Racial and Ethnic Disparities in Access to Pediatric Trauma Centers in the United States: A Geographic Information Systems Analysis - 20/02/23
, Lois K. Lee, MD, MPH b, c, d, Rebekah Mannix, MD, MPH b, c, d, Michael C. Monuteaux, ScD b, c, Michael P. Hirsh, MD a, Eric W. Fleegler, MD, MPH b, c, dAbstract |
Study objective |
Injury is the leading cause of death and disability for children, making access to pediatric trauma centers crucial to pediatric trauma care. Our objective was to describe the pediatric population with timely access to a pediatric trauma center by demographics and geography in the United States.
Methods |
Level 1, 2, and 3 pediatric trauma center locations were provided by the American Trauma Society. Geographic information systems road network and rotor wing analysis determined US Census Block Groups with the ground and/or air access to a pediatric trauma center within a 60-minute transport time. We then described, at the national and state levels, the 2020 pediatric population (< 15 years old) with and without pediatric trauma center access by ground and air, stratified by race, ethnicity, and urbanicity.
Results |
There were 157 pediatric trauma centers (82 Level 1, 64 Level 2, 11 Level 3). Of the 2020 US pediatric population, 33,352,872 (54.5%) had timely access to Level 1–3 pediatric trauma centers by ground and 45,431,026 (74.1%) by air. The percentage of children with access by race and ethnicity were (by ground, by air): American Indian/Alaskan Native (31.0%, 43.5%), White (48.7%, 71.3%), Native Hawaiian/Pacific Islander (59.3%, 61.0%), Hispanic (60.2%, 76.9%), Black (64.2%, 78.0%), and Asian (76.5%, 89.5%). Only 48.2% of children living in rural block groups had access, compared with 83.6% in urban block groups.
Conclusion |
Significant disparities in current access to pediatric trauma centers exist by race and ethnicity, and geography, leaving some children at risk for poor trauma outcomes.
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| Please see page 326 for the Editor’s Capsule Summary of this article. |
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| Supervising editor: Steven M. Green, MD. Specific detailed information about possible conflicts of interest for individual editors is available at editors. |
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| Author contributions: KJB and EWF conceived the study. KJB obtained research funding. KJB and MCM provided statistical advice on study design and analyzed the data. KJB and EWF drafted the manuscript, and all authors contributed substantially to its revision. KJB takes responsibility for the paper as a whole. |
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| All authors attest to meeting the four ICMJE.org authorship criteria: (1) Substantial contributions to the conception or design of the work; or the acquisition, analysis, or interpretation of data for the work; AND (2) Drafting the work or revising it critically for important intellectual content; AND (3) Final approval of the version to be published; AND (4) Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. |
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| Funding and support: By Annals policy, all authors are required to disclose any and all commercial, financial, and other relationships in any way related to the subject of this article as per ICMJE conflict of interest guidelines (see www.icmje.org). The authors have stated that they have no commercial, financial, or other relationships in any way related to the subject of this article. KJB was supported by the Emergency Medicine Foundation/ Society of Academic Emergency Medicine 2021 Medical Student Research Grant. |
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| Meetings: |
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| Burdick KJ, Lee LK, Mannix R, Monuteaux MC, Hirsh MP, Fleegler EW. What 9-1-1 gets you: Who has appropriate access to a pediatric trauma center? Society of Academic Emergency Medicine Annual Meeting. May 2021 (Virtual). |
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| Burdick KJ, Lee LK, Mannix R, Monuteaux MC, Hirsh MP, Fleegler EW. Racial & Ethnic Disparities in Access to Pediatric Trauma Centers in the US, American College of Emergency Physicians Annual Meeting. October 2021 (Boston, MA). |
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| Burdick KJ, Lee LK, Mannix R, Monuteaux MC, Hirsh MP, Fleegler EW. What 9-1-1 gets you: Who has appropriate access to a pediatric trauma center? New England Regional Meeting of the Society for Academic Emergency Medicine. April 2021 (Virtual). |
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| Burdick KJ, Lee LK, Mannix R, Monuteaux MC, Hirsh MP, Fleegler EW. What 9-1-1 gets you: Who has appropriate access to a pediatric trauma center? Pediatric Academic Societies. May 2021 (Virtual). |
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Vol 81 - N° 3
P. 325-333 - mars 2023 Retour au numéro
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