Faculty Collaboration Database

Disparities in access to trauma care in the United States: A population-based analysis. Injury 2017 Feb;48(2):332-338

Date

01/11/2017

Pubmed ID

28069138

Pubmed Central ID

PMC5292279

DOI

10.1016/j.injury.2017.01.008

Scopus ID

2-s2.0-85008470371 (requires institutional sign-in at Scopus site)   123 Citations

Abstract

BACKGROUND: Injury is a major contributor to morbidity and mortality in the United States. Accordingly, expanding access to trauma care is a Healthy People priority. The extent to which disparities in access to trauma care exist in the US is unknown. Our objective was to describe geographic, demographic, and socioeconomic disparities in access to trauma care in the United States.

METHODS: Cross-sectional study of the US population in 2010 using small units of geographic analysis and validated estimates of population access to a Level I or II trauma center within 60minutes via ambulance or helicopter. We examined the association between geographic, demographic, and socioeconomic factors and trauma center access, with subgroup analyses of urban-rural disparities.

RESULTS: Of the 309 million people in the US in 2010, 29.7 million lacked access to trauma care. Across the country, areas with higher income were significantly more likely to have access (OR 1.30, 95% CI 1.12-1.50), as were major cities (OR 2.13, 95% CI 1.25-3.62) and suburbs (OR 1.27, 95% CI 1.02-1.57). Areas with higher rates of uninsured (OR 0.09, 95% CI 0.07-0.11) and Medicaid or Medicare eligible patients (OR 0.69, 95% CI 0.59-0.82) were less likely to have access. Areas with higher proportions of blacks and non-whites were more likely to have access (OR 1.37, 95% CI 1.19-1.58), as were areas with higher proportions of Hispanics and foreign-born persons (OR 1.51, 95% CI 1.13-2.01). Overall, rurality was associated with significantly lower access to trauma care (OR 0.20, 95% CI 0.18-0.23).

CONCLUSION: While the majority of the United States has access to trauma care within an hour, almost 30 million US residents do not. Significant disparities in access were evident for vulnerable populations defined by insurance status, income, and rurality.

Author List

Carr BG, Bowman AJ, Wolff CS, Mullen MT, Holena DN, Branas CC, Wiebe DJ

Author

Daniel N. Holena MD Professor in the Surgery department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Cross-Sectional Studies
Female
Health Services Accessibility
Healthcare Disparities
Humans
Insurance Coverage
Male
Rural Population
Time-to-Treatment
Trauma Centers
United States
Urban Population