P. J. Schenarts1, R. Cooper1, L. Schlitzkus1, K. Buesing1, C. Evans1, M. Goede1, J. Stothert1 1University Of Nebraska,Acute Care Surgery,Omaha, NE, USA
Introduction: There is a strong relationship of poverty in a rural setting with increased trauma deaths. To date, there are no studies characterizing the influence of poverty on trauma patients from urban vs. rural environments. Therefore our purpose was to determine if there were differences in urban vs. rural trauma patients based upon poverty level.
Methods: Data from 46 hospitals collected in the Nebraska Trauma Registry between 2007-2012 was geocoded by patient’s home address. Census information regarding income level was used to stratify patients into three income groups (low, middle & high), based on percentage of the census tract below the poverty line. Rural was defined on the county level, using county health district designations. Differences in demographics, insurance status, mode of transport, injury severity score (ISS), hospital length of stay (LOS), need for health services after hospital discharge and mortality were compared between urban and rural patients within each income group. Statistical analysis: ANOVA and chi-square
Results: Of 54,592 patients, 36,309 were urban; 18,283 were rural. In table at bottom, data is presented as mean ± SD, or percent.. In all income groups urban patients are significantly younger (p<0.001) (Low income 44 ± 25 vs 52 ± 29 yrs, Middle Income 52 ± 28 vs 56 ± 28 yrs, High income 47 ± 28 vs 52 ± 28 yrs); utilize EMS more frequently (p<0.001) (Low income 70 vs 61%, Middle Income 68 vs 63%, High income 72 vs 64%) and have longer hospital LOS (p<0.001) (Low income 3.8 ± 9 vs 2.6 ± 11 days, Middle Income 3.7 ± 5.1 vs 2.9 ± 4.4 days, High income 3.6 ± 5.1 vs 2.2 ± .4 days).
Conclusion: ~~Differences between urban and ruralprimarily occur in the low and middle income groups. Across all income levels, fewer rural patients are self-pay. In the low and middle income groups, urban patients have more penetrating injuries and are hospitalized more frequently for minor injuries (ISS<14). Mortality is higher in the rural low income group, but higher in the urban middle income group.
