School of Medicine, University of Texas Medical Branch, Galveston, Texas.
School of Medicine, University of Texas Medical Branch, Galveston, Texas.
J Surg Res. 2021 Mar;259:480-486. doi: 10.1016/j.jss.2020.09.004. Epub 2020 Oct 15.
Trauma mortality disproportionately affects populations farther from potentially lifesaving trauma care, and traumatic brain injury (TBI) is no exception. Previous examinations have examined proximity to trauma centers as an explanation for trauma mortality, but little is known about the relationship between proximity to neurosurgeons specifically in TBI mortality.
In this cross-sectional study, county-level TBI mortality rates from 2008 to 2014 were examined in relation to the distance to the nearest neurosurgeon and trauma facility. The locations of practicing neurosurgeons and trauma facilities in the United States were determined by geocoding data from the 2017 Medicare Physician and Other Supplier and Provider of Services files (respectively). The association between TBI mortality and the distance from the population-weighted centroid of the county to a closest neurosurgeon and trauma facility was examined using multivariate negative binomial regression.
A total of 761 of the 3108 counties (24.5%) in the continental United States were excluded from the analysis because they had 20 or fewer TBI deaths during this time, producing unstable estimates. Excluded counties accounted for 1.67% of the US population. Multivariate analysis revealed a county's mortality increased 10% for every 25 miles from the nearest neurosurgeon (adjusted incident rate ratio: 1.10 [95% confidence interval: 1.08-1.12]; P < 0.001). The distance to the nearest trauma facility was not found to be significantly associated with mortality (adjusted incident rate ratio: 1.01 [95% confidence interval: 0.99-1.03]; P = 0.36).
These findings suggest that proximity to neurosurgeons may influence county-level TBI mortality. Further research into this topic with more granular data may help to allocate scarce public health resources.
创伤死亡率不成比例地影响到离潜在救命创伤护理更远的人群，创伤性脑损伤 (TBI) 也不例外。以前的研究检查了接近创伤中心作为创伤死亡率的解释，但对于 TBI 死亡率与神经外科医生的接近程度知之甚少。
在这项横断面研究中，检查了 2008 年至 2014 年县一级 TBI 死亡率与最近神经外科医生和创伤设施的距离之间的关系。美国神经外科医生和创伤设施的位置通过对 2017 年医疗保险医生和其他供应商和服务提供者文件中的地理编码数据进行地理编码来确定（分别）。使用多变量负二项式回归检查 TBI 死亡率与县人口加权质心到最近神经外科医生和创伤设施的距离之间的关系。
由于在此期间有 20 或更少的 TBI 死亡，总共排除了 3108 个县中的 761 个县（24.5%）进行分析，这导致估计结果不稳定。被排除的县占美国人口的 1.67%。多变量分析显示，每离最近的神经外科医生增加 25 英里，该县的死亡率增加 10%（调整后的发病率比：1.10[95%置信区间：1.08-1.12]；P<0.001）。到最近创伤设施的距离与死亡率无显著相关性（调整后的发病率比：1.01[95%置信区间：0.99-1.03]；P=0.36）。
这些发现表明，接近神经外科医生可能会影响县一级的 TBI 死亡率。进一步研究这个问题，使用更细粒度的数据，可能有助于分配稀缺的公共卫生资源。
