title: Disparities in trauma center access despite increasing utilization: data from California, 1999 to 2006.
abstract: BACKGROUND
  Although efforts have been made to address disparities in access to trauma care in the past decade, there is little evidence to show if utilization has changed. We use patient-level data to describe the changes in utilization of trauma centers (TCs) in an 8-year period in California.
  
  
  METHODS
  We analyzed all statewide trauma admissions (n = 752,706) using the California Office of Statewide Health Planning and Discharge Patient Discharge Database from the period of 1999 to 2006, and determined the trends in admissions and place of care.
  
  
  RESULTS
  The proportion of severe injuries admitted increased by 3.6% (p < 0.05), with a concomitant rise in the proportion of patients with trauma to TCs, from 39.3% (95% CI: 39.0%-39.7%) to 49.7% (49.4%-50.0%). Within the severely injured with injury severity scores (ISS) >15, 82.4% were treated in a TC if they resided in a county with a TC, compared with 30.8% of patients who did not live in a county with a TC. After adjustment, patients living greater than 50 miles away from a TC still had a likelihood ratio of 0.11 (p < 0.0001) of receiving care in a TC compared with those less than 10 miles away. Similarly, even severely injured patients not living in a county with a TC had a likelihood ratio of 0.35 (p < 0.0001) of being admitted to a TC compared with those residing in counties with TCs.
  
  
  CONCLUSIONS
  Admissions to TCs for all categories of injury severity are increasing. There remains, however, a large disparity in TC care depending on geographical distance and availability of a TC within county.
authors.affiliation: University of California-San Francisco, San Francisco, California, USA. renee.hsia@emergency.ucsf.edu
authors.forename: Renee Y
authors.initials: RY
authors.lastname: Hsia
authors.forename: Ewen
authors.initials: E
authors.lastname: Wang
authors.forename: Hugo
authors.initials: H
authors.lastname: Torres
authors.forename: Olga
authors.initials: O
authors.lastname: Saynina
authors.forename: Paul H
authors.initials: PH
authors.lastname: Wise
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D002648:Child; D002675:Child, Preschool; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000706:statistics & numerical data; D014193:Trauma Centers / Q000145:classification / Q000458:organization & administration / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000473:pathology / Q000628:therapy