Disparities in access to trauma care in the United States: A population-based analysis

Brendan G. Carr, Ariel J. Bowman, Catherine S. Wolff, Michael T. Mullen, Daniel N. Holena, Charles C. Branas, Douglas J. Wiebe

Research output: Contribution to journalArticlepeer-review

123 Scopus 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 60 minutes 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.

Original languageEnglish
Pages (from-to)332-338
Number of pages7
JournalInjury
Volume48
Issue number2
DOIs
StatePublished - 1 Feb 2017
Externally publishedYes

Keywords

  • Health services geographic accessibility
  • Health services research
  • Healthcare disparities
  • Trauma centers

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