Historical redlining, a discriminatory practice of the 1930s, present-day social vulnerability (SVI), and sports and recreational injury (SRI) hospitalizations are interconnected topics that highlight the intersection of race, class, and health in the United States but the relationships have not been studied to date. Thus, the overall aim of this dissertation is to examine the effects of historical redlining and present-day social vulnerability on SRI hospitalizations in the United States. The first study systematically reviewed studies that examined the relationships between neighborhood characteristics and SRI using multilevel modeling approach. Studies reviewed show that certain neighborhood factors, such as living in urban communities, were associated with increased risk of SRI. The second study examined the association between historical redlining and present-day neighborhood SVI in the United States. Results show that formerly redlined areas have higher SVI presently. The third study examined the association between historical redlining and present-day SRI hospitalization in the United States. Results show that redlining was not associated with increased odds of SRI hospitalizations, but was associated with longer length of hospital stay (LOS) among Black and Hispanic patients, and higher total hospital charges among Hispanic patients. The fourth study examined the association between individual and neighborhood social vulnerability and sports and recreation-related traumatic brain injury (SR-TBI) hospitalizations among pediatric patients in the United States. Results show that Native American children had higher odds of hospitalization for SR-TBI, longer LOS, but lower odds of discharge to post-acute care compared to White children. Older age was associated with higher odds of hospitalization and longer LOS while male sex was associated with shorter LOS for SR-TBI in children. Compared to children with private insurance, children with public insurance had longer LOS while uninsured children had shorter LOS. Also, hospitalization in neighborhood with higher overall SVI was associated with longer LOS. This study advances our knowledge on the impact of structural racism on present-day SRI outcomes and will inform policy makers to prioritize health equity by addressing the underlying social determinants of health and the root causes of disparities in SRI outcomes. / Doctor of Philosophy / Every year, around 9 million people get hurt while playing sports or participating in recreational activities in the United States. Out of these, more than a third go to the emergency department for treatment, and several thousands need to stay in the hospital because their injuries are more serious. Even though only a small number of sports and recreational injuries (SRI) require hospitalization compared to those treated in the emergency department or outpatient clinics, these injuries tend to be more severe. They can cause significant harm to a person's physical, mental, and emotional well-being, and they also put a lot of pressure on the healthcare system and society as a whole. This dissertation assessed how historical discrimination against certain neighborhoods, called redlining, and present-day social vulnerability affect sports and recreational injury hospitalizations in the United States. This research found that the neighborhood where people live or are hospitalized matter for how often they are hospitalized for SRI, their length of stay in hospital, the amount of money they pay while in hospital, and how often they receive follow-up care after leaving hospital. While historical redlining was not directly linked to higher odds of hospitalization, it was associated with longer hospital stays for Black and Hispanic patients and higher costs for Hispanic patients. This research also found that children from socially vulnerable backgrounds were more likely to be hospitalized for sports-related traumatic brain injuries (SR-TBI) and stay in hospital longer, but were less like to receive follow-up care after leaving hospital. For instance, children from Native American backgrounds were three times more likely to be hospitalized for SR-TBI and stayed in the hospital 27% longer, but were 99.9% less likely to receive follow-up care after leaving hospital compared to White children. Also, children with public health insurance tended to have longer stays in hospital for SR-TBI compared to those with private health insurance. This research highlights how structural discrimination can impact health outcomes, and suggests that policymakers should address the root causes of health disparities in order to promote health equity.
| Identifer | oai:union.ndltd.org:VTETD/oai:vtechworks.lib.vt.edu:10919/115777 |
| Date | 14 July 2023 |
| Creators | Ogunmayowa, Oluwatosin Thompson |
| Contributors | Biomedical and Veterinary Sciences, Baker, Charlotte, Hanlon, Alexandra L., Paige, Frederick, Cook, Natalie E. |
| Publisher | Virginia Tech |
| Source Sets | Virginia Tech Theses and Dissertation |
| Language | English |
| Detected Language | English |
| Type | Dissertation |
| Format | ETD, application/pdf, application/pdf |
| Coverage | United States |
| Rights | In Copyright, http://rightsstatements.org/vocab/InC/1.0/ |
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