Race/Ethnicity and Geographic Access to Urban Trauma Care
Race/Ethnicity and Geographic Access to Urban Trauma Care
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DOI：
10.1001/jamanetworkopen.2019.0138
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发表时间：
2019-03-01
影响因子：
13.8
通讯作者：
Peek, Monica E.
中科院分区：
文献类型：
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作者：
Tung, Elizabeth L.;Hampton, David A.;Peek, Monica E.
人们对美国城市中种族/民族构成的救命创伤资源分布知之甚少，以及种族/少数民族人口是否不成比例地生活在美国城市创伤沙漠中。目的：考虑到居住隔离和社区贫困的作用，研究美国3个最大城市在创伤护理的地理可及性方面的种族/民族差异。设计、环境和参与者一项横断面、多方法研究评估了伊利诺伊州芝加哥市2015年美国社区调查的人口普查区数据；加州洛杉矶（LA）；纽约市（NYC），纽约（N = 3932）。这些数据与每个城市8.0公里缓冲区内所有成人一级和二级创伤中心的地理坐标配对。在2018年2月至9月期间，进行了小区域分析，以评估创伤沙漠状况作为社区种族/民族组成的函数，并进行了地理空间分析，以检查统计上显著的创伤沙漠热点。在小区域分析中，创伤沙漠被定义为到最近的成人一级或二级创伤中心的旅行距离大于8.0 km。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沙漠。人口普查区被分为(1)种族/民族构成类别，基于居住隔离模式，包括白人占多数，黑人占多数，西班牙裔/拉丁裔占多数，以及其他或综合；(2)贫困类别，包括非贫困和贫困。结果芝加哥、洛杉矶和纽约市分别包含798、1006和2128个人口普查区。与洛杉矶（2.7%）相比，芝加哥（35.1%）和纽约（21.4%）的黑人人口占很大比例。在初步分析中，黑人占多数的人口普查区比白人占多数的人口普查区更有可能位于芝加哥的创伤沙漠（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）。在纽约市，种族/民族差异在未调整的模型中不显著，但在调整贫困和种族-贫困相互作用效应的模型中显著（调整OR， 1.87; 95% CI, 1.27-2.74）。相比之下，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），西班牙裔/拉丁裔人口普查区位于创伤沙漠的可能性较小，但在芝加哥（OR, 2.38; 95% CI, 1.56-3.64）的可能性略高。结论和相关性在本研究中，黑人占多数的人口普查区是唯一与创伤中心地理通道差异相关的种族/族裔群体。
IMPORTANCE 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.OBJECTIVE 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.MAIN OUTCOMES AND MEASURES 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.RESULTS 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).CONCLUSIONS AND RELEVANCE 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.