Quantifying geographic barriers to trauma care: Urban-rural variation in prehospital mortality
Quantifying geographic barriers to trauma care: Urban-rural variation in prehospital mortality
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DOI：
10.1097/ta.0000000000002335
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发表时间：
2019-07-01
影响因子：
3.4
通讯作者：
Haider, Adil H.
中科院分区：
文献类型：
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作者：
Jarman, Molly P.;Hashmi, Zain;Haider, Adil H.
背景很少有关于创伤护理可及性和质量的研究能够解释院前伤害死亡率。关于院前死亡率的地理差异或院前护理对伤害差异的影响知之甚少。方法使用疾病控制中心流行病学研究数据库的广泛在线数据，我们查询了1999年至2016年的县级院前伤害死亡率。我们将死亡率与国家卫生统计中心的县级城乡分类和美国人口普查局的人口数据联系起来。我们使用负二项回归估计农村和院前伤害死亡率之间的关系，调整县级种族，性别，年龄，收入和保险覆盖范围的分布。然后根据损伤机制（机动车交通[MVT]与穿透）对模型进行分层，以确定院前死亡率是否因损伤类型而异。结果：与大的中心城市县相比，所有城乡县的院前伤害死亡率都有所升高，发病率比（IRR）范围从边缘城市县的1.25（95%置信区间[CI]，1.16-1.35）到非中心城市县的1.69（95% CI，1.58-1.82）。对于MVT损伤，与大的中心城市县相比，城乡班的IRR范围从边缘城市县的2.02（95%CI，1.85-2.21）到非核心县的3.02（95%CI，2.76-3.30）。非核心县的穿透伤院前死亡率比大的中心城市县高14%（IRR，1.14; 95%CI，1.05-1.23）。结论：在美国，院前损伤死亡率存在显著的地理差异，院前死亡的风险随着农村地区的增加而增加。与穿透性和MVT损伤相关的院前死亡模式表明，改善创伤中心准入、院前护理和初级损伤预防对于减少可预防的损伤死亡至关重要。版权所有（c）2019威科医疗集团All rights reserved.
BACKGROUND Few studies of trauma care access and quality account for prehospital injury mortality. Little is known about geographic variation in prehospital mortality or the impact of prehospital care on injury disparities. METHODS Using the Centers for Disease Control Wide-ranging Online Data for Epidemiologic Research database, we queried county-level incidence of prehospital injury mortality from 1999 to 2016. We linked mortality incidence with county-level urban-rural classifications from the National Center for Health Statistics and population data from the US Census Bureau. We used negative binomial regression to estimate the relationship between rurality and prehospital injury mortality, adjusting for county-level distribution of race, sex, age, income, and insurance coverage. Models were then stratified by injury mechanism (motor vehicle traffic [MVT] vs. penetrating) to determine if prehospital mortality rates varied by type of injury. RESULTS Prehospital injury mortality rates were elevated for all urban-rural county classes, relative to large central metro counties, with incidence rate ratios (IRR) ranging from 1.25 (95% confidence interval [CI], 1.16-1.35) for fringe metro counties to 1.69 (95% CI, 1.58-1.82) for noncore counties. For MVT injury, IRRs for urban-rural classes compared with large central metro counties ranged from 2.02 (95% CI, 1.85-2.21) for fringe metro counties to 3.02 (95% CI, 2.76-3.30) to noncore counties. Incidence of prehospital mortality from penetrating injury was 14% higher for noncore counties compared to large central metro counties (IRR, 1.14; 95% CI, 1.05-1.23). CONCLUSION There is substantial geographic variation in prehospital injury mortality in the United States, with risk of prehospital death increasing with rurality. Patterns of prehospital death associated with penetrating and MVT injuries suggest that improvements to both trauma center access, prehospital care, and primary injury prevention are essential to reduce preventable injury deaths. Copyright (c) 2019 Wolters Kluwer Health, Inc. All rights reserved.