title: Disparities in access to trauma care in the United States: A population-based analysis.
abstract: BACKGROUND
  Injury is a major contributor to morbidity and mortality in the United States. Accordingly, expanding access to trauma care is a Healthy People priority. The extent to which disparities in access to trauma care exist in the US is unknown. Our objective was to describe geographic, demographic, and socioeconomic disparities in access to trauma care in the United States.
  
  
  METHODS
  Cross-sectional study of the US population in 2010 using small units of geographic analysis and validated estimates of population access to a Level I or II trauma center within 60minutes via ambulance or helicopter. We examined the association between geographic, demographic, and socioeconomic factors and trauma center access, with subgroup analyses of urban-rural disparities.
  
  
  RESULTS
  Of the 309 million people in the US in 2010, 29.7 million lacked access to trauma care. Across the country, areas with higher income were significantly more likely to have access (OR 1.30, 95% CI 1.12-1.50), as were major cities (OR 2.13, 95% CI 1.25-3.62) and suburbs (OR 1.27, 95% CI 1.02-1.57). Areas with higher rates of uninsured (OR 0.09, 95% CI 0.07-0.11) and Medicaid or Medicare eligible patients (OR 0.69, 95% CI 0.59-0.82) were less likely to have access. Areas with higher proportions of blacks and non-whites were more likely to have access (OR 1.37, 95% CI 1.19-1.58), as were areas with higher proportions of Hispanics and foreign-born persons (OR 1.51, 95% CI 1.13-2.01). Overall, rurality was associated with significantly lower access to trauma care (OR 0.20, 95% CI 0.18-0.23).
  
  
  CONCLUSIONS
  While the majority of the United States has access to trauma care within an hour, almost 30 million US residents do not. Significant disparities in access were evident for vulnerable populations defined by insurance status, income, and rurality.
authors.affiliation: Department of Emergency Medicine, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA, United States. Electronic address: brendan.carr@jefferson.edu.
authors.forename: Brendan G
authors.initials: BG
authors.lastname: Carr
authors.affiliation: Department of Emergency Medicine, LAC + USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States. Electronic address: arieljbowman@gmail.com.
authors.forename: Ariel J
authors.initials: AJ
authors.lastname: Bowman
authors.affiliation: School of Medicine, Duke University, Durham, NC, United States. Electronic address: wolff3@email.unc.edu.
authors.forename: Catherine S
authors.initials: CS
authors.lastname: Wolff
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States; Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA,United States. Electronic address: michael.mullen@uphs.upenn.edu.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Mullen
authors.affiliation: Department of Surgery; Division of Traumatology, Surgical Critical Care, and Emergency Surgery; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: holenad@upenn.edu.
authors.forename: Daniel N
authors.initials: DN
authors.lastname: Holena
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States; Department of Surgery; Division of Traumatology, Surgical Critical Care, and Emergency Surgery; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: cbranas@upenn.edu.
authors.forename: Charles C
authors.initials: CC
authors.lastname: Branas
authors.affiliation: Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, United States; Department of Surgery; Division of Traumatology, Surgical Critical Care, and Emergency Surgery; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Emergency Care Policy & Research, Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Center for Clinical Epidemiology and Biostatistics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States; Department of Emergency Medicine, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States. Electronic address: dwiebe@upenn.edu.
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Wiebe
mesh_terms: D003430:Cross-Sectional Studies; D005260:Female; D006297:Health Services Accessibility / Q000458:organization & administration / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data; D008297:Male; D012424:Rural Population; D061665:Time-to-Treatment / Q000706:statistics & numerical data*; D014193:Trauma Centers; D014481:United States / Q000453:epidemiology; D014505:Urban Population
keywords: Health services geographic accessibility; Health services research; Healthcare disparities; Trauma centers