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.

Conclusion: 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.

Figure 1

Study criteria for selection of data

Figure 2

Proportion of trauma patients admitted to trauma centers, stratified by injury severity, with 95% CI in dotted lines (total patients, 752,706; mild ISS, 382,234; moderate ISS, 291,774; severe ISS, 78,698).

Figure A1

Proportion of patients with moderate and severe injury, hospitalized in a trauma-designated center by insurance status, 1999–2006, with confidence intervals

Figure A2

Proportion of patients with moderate and severe injury, hospitalized in a trauma-designated center by geographical distance from patient residence to nearest trauma facility, 1999–2006, with confidence intervals

Figure A3

Proportion of patients with moderate and severe injury, hospitalized in a trauma-designated center by availability of trauma center in county of residence, 1999–2006, with confidence intervals