Section of General Internal Medicine and Center for Health and the Social Sciences, University of Chicago, Chicago, Illinois.
Section of Trauma and Acute Care Surgery, Department of Surgery, University of Chicago, Chicago, Illinois.
JAMA Netw Open. 2019 Mar 1;2(3):e190138. doi: 10.1001/jamanetworkopen.2019.0138.
Little is known about the distribution of life-saving trauma resources by racial/ethnic composition in US cities, and if racial/ethnic minority populations disproportionately live in US urban trauma deserts.
To examine racial/ethnic differences in geographic access to trauma care in the 3 largest US cities, considering the role of residential segregation and neighborhood poverty.
DESIGN, SETTING, AND PARTICIPANTS: A cross-sectional, multiple-methods study evaluated census tract data from the 2015 American Community Survey in Chicago, Illinois; Los Angeles (LA), California; and New York City (NYC), New York (N = 3932). These data were paired to geographic coordinates of all adult level I and II trauma centers within an 8.0-km buffer of each city. Between February and September 2018, small-area analyses were conducted to assess trauma desert status as a function of neighborhood racial/ethnic composition, and geospatial analyses were conducted to examine statistically significant trauma desert hot spots.
In small-area analyses, a trauma desert was defined as travel distance greater than 8.0 km to the nearest adult level I or level II trauma center. In geospatial analyses, relative trauma deserts were identified using travel distance as a continuous measure. Census tracts were classified into (1) racial/ethnic composition categories, based on patterns of residential segregation, including white majority, black majority, Hispanic/Latino majority, and other or integrated; and (2) poverty categories, including nonpoor and poor.
Chicago, LA, and NYC contained 798, 1006, and 2128 census tracts, respectively. A large proportion comprised a black majority population in Chicago (35.1%) and NYC (21.4%), compared with LA (2.7%). In primary analyses, black majority census tracts were more likely than white majority census tracts to be located in a trauma desert in Chicago (odds ratio [OR], 8.48; 95% CI, 5.71-12.59) and LA (OR, 5.11; 95% CI, 1.50-17.39). In NYC, racial/ethnic disparities were not significant in unadjusted models, but were significant in models adjusting for poverty and race-poverty interaction effects (adjusted OR, 1.87; 95% CI, 1.27-2.74). In comparison, Hispanic/Latino majority census tracts were less likely to be located in a trauma desert in NYC (OR, 0.03; 95% CI, 0.01-0.11) and LA (OR, 0.30; 95% CI, 0.22-0.40), but slightly more likely in Chicago (OR, 2.38; 95% CI, 1.56-3.64).
In this study, black majority census tracts were the only racial/ethnic group that appeared to be associated with disparities in geographic access to trauma centers.
在美国城市中，关于按种族/民族构成分布的救生创伤资源知之甚少，而且少数民族人口是否不成比例地生活在美国城市创伤荒漠地区。
研究美国 3 个最大城市中种族/民族在创伤护理方面的地理可及性差异，同时考虑到居住隔离和邻里贫困的作用。
设计、地点和参与者：这是一项横断面、多方法研究，评估了 2015 年美国社区调查中伊利诺伊州芝加哥市、加利福尼亚州洛杉矶市和纽约市的人口普查区数据（n=3932）。这些数据与每个城市 8.0 公里缓冲区内所有成人 I 级和 II 级创伤中心的地理坐标相对应。2018 年 2 月至 9 月期间，进行了小区域分析，以评估作为邻里种族/民族构成函数的创伤荒漠状态，进行了地理空间分析以检查具有统计学意义的创伤荒漠热点。
在小区域分析中，将创伤荒漠定义为到最近的成人 I 级或 II 级创伤中心的旅行距离大于 8.0 公里。在地理空间分析中，使用旅行距离作为连续度量来确定相对创伤荒漠。根据居住隔离模式，将人口普查区分为（1）种族/民族构成类别，包括白人多数、黑人多数、西班牙裔/拉丁裔多数和其他或融合；以及（2）贫困类别，包括非贫困和贫困。
芝加哥、洛杉矶和纽约市分别包含 798、1006 和 2128 个人口普查区。芝加哥（35.1%）和纽约市（21.4%）的黑人多数人口普查区比例大大高于洛杉矶（2.7%）。在主要分析中，与白人多数人口普查区相比，黑人多数人口普查区更有可能位于芝加哥（优势比[OR]，8.48；95%CI，5.71-12.59）和洛杉矶（OR，5.11；95%CI，1.50-17.39）的创伤荒漠中。在纽约市，在未调整模型中种族差异不显著，但在调整贫困和种族-贫困相互作用效应的模型中差异显著（调整 OR，1.87；95%CI，1.27-2.74）。相比之下，西班牙裔/拉丁裔多数人口普查区位于创伤荒漠的可能性较小，在纽约市（OR，0.03；95%CI，0.01-0.11）和洛杉矶（OR，0.30；95%CI，0.22-0.40），但在芝加哥（OR，2.38；95%CI，1.56-3.64）则略高。
在这项研究中，黑人多数人口普查区是唯一似乎与创伤中心地理可达性差异相关的种族/民族群体。
