|dc.description||The article of record as published may be found at http://dx.doi.org/10.1001/archsurg.2010.299||
|dc.description.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–
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.||
|dc.rights||This publication is a work of the U.S. Government as defined in Title 17, United States Code, Section 101. Copyright protection is not available for this work in the United States.||en_US
|dc.title||Possible Geographical Barriers to Trauma Center Access for Vulnerable Patients in the United States: An Analysis of Urban and Rural Communitie||en_US
|dc.contributor.corporate||Naval Postgraduate School (U.S.)||
|dc.contributor.department||Business & Public Policy (GSBPP)||
|dc.description.funder||grant 63974 from the Robert Wood Johnson Foundation’s
Health Care Financing and Organization Initiative and the Graduate School of Business and Public Policy Direct
Funded Research Program (Dr Shen)||en_US
|dc.description.funder||grant KL2 RR024130 from the National Institutes of Health/National
Center for Research Resources/OD University of California–San Francisco-Clinical and Translational Science
Institute and a grant under the Robert Wood Johnson Foundation Physician Faculty Scholars Program (Dr Hsia)||en_US
|dcterms.publisher||American Medical Association||