Abstract
BackgroundUnintentional injury leads all other causes of death for those 1 to 45 years old. The expense of medical care for injured people is estimated to exceed $406 billion annually. Given this burden on the population, the Centers for Disease Control and Prevention consistently refers to injury prevention as a national priority. We postulated that exposure to crime and the density of alcohol outlets in one's neighborhood will be positively associated with the incidence of hospitalization for and mortality from traumatic injuries, independent of other neighborhood characteristics.MethodsWe conducted a cross-sectional study with ecological and individual analyses. Patient-level data for traumatic injury, injury severity, and hospital mortality due to traumatic injury in 2010 were gathered from the Dallas-Fort Worth Hospital Council Foundation. Each case of traumatic injury or death was geospatially linked with neighborhood of origin information from the 2010 U.S. Census within Dallas County, Texas. This information was subsequently linked with crime data gathered from 20 local police departments and the Texas Alcoholic Beverage Commission alcohol outlet dataset. The crime data are the Part One crimes reported to the Federal Bureau of Investigation.ResultsThe proportion of persons 65 years old or older was the strongest predictor of the incidence of hospitalization for traumatic injury (b = 12.64, 95% confidence interval (CI) 8.73 to 16.55). In turn, the incidence of traumatic injury most strongly predicted the severity of traumatic injury (b = 0.008, 95% CI 0.0003 – 0.0012). The tract-level unemployment rate was associated with a 5% increase in the odds of hospital mortality among hospitalized trauma patients.ConclusionsSeveral neighborhood characteristics were associated with the incidence, severity, and hospital mortality from traumatic injury. However, crime rates and alcohol outlet density carried no such association. Prevention efforts should focus on neighborhood characteristics such as population density, mean age of the residents, and unemployment rate, regardless of crime rates and alcohol outlet density.Electronic supplementary materialThe online version of this article (doi:10.1186/s40621-014-0023-2) contains supplementary material, which is available to authorized users.
Highlights
Unintentional injury leads all other causes of death for those 1 to 45 years old
We postulated that exposure to crime and the density of alcohol outlets in one's neighborhood will be positively associated with the incidence of hospitalization for and mortality from traumatic injuries, independent of established socioeconomic status (SES) measures such as income, employment status, and education
We found that several well-established neighborhoodlevel SES measures were significantly associated with injury that required hospital admission and treatment
Summary
The expense of medical care for injured people is estimated to exceed $406 billion annually. Given this burden on the population, the Centers for Disease Control and Prevention consistently refers to injury prevention as a national priority. Traumatic injuries cost more than $406 billion in medical care and lost productivity annually (Finkelstein et al 2006), and unintentional injury remains the leading cause of death among several age groups in the USA (Centers for Disease Control and Prevention 2010). Because SES is a multidimensional construct (that continues to generate definitional debate), it is important that multiple measurement sources be investigated to elucidate the effect of ‘SES’ along with other neighborhood characteristics on trauma incidence, injury severity, and hospital mortality. Other factors shown to be associated with the occurrence and outcomes of traumatic injury must be taken into account
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