title: Increased population density of neurosurgeons associated with decreased risk of death from motor vehicle accidents in the United States.
abstract: OBJECTIVE
  Motor vehicle accidents (MVAs) are a leading cause of death and disability in young people. Given that a major cause of death from MVAs is traumatic brain injury, and neurosurgeons hold special expertise in this area relative to other members of a trauma team, the authors hypothesized that neurosurgeon population density would be related to reduced mortality from MVAs across US counties.
  
  
  METHODS
  The Area Resource File (2009-2010), a national health resource information database, was retrospectively analyzed. The primary outcome variable was the 3-year (2004-2006) average in MVA deaths per million population for each county. The primary independent variable was the density of neurosurgeons per million population in the year 2006. Multiple regression analysis was performed, adjusting for population density of general practitioners, urbanicity of the county, and socioeconomic status of the county.
  
  
  RESULTS
  The median number of annual MVA deaths per million population, in the 3141 counties analyzed, was 226 (interquartile range [IQR] 151-323). The median number of neurosurgeons per million population was 0 (IQR 0-0), while the median number of general practitioners per million population was 274 (IQR 175-410). Using an unadjusted analysis, each increase of 1 neurosurgeon per million population was associated with 1.90 fewer MVA deaths per million population (p < 0.001). On multivariate adjusted analysis, each increase of 1 neurosurgeon per million population was associated with 1.01 fewer MVA deaths per million population (p < 0.001), with a respective decrease in MVA deaths of 0.03 per million population for an increase in 1 general practitioner (p = 0.007). Rural location, persistent poverty, and low educational level were all associated with significant increases in the rate of MVA deaths.
  
  
  CONCLUSIONS
  A higher population density of neurosurgeons is associated with a significant reduction in deaths from MVAs, a major cause of death nationally. This suggests that the availability of local neurosurgeons is an important factor in the overall likelihood of survival from an MVA, and therefore indicates the importance of promoting neurosurgical education and practice throughout the country.
authors: Section of Neurosurgery, Dartmouth-Hitchcock Medical Center, Lebanon,New Hampshire 03756, USA. desai@hitchcock.org
authors: Atman
authors: A
authors: Desai
authors: Kimon
authors: K
authors: Bekelis
authors: Wenyan
authors: W
authors: Zhao
authors: Perry A
authors: PA
authors: Ball
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D006297:Health Services Accessibility; D006801:Humans; D009026:Mortality / Q000639:trends*; D009493:Neurosurgery; D011156:Population Density; D012044:Regression Analysis; D012189:Retrospective Studies; D015996:Survival Rate; D014481:United States; D000078329:Workforce