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1.
Hulka  FMullins  RJMann  NC  et al.  Influence of a statewide trauma system on pediatric hospitalization and outcome.  J Trauma 1997;42 (3) 514- 519PubMedGoogle ScholarCrossref
2.
DeMaria  EJKenney  PRMerriam  MACasanova  LAGann  DS Aggressive trauma care benefits the elderly.  J Trauma 1987;27 (11) 1200- 1206PubMedGoogle ScholarCrossref
3.
MacKenzie  EJRivara  FPJurkovich  GJ  et al.  A national evaluation of the effect of trauma-center care on mortality.  N Engl J Med 2006;354 (4) 366- 378PubMedGoogle ScholarCrossref
4.
Gaskin  DJHadley  J Population characteristics of markets of safety-net and non–safety-net hospitals.  J Urban Health 1999;76 (3) 351- 370PubMedGoogle ScholarCrossref
5.
Bazzoli  GJKang  RHasnain-Wynia  RLindrooth  RC An update on safety-net hospitals: coping with the late 1990s and early 2000s.  Health Aff (Millwood) 2005;24 (4) 1047- 1056PubMedGoogle ScholarCrossref
6.
Bazzoli  GJMeersman  PJChan  C Factors that enhance continued trauma center participation in trauma systems.  J Trauma 1996;41 (5) 876- 885PubMedGoogle ScholarCrossref
7.
Eastman  ABBishop  GSWalsh  JCRichardson  JDRice  CL The economic status of trauma centers on the eve of health care reform.  J Trauma 1994;36 (6) 835- 846PubMedGoogle ScholarCrossref
8.
Eastman  ABRice  CLBishop  GRichardson  JD An analysis of the critical problem of trauma center reimbursement.  J Trauma 1991;31 (7) 920- 926PubMedGoogle ScholarCrossref
9.
Shen  YCHsia  RYKuzma  K Understanding the risk factors of trauma center closures: do financial pressure and community characteristics matter?  Med Care 2009;47 (9) 968- 978PubMedGoogle ScholarCrossref
10.
Branas  CCMacKenzie  EJWilliams  JC  et al.  Access to trauma centers in the United States.  JAMA 2005;293 (21) 2626- 2633PubMedGoogle ScholarCrossref
11.
Institute of Medicine Hospital-Based Emergency Care: At the Breaking Point.  Washington, DC: Institute of Medicine; 2007
12.
Institute of Medicine America's Health Care Safety Net: Intact but Endangered.  Washington, DC: National Academies Press; 2000
13.
Taheri  PAButz  DALottenberg  LClawson  AFlint  LM The cost of trauma center readiness.  Am J Surg 2004;187 (1) 7- 13PubMedGoogle ScholarCrossref
14.
Taheri  PAButz  DAWatts  CMGriffes  LCGreenfield  LJ Trauma services: a profit center?  J Am Coll Surg 1999;188 (4) 349- 354PubMedGoogle ScholarCrossref
15.
Champion  HRSacco  WJCopes  WS Improvement in outcome from trauma center care.  Arch Surg 1992;127 (3) 333- 338PubMedGoogle ScholarCrossref
16.
Nathens  ABJurkovich  GJMaier  RV  et al.  Relationship between trauma center volume and outcomes.  JAMA 2001;285 (9) 1164- 1171PubMedGoogle ScholarCrossref
17.
Sampalis  JSDenis  RLavoie  A  et al.  Trauma care regionalization: a process-outcome evaluation.  J Trauma 1999;46 (4) 565- 581PubMedGoogle ScholarCrossref
18.
Overpeck  MDJones  DHTrumble  ACScheidt  PCBijur  PE Socioeconomic and racial/ethnic factors affecting non-fatal medically attended injury rates in US children.  Inj Prev 1997;3 (4) 272- 276PubMedGoogle ScholarCrossref
19.
Haider  AHChang  DCEfron  DTHaut  ERCrandall  MCornwell  EE  III Race and insurance status as risk factors for trauma mortality.  Arch Surg 2008;143 (10) 945- 949PubMedGoogle ScholarCrossref
20.
US Census Bureau United States Census 2000. http://www.census.gov/main/www/cen2000.html. Accessed September 10, 2009
21.
MelissaDATA Mailing and Data Management Software. http://www.MelissaData.com/software.htm. Accessed January 10, 2009
22.
MacKenzie  EJHoyt  DBSacra  JC  et al.  National inventory of hospital trauma centers.  JAMA 2003;289 (12) 1515- 1522PubMedGoogle ScholarCrossref
23.
Horwitz  JRNichols  A What do nonprofits maximize? nonprofit hospital service provision and market ownership mix. 2007.  National Bureau of Economic Research Working Paper Series 13246. http://www.nber.org/authors/jill_horwitz. Accessed September 17, 2009
24.
Love  RFMorris  JG Mathematical models of road travel distances.  Manage Sci 1979;25 (4) 130- 139Google ScholarCrossref
25.
Phibbs  CSLuft  HS Correlation of travel time on roads versus straight line distance.  Med Care Res Rev 1995;52 (4) 532- 542PubMedGoogle ScholarCrossref
26.
Lerner  EBMoscati  RM The golden hour: scientific fact or medical “urban legend”?  Acad Emerg Med 2001;8 (7) 758- 760PubMedGoogle ScholarCrossref
27.
Lucas  JWBarr-Anderson  DJKington  RS Health status of non-Hispanic U.S.-born and foreign-born black and white persons: United States, 1992-95.  Vital Health Stat 10 2005; (226) 1- 20PubMedGoogle Scholar
28.
Singh  GKHiatt  RA Trends and disparities in socioeconomic and behavioural characteristics, life expectancy, and cause-specific mortality of native-born and foreign-born populations in the United States, 1979-2003.  Int J Epidemiol 2006;35 (4) 903- 919PubMedGoogle ScholarCrossref
29.
Thamer  MRichard  CCasebeer  AWRay  NF Health insurance coverage among foreign-born US residents: the impact of race, ethnicity, and length of residence.  Am J Public Health 1997;87 (1) 96- 102PubMedGoogle ScholarCrossref
30.
Shen  YCZuckerman  S The effect of Medicaid payment generosity on access and use among beneficiaries.  Health Serv Res 2005;40 (3) 723- 744PubMedGoogle ScholarCrossref
31.
Zuckerman  SShen  YC Characteristics of occasional and frequent emergency department users: do insurance coverage and access to care matter?  Med Care 2004;42 (2) 176- 182PubMedGoogle ScholarCrossref
32.
O’Hare  WP Poverty in America: trends and new patterns.  Popul Bull 1985;40 (3) 1- 44PubMedGoogle Scholar
33.
O’Toole  TPGibbon  JLSeltzer  DHanusa  BHFine  MJ Urban homelessness and poverty during economic prosperity and welfare reform: changes in self-reported comorbidities, insurance, and sources for usual care, 1995-1997.  J Urban Health 2002;79 (2) 200- 210PubMedGoogle ScholarCrossref
34.
Shen  YC The effect of financial pressure on the quality of care in hospitals.  J Health Econ 2003;22 (2) 243- 269PubMedGoogle ScholarCrossref
35.
Institute of Medicine Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care.  Washington, DC: National Academy Press; 2003
36.
Shepherd  MVTrethewy  CEKennedy  JDavis  L Helicopter use in rural trauma.  Emerg Med Australas 2008;20 (6) 494- 499PubMedGoogle ScholarCrossref
37.
Greengross  P Effects of helicopter service on survival after trauma: service is part of a continuum of care.  BMJ 1995;311 (7013) 1164- 1165PubMedGoogle ScholarCrossref
38.
Gearhart  PAWuerz  RLocalio  AR Cost-effectiveness analysis of helicopter EMS for trauma patients.  Ann Emerg Med 1997;30 (4) 500- 506PubMedGoogle ScholarCrossref
39.
Diaz  MAHendey  GWBivins  HG When is the helicopter faster? a comparison of helicopter and ground ambulance transport times.  J Trauma 2005;58 (1) 148- 153PubMedGoogle ScholarCrossref
40.
Diaz  MAHendey  GWWinters  RC How far is that by air? the derivation of an air:ground coefficient.  J Emerg Med 2003;24 (2) 199- 202PubMedGoogle ScholarCrossref
Original Article
January 2011January 17, 2011

Possible Geographical Barriers to Trauma Center Access for Vulnerable Patients in the United States: An Analysis of Urban and Rural Communities

Author Affiliations

Author Affiliations: Department of Emergency Medicine, University of California, San Francisco, and San Francisco General Hospital (Dr Hsia); and Graduate School of Business and Public Policy, Naval Postgraduate School, Monterey, California (Dr Shen).

Arch Surg. 2011;146(1):46-52. doi:10.1001/archsurg.2010.299
Abstract

Objective  To study whether traditionally vulnerable populations have worse geographic access to trauma centers.

Design  A cross-sectional analysis using data from the American Hospital Association Annual Survey from 2005 linked with zip code–level data from the US Census. We used a multinomial logit model to examine the odds of having difficult as opposed to easy access to trauma centers for a given subgroup of vulnerable populations.

Setting and Participants  Population in rural and urban communities as defined by zip codes in the United States.

Main Outcome Measures  Each community's distance to the nearest trauma center (levels I-III).

Results  In urban areas, 67% of the population had easy access to trauma centers and 12% had difficult access compared with 24% and 31% in rural areas, respectively. Areas with higher shares of the following vulnerable population groups had higher risks (odds ratios) of facing difficult access to trauma center services in 2005: foreign born in urban areas (1.65 for a medium share and 2.18 for a high share [both P < .01]); African American in urban and rural areas (1.25 for a medium share and 1.35 for a high share, respectively [both P < .05]); and near-poor in urban and rural areas (1.52 [P < .05] and 1.69 [P < .01] for a high share, respectively).

Conclusions  A significant segment of the US population (representing 38.4 million people) does not have access to trauma care within 1 hour of driving time. Moreover, certain vulnerable groups are at higher risk than others for worse access to trauma centers. Stakeholders and health care planners should consider these factors in the development of trauma systems because a mismatch of potential need and access could signal inefficiencies in the delivery of care.

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