M. P. Jarman1, R. C. Castillo1 1Johns Hopkins Bloomberg School Of Public Health,Department Of Health Policy And Management,Baltimore, MD, USA
Introduction: Disparities in access to trauma care and injury mortality persist for rural, low income, and minority populations despite nearly 50 years of effort to regionalize and standardize trauma care in the US. Little is known about the contribution of injury incident location to these disparities. This study sought to examine the role of environmental and community-level factors in predicting injury mortality.
Methods: Injury incident locations (n = 11,070) in the 2015 Maryland eMEDS Patient Care Reporting system were geocoded and linked with individual and hospital characteristics drawn from the Maryland Adult Trauma Registry, as well as environmental factors present at each injury scene using data from the Maryland Department of Planning and the Maryland State Highway Administration, and community-level factors at the census tract level from the United States Census Bureau. Multivariate logistic regression models were used to estimate odds of death associated with environmental factors present at the scene of the injury incident and community-level factors at the census tract level, while controlling for total pre-hospital time, injury severity, comorbidities, age, sex, and race.
Results: Relative to patients who travel less than 25 miles from the injury incident scene to a trauma center, patients who traveled 50-75 miles were 3.88 times more likely to die (p = 0.003), and patients who traveled 75-100 miles were 7.15 times more likely to die (p < 0.001). Odds of death for patients traveling 25-50 miles did not differ from those traveling less than 25 miles. Compared to commercial land use, patients who were injured at locations with residential land use were 53% more likely to die (p = 0.038), and those injured at locations with transportation land use were 2.00 times more likely to die (p = 0.079). Odds of death increased by 5.90% for every 5% increase in the proportion of residents using private vehicles to commute to/from work (p = 0.030), and by 8.67% for every 5% increase in the proportion of residents with commutes longer than 25 minutes (p = 0.004)
Conclusions: Distance from the injury scene to a trauma center appears to be a significant determinant of injury mortality, independent of pre-hospital time. Residential and transportation land and community characteristics related to transportation also appear to increase odds of injury mortality. These factors may contribute to persistent disparities in trauma mortality. The findings of this study can inform policy and practice decisions regarding organization of trauma systems, delivery of pre-hospital care, and injury prevention in geographic areas at high risk for fatal injuries.