PhD, SM 677 Huntington Avenue Boston, Massachusetts USA 02115 E-mail:
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Conflicts of interest/funding: This publication was made possible by a pilot grant to Emory University (Atlanta, Georgia USA) from the Centers for Disease Control and Prevention (Atlanta, Georgia USA)-funded Emory Center for Injury Control (1 R49 CE001494). The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

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Prehospital and Disaster Medicine
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