Gender-associated differences in access to trauma center care: A population-based analysis.
BACKGROUND
Disparities in access to services across genders have been reported in many healthcare settings. The extent to which this occurs in the case of emergency surgical care is unknown. We set out to evaluate whether gender is a determinant of access to trauma center care, particularly in the setting where trauma triage guidelines are strong facilitators to ensure that access is determined by physiologic status and injury characteristics.


METHODS
Population-based retrospective cohort analysis of severely injured (Injury Severity Score >15) adults surviving to reach hospital. Differential in access to trauma center care was evaluated for females compared with males. Secondary analyses evaluated gender-based differences in direct transport from the scene and transfer from nontrauma centers. The adjusted odd of trauma center care was determined using logistic regression models. Separate models were used to stratify patients based on age, mechanism, and injury severity.


RESULTS
We identified 26,861 severely injured patients; 35% were women. A smaller proportion of females received trauma center care compared with males (49% vs 62%; P < .0001), an association that persisted after adjustment for confounders (odds ratio [OR], 0.87; 95% confidence interval [CI], 0.79-0.96). Emergency medical service personnel were less likely to transport females from the field to a trauma center compared with males (OR, 0.88; 95% CI, 0.81-0.97). Similarly, physicians were less likely to transfer females to trauma centers compared with males (OR, 0.85; 95% CI, 0.73-0.99).


CONCLUSIONS
Severely injured women were less likely to be directed to a trauma center across 2 types of providers. The reasons for this differential in access might be related to perceived difference in injury severity, likelihood of benefiting from trauma center care, or subconscious gender bias.
Division of General Surgery, Department of Surgery, University of Toronto, Ontario, Canada.david.gomezjaramillo@utoronto.ca
David
D
Gomez
Barbara
B
Haas
Charles
C
de Mestral
Sunjay
S
Sharma
Marvin
M
Hsiao
Brandon
B
Zagorski
Gordon
G
Rubenfeld
Joel
J
Ray
Avery B
AB
Nathens
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D010360:Patient Transfer / Q000706:statistics & numerical data; D011287:Prejudice; D012189:Retrospective Studies; D012737:Sex Factors; D014193:Trauma Centers / Q000706:statistics & numerical data*; D014930:Women; D014947:Wounds and Injuries / Q000628:therapy*; D055815:Young Adult