Leonhard Megan J, Wright Dagan A, Fu Rongwei, Lehrfeld David P, Carlson Kathleen F
Department of Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098 USA.
Department of Public Health and Preventive Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Road, Mail Code CB 669, Portland, OR 97239-3098 USA ; Injury and Violence Prevention Section, Oregon Health Authority, 800 NE Oregon Street, Suite 730, Portland, OR 97232 USA.
Inj Epidemiol. 2015 Dec 11;2(1):32. doi: 10.1186/s40621-015-0063-2. eCollection 2015.
Traumatic brain injury (TBI) greatly contributes to morbidity and mortality in the pediatric population. We examined potential urban/rural disparities in mortality amongst Oregon pediatric patients with TBI treated in trauma hospitals.
We conducted a retrospective study of children ages 0-19 using the Oregon Trauma Registry for years 2009-2012. Geographic location of injury was classified using the National Center for Health Statistics Urban/Rural Classification Scheme. Incidence rates were calculated using Census data for denominators. Associations between urban/rural injury location and mortality were assessed using multivariable logistic regression, controlling for potential confounders. Generalized estimating equations were used to help account for clustering of data within hospitals.
Of 2794 pediatric patients with TBI, 46.6 % were injured in large metropolitan locations, 24.8 % in medium/small metropolitan locations, and 28.6 % in non-metropolitan (rural) locations. Children with rural locations of injury had a greater annualized TBI incidence rate, at 107/100,000 children per year, than those from large metropolitan areas (71/100,000 per year). Compared to children injured in urban locations, those in rural locations had more than twice the crude odds of mortality (odds ratio [OR], 2.5; 95 % CI, 1.6-4.0). This association remained significant (OR, 1.8; 95 % CI, 1.04-3.3) while adjusting for age, gender, race, insurance status, injury severity, and type of TBI (blunt vs. penetrating).
We observed higher rates of TBI and greater proportions of severe injury in rural compared to urban areas in Oregon. Rural children treated in the trauma system for TBI were more likely to die than urban children after controlling for demographic and injury factors associated with urban/rural residence. Further research is needed to examine treatment disparities by urban/rural location. Future work should also identify interventions that can reduce risk of TBI and TBI-related mortality among children, particularly those who live in rural areas.
创伤性脑损伤（TBI）是导致儿童发病率和死亡率的重要因素。我们研究了俄勒冈州创伤医院收治的小儿创伤性脑损伤患者在死亡率方面潜在的城乡差异。
我们利用俄勒冈创伤登记处的数据，对2009年至2012年期间0至19岁的儿童进行了一项回顾性研究。使用国家卫生统计中心的城乡分类方案对受伤地点进行分类。发病率以人口普查数据为分母进行计算。使用多变量逻辑回归评估城乡受伤地点与死亡率之间的关联，并控制潜在的混杂因素。使用广义估计方程来处理医院内部数据的聚集性。
在2794例小儿创伤性脑损伤患者中，46.6%在大城市地区受伤，24.8%在中小城市地区受伤，28.6%在非大城市（农村）地区受伤。农村地区受伤的儿童每年的创伤性脑损伤发病率更高，为每10万名儿童中有107例，高于大城市地区（每年每10万名儿童中有71例）。与城市地区受伤的儿童相比，农村地区受伤儿童的粗死亡率高出两倍多（优势比[OR]为2.5；95%可信区间为1.6 - 4.0）。在调整年龄、性别、种族、保险状况、损伤严重程度和创伤性脑损伤类型（钝器伤与穿透伤）后，这种关联仍然显著（OR为1.8；95%可信区间为1.04 - 3.3）。
我们观察到，与城市地区相比，俄勒冈州农村地区的创伤性脑损伤发病率更高，重伤比例更大。在控制了与城乡居住相关的人口统计学和损伤因素后，在创伤系统中接受治疗的农村儿童比城市儿童更有可能死亡。需要进一步研究以检查城乡治疗差异。未来的工作还应确定能够降低儿童，特别是农村地区儿童创伤性脑损伤风险和与创伤性脑损伤相关死亡率的干预措施。
