Abstract
BackgroundInjury-causing events are not randomly distributed across a landscape, but how they are associated with the features and characteristics of the places where they occur in Arizona (AZ) remains understudied. Clustering of trauma events and associations with areal sociodemographic characteristics in the greater Phoenix (PHX), AZ region can promote understanding and inform efforts to ameliorate a leading cause of death and disability for Arizonans. The outcomes of interest are trauma events unrelated to motor vehicle crashes (MVC) and the subgroup of trauma events due to interpersonal assaults.MethodsA retrospective, ecological study was performed incorporating data from state and national sources for the years 2013–2017. Geographically weighted regression models explored associations between the rates of non-MVC trauma events (n/10,000 population) and the subgroup of assaultive trauma events per 1000 and areal characteristics of socioeconomic deprivation (areal deprivation index [ADI]), the density of retail alcohol outlets for offsite consumption, while controlling for race/ethnicity, population density, and the percentage urban population.ResultsThe 63,451 non-MVC traumas within a 3761 mile2 study area encompassing PHX and 22 surrounding communities, an area with nearly 60% of the state’s population and 54% of the trauma events in the AZ State Trauma Registry for the years 2013–2017. Adjusting for confounders, ADI was associated with the rates of non-MVC and assaultive traumas in all census block groups studied (mean coefficients 0.05 sd. 0.001 and 0.07 sd. 0.002 for non-MVC and assaultive trauma, respectively). Alcohol retail outlet density was also associated with non-MVC and assaultive traumas in fewer block groups compared to ADI.ConclusionSocioeconomic deprivation and alcohol outlet density were associated with injury producing events in the greater PHX area. These features persist in the environment before and after the traumas occur. Ongoing research is warranted to identify the most influential areal predictors of traumatic injury-causing events in the greater PHX area to inform and geographically target prevention initiatives.
Highlights
Traumatic injuries affect individuals, families and communities
Patients are included in the AZ State Trauma Registry (ASTR) registry if the emergency medical team transporting the patient deems the patient has suffered traumatic injury, transferred from one trauma center to another via EMS, required a trauma team activation, or were admitted to hospital or died due to traumatic injuries.(Arizona Department of Health Services Emergency Medical Services and Trauma System, 2019) Patients were excluded from this study if their trauma occurred outside of AZ, their injuries were caused by burns, drowning, insect or animal bites or stings, overexertion, poisoning, or other mechanisms unrelated to gross anatomic injury
During the five-year study period, the number of traumas in the study area reported to the ASTR increased by 73.1%, from 9247 events in 2013 to 16,008 events in 2017 while the population of the study area increased by only 6.8%.(Arizona Office of Economic Opportunity
Summary
Families and communities. Nationally, unintentional injury is the leading cause of death and disability for Americans one to 44 years-old and the third leading cause of death overall, primarily due to brain injuries.(Centers for Disease Control and Prevention National Center for Injury Prevention and Control, 2010; Gunst et al, 2010) According to the most recent report of the National Vital Statistics System from the Centers for Disease Control and Prevention, in 2016 over 161,000 people in the United States (US) died from unintentional injuries. Motor vehicle crashes and falls combined for another 75,000 deaths.(Xu et al, n.d.) In Arizona (AZ), 46,842 patients were treated for traumatic injuries, of whom 1111 (2.4%) people (75 per 100,000) died in 2016.(Arizona Bureau of Emergency Medical Services and Trauma System, 2017) In addition to the toll of lives lost, an enormous financial cost is associated with fatal and nonfatal injury. The annual inpatient costs for trauma patients in the US have been estimated to be more than $37 billion dollars.(Velopulos et al, 2013) When lifetime productivity losses are included, the costs exceed $99 billion dollars among those involved in fatal and nonfatal motor vehicle crashes.(Naumann et al, 2010) In 2016, the sum of trauma center charges in AZ was $1.9 billion with a median charge of $22,418 per patient.(Arizona Bureau of Emergency Medical Services and Trauma System, 2017). The outcomes of interest are trauma events unrelated to motor vehicle crashes (MVC) and the subgroup of trauma events due to interpersonal assaults
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