TY - JOUR
T1 - Mapping areas with concentrated risk of trauma mortality
T2 - A first step toward mitigating geographic and socioeconomic disparities in trauma
AU - Jarman, Molly P.
AU - Haut, Elliott R.
AU - Curriero, Frank C.
AU - Castillo, Renan C.
N1 - Funding Information:
Conflicts of Interest and Sources of Funding: M. P. Jarman’s work on this study was funded by a National Research Service Award from the Agency for Healthcare Research Quality (T32HS000029) and by the Johns Hopkins Center for Injury Research and Policy (William Haddon Jr. Fellowship). She is currently supported by a research grant from the Center for Orthopaedic Trauma Advancement (“Treatment of injury in the United States: Projections for an ideal system of trauma care”). E.R.H. is the primary investigator of a grant from the Agency for Healthcare Research and Quality (AHRQ) (1R01HS024547-01, “Individualized Performance Feedback on Venous Thromboembolism Prevention Practice”). He is also a co-investigator for grants from the National Institutes of Health National Heart, Lung, and Blood Institute (NIH-NHLBI) (1R21HL129028-01A1, “Analysis of the impact of missed doses of venous thromboembolism prophylaxis”) and The Henry M. Jackson Foundation, Uniformed Services University of the Health Sciences (HU0001-14-0038, “Validation of Training for Cricothyroidotomy”). E.R.H. is the primary investigator of two contracts with The Patient-Centered Outcomes Research Institute (PCORI) (CE-12-11-4489, “Preventing Venous Thromboembolism: Empowering Patients and Enabling Patient-Centered Care via Health Information Technology” & DI-1603-34596, “Preventing Venous Thromboembolism (VTE): Engaging Patients to Reduce Preventable Harm from Missed/Refused Doses of VTE Prophylaxis”), and co-investigator for the PCORI contract titled “A Randomized Pragmatic Trial Comparing the Complications and Safety of Blood Clot Prevention Medicines Used in Orthopaedic Trauma Patients” (PCS-1511-32745). E.R.H. receives royalties from Lippincott, Williams, Wilkins for a book—“Avoiding Common ICU Errors.” For remaining authors, no conflicts were declared.
Publisher Copyright:
© 2018 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2018/7/1
Y1 - 2018/7/1
N2 - BACKGROUND Many rural, low-income, and historically underrepresented minority communities lack access to trauma center services, including surgical care and injury prevention efforts. Along with features of the built and social environment at injury incident locations, geographic barriers to trauma center services may contribute to injury disparities. This study sought to classify injury event locations based on features of the built and social environment at the injury scene, and to examine patterns in individual patient demographics, injury characteristics, and mortality by location class. METHODS Data from the 2015 Maryland Adult Trauma Registry and associated prehospital records (n = 16,082) were used in a latent class analysis of characteristics of injury event locations, including trauma center distance, trauma center characteristics, land use, community-level per capita income, and community-level median age. Mortality effects of location class were estimated with logistic regression, with and without adjustment for individual patient demographics and injury characteristics. RESULTS Eight classes were identified: rural, exurban, young suburban, aging suburban, inner suburban, urban fringe, high-income urban core, and low-income urban core. Patient characteristics and odds of death varied across classes. Compared with inner suburban locations, adjusted odds of death were highest at rural (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.36-2.88), young suburb (OR, 1.57; 95% CI, 1.14-2.17), aging suburb (OR, 1.36; 95% CI, 1.04-1.78), and low-income urban core (OR, 1.38; 95% CI, 1.04-1.83) locations. CONCLUSION Injury incident locations can be categorized into distinguishable classes with varying mortality risk. Identification of location classes may be useful for targeted primary prevention and treatment interventions, both by identifying geographic areas with the highest risk of injury mortality and by identifying patterns of individual risk within location classes. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
AB - BACKGROUND Many rural, low-income, and historically underrepresented minority communities lack access to trauma center services, including surgical care and injury prevention efforts. Along with features of the built and social environment at injury incident locations, geographic barriers to trauma center services may contribute to injury disparities. This study sought to classify injury event locations based on features of the built and social environment at the injury scene, and to examine patterns in individual patient demographics, injury characteristics, and mortality by location class. METHODS Data from the 2015 Maryland Adult Trauma Registry and associated prehospital records (n = 16,082) were used in a latent class analysis of characteristics of injury event locations, including trauma center distance, trauma center characteristics, land use, community-level per capita income, and community-level median age. Mortality effects of location class were estimated with logistic regression, with and without adjustment for individual patient demographics and injury characteristics. RESULTS Eight classes were identified: rural, exurban, young suburban, aging suburban, inner suburban, urban fringe, high-income urban core, and low-income urban core. Patient characteristics and odds of death varied across classes. Compared with inner suburban locations, adjusted odds of death were highest at rural (odds ratio [OR], 1.98; 95% confidence interval [CI], 1.36-2.88), young suburb (OR, 1.57; 95% CI, 1.14-2.17), aging suburb (OR, 1.36; 95% CI, 1.04-1.78), and low-income urban core (OR, 1.38; 95% CI, 1.04-1.83) locations. CONCLUSION Injury incident locations can be categorized into distinguishable classes with varying mortality risk. Identification of location classes may be useful for targeted primary prevention and treatment interventions, both by identifying geographic areas with the highest risk of injury mortality and by identifying patterns of individual risk within location classes. LEVEL OF EVIDENCE Prognostic and epidemiological, level III.
KW - Access to care
KW - disparities
KW - geography
UR - http://www.scopus.com/inward/record.url?scp=85055671742&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85055671742&partnerID=8YFLogxK
U2 - 10.1097/TA.0000000000001883
DO - 10.1097/TA.0000000000001883
M3 - Article
C2 - 29538227
AN - SCOPUS:85055671742
VL - 85
SP - 54
EP - 61
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
SN - 2163-0755
IS - 1
ER -