Exposure to Neighborhood Racialized Economic Segregation and Reinjury and Violence Perpetration Among Survivors of Violent Injuries

Abstract

This cohort study investigates the association of racialized economic segregation with the risk of reinjury and violence perpetration among survivors of violent injuries.

Key Points

Question

Is the level of residential racialized economic segregation associated with the risk of violent reinjury and police encounters for violence perpetration among survivors of violent injuries?

Findings

In this cohort study that included 1843 survivors of violent penetrating injuries, there was an association between the level of racialized economic segregation in the neighborhood to which a patient returned after hospital discharge and the risk for future use of violence against others. The level of neighborhood deprivation was not associated with reinjury risk.

Meaning

This study found that racialized poverty in urban communities was associated with adverse outcomes among survivors of violent injuries, suggesting the importance of addressing the root causes of violence.

Abstract

Importance

Much is unknown about how individual and neighborhood factors converge in the association with risk for violent reinjury and violence perpetration.

Objectives

To investigate the association of exposure to neighborhood racialized economic segregation with reinjury and use of violence against others among survivors of violent penetrating injury.

Design, Setting, and Participants

This retrospective cohort study was performed using data obtained from hospital, police, and state vital records. The study was performed at Boston Medical Center, an urban, level I trauma center that is the largest safety-net hospital and busiest trauma center in New England. The cohort included all patients treated for a nonfatal violent penetrating injury from 2013 to 2018. Patients with no Boston metropolitan area home address were excluded. Individuals were followed up through 2021. Data were analyzed from February to August 2022.

Exposure

American Community Survey data were used to measure neighborhood deprivation using the racialized economic Index of Concentration at the Extremes (ICE) for patient residential address upon hospital discharge. ICE was measured on a scale from −1 (most deprived) to 1 (most privileged).

Main Outcomes and Measures

Primary outcomes were violent reinjury and police-reported perpetration of violence within 3 years of an index injury.

Results

Of 1843 survivors of violence (median [IQR] age, 27 [22-37] years; 1557 men [84.5%]; 351 Hispanic [19.5%], 1271 non-Hispanic Black [70.5%], and 149 non-Hispanic White [8.3%] among 1804 patients with race and ethnicity data), the cohort was skewed toward residing in neighborhoods with higher racialized economic segregation (median [IQR] ICE = −0.15 [−0.22 to 0.07]) compared with the state overall (ICE = 0.27). There were police encounters for violence perpetration among 161 individuals (8.7%) and violent reinjuries among 214 individuals (11.6%) within 3 years after surviving a violent penetrating injury. For each 0.1-unit increase in neighborhood deprivation, there was a 13% (hazard ratio [HR], 1.13; 95% CI, 1.03 to 1.25; P = .01) increase in risk of violence perpetration but no difference in risk for violent reinjury (HR, 1.03; 95% CI, 0.96 to 1.11; P = .38). The greatest occurrence for each outcome was within the first year after index injury; for example, incidents of violence perpetration occurred among 48 of 614 patients (7.8%) at year 1 vs 10 of 542 patients (1.8%) at year 3 in tertile 3 of neighborhood deprivation.

Conclusions and Relevance

This study found that living in a more economically deprived and socially marginalized area was associated with increased risk of using violence against others. The finding suggests that interventions may need to include investments in neighborhoods with the highest levels of violence to help reduce downstream transmission of violence.