Carr Brendan G, Bowman Ariel J, Wolff Catherine S, Mullen Michael T, Holena Daniel N, Branas Charles C, Wiebe Douglas J
Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States.
Department of Emergency Medicine, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
Injury. 2017 Feb;48(2):332-338. doi: 10.1016/j.injury.2017.01.008. Epub 2017 Jan 3.
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.
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 60minutes 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.
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).
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.
在美国，伤害是导致发病和死亡的主要因素。因此，扩大创伤护理的可及性是“健康人民”计划的一项重点。美国创伤护理可及性方面的差异程度尚不清楚。我们的目标是描述美国创伤护理可及性方面的地理、人口统计学和社会经济差异。
使用地理分析的小单元对2010年美国人口进行横断面研究，并通过经验证的估计方法，评估民众在60分钟内通过救护车或直升机抵达一级或二级创伤中心的可及性。我们研究了地理、人口统计学和社会经济因素与创伤中心可及性之间的关联，并对城乡差异进行了亚组分析。
2010年美国3.09亿人口中，有2970万人无法获得创伤护理。在全国范围内，高收入地区获得创伤护理的可能性显著更高（比值比1.30，95%置信区间1.12 - 1.50），大城市（比值比2.13，95%置信区间1.25 - 3.62）和郊区也是如此（比值比1.27，95%置信区间1.02 - 1.57）。未参保率较高的地区（比值比0.09，95%置信区间0.07 - 0.11）以及符合医疗补助或医疗保险资格的患者所在地区（比值比0.69，95%置信区间0.59 - 0.82）获得创伤护理的可能性较小。黑人及非白人比例较高以及西班牙裔和外国出生人口比例较高的地区获得创伤护理的可能性更大（比值比1.37，95%置信区间1.19 - 1.58），西班牙裔和外国出生人口比例较高的地区也是如此（比值比1.51，95%置信区间1.13 - 2.01）。总体而言，农村地区获得创伤护理的可及性显著较低（比值比0.20，95%置信区间0.18 - 0.23）。
虽然美国大部分地区在一小时内能够获得创伤护理，但近3000万美国居民无法获得。在由保险状况、收入和农村地区定义的弱势群体中，可及性存在显著差异。
