National community disparities in prehospital penetrating trauma adjusted for income, 2020–2021

Introduction: While Black individuals experienced disproportionately increased firearm violence and deaths during the COVID-19 pandemic, less is known about community level disparities. We sought to evaluate national community race and ethnicity differences in 2020 and 2021 rates of penetrating trauma. Methods: We linked the 2018–2021 National Emergency Medical Services Information System databases to ZIP Code demographics. We stratified encounters into majority race/ethnicity communities (>50% White, Black, or Hispanic/Latino). We used logistic regression to compare penetrating trauma for each community in 2020 and 2021 to a combined 2018–2019 historical baseline. Majority Black and majority Hispanic/Latino communities were compared to majority White communities for each year. Analyses were adjusted for household income. Results: We included 87,504,097 encounters (259,449 penetrating traumas). All communities had increased odds of trauma in 2020 when compared to 2018–2019, but this increase was largest for Black communities (aOR 1.4, [1.3–1.4]; White communities – aOR 1.2, [1.2–1.3]; Hispanic/Latino communities – aOR 1.1. [1.1–1.2]). There was a similar trend of increased penetrating trauma in 2021 for Black (aOR 1.2, [1.2–1.3]); White (aOR 1.2, [1.1–1.2]); Hispanic/Latino (aOR 1.1, [1.1–1.1]). Comparing penetrating trauma in each year to White communities, Black communities had higher odds of trauma in all years (2018/2019 – aOR 3.0, [3.0–3.1]; 2020 – aOR 3.3, [3.3–3.4]; 2021 – aOR 3.3, [3.2–3.2]). Hispanic/Latino also had more trauma each year but to a lesser degree (2018/2019 – aOR 2.0, [2.0–2.0]; 2020 – aOR 1.8, [1.8–1.9]; 2021 – aOR 1.9, [1.8–1.9]). Conclusion: Black communities were most impacted by increased penetrating trauma rates in 2020 and 2021 even after adjusting for income.