Abstract
Little is known about the distribution of life-saving trauma resources by racial/ethnic composition in US cities, and if racial/ethnic minority populations disproportionately live in US urban trauma deserts. To examine racial/ethnic differences in geographic access to trauma care in the 3 largest US cities, considering the role of residential segregation and neighborhood poverty. A cross-sectional, multiple-methods study evaluated census tract data from the 2015 American Community Survey in Chicago, Illinois; Los Angeles (LA), California; and New York City (NYC), New York (N = 3932). These data were paired to geographic coordinates of all adult level I and II trauma centers within an 8.0-km buffer of each city. Between February and September 2018, small-area analyses were conducted to assess trauma desert status as a function of neighborhood racial/ethnic composition, and geospatial analyses were conducted to examine statistically significant trauma desert hot spots. In small-area analyses, a trauma desert was defined as travel distance greater than 8.0 km to the nearest adult level I or level II trauma center. In geospatial analyses, relative trauma deserts were identified using travel distance as a continuous measure. Census tracts were classified into (1) racial/ethnic composition categories, based on patterns of residential segregation, including white majority, black majority, Hispanic/Latino majority, and other or integrated; and (2) poverty categories, including nonpoor and poor. Chicago, LA, and NYC contained 798, 1006, and 2128 census tracts, respectively. A large proportion comprised a black majority population in Chicago (35.1%) and NYC (21.4%), compared with LA (2.7%). In primary analyses, black majority census tracts were more likely than white majority census tracts to be located in a trauma desert in Chicago (odds ratio [OR], 8.48; 95% CI, 5.71-12.59) and LA (OR, 5.11; 95% CI, 1.50-17.39). In NYC, racial/ethnic disparities were not significant in unadjusted models, but were significant in models adjusting for poverty and race-poverty interaction effects (adjusted OR, 1.87; 95% CI, 1.27-2.74). In comparison, Hispanic/Latino majority census tracts were less likely to be located in a trauma desert in NYC (OR, 0.03; 95% CI, 0.01-0.11) and LA (OR, 0.30; 95% CI, 0.22-0.40), but slightly more likely in Chicago (OR, 2.38; 95% CI, 1.56-3.64). In this study, black majority census tracts were the only racial/ethnic group that appeared to be associated with disparities in geographic access to trauma centers.
Highlights
Death from violent crime among racial and ethnic minorities has gained widespread attention in the media and political discourse
Black majority census tracts were more likely than white majority census tracts to be located in a trauma desert in Chicago and Los Angeles (LA) (OR, 5.11; 95% CI, 1.50-17.39)
Hispanic/Latino majority census tracts were less likely to be located in a trauma desert in New York City (NYC) (OR, 0.03; 95% CI, 0.01-0.11) and LA (OR, 0.30; 95% CI, 0.22-0.40), but slightly more likely in Chicago (OR, 2.38; 95% CI, 1.56-3.64)
Summary
Death from violent crime among racial and ethnic minorities has gained widespread attention in the media and political discourse. Civil rights campaigns have emphasized the structural processes that routinely and fundamentally devalue black lives, such as inadequate access to life-saving medical care. Prior studies examining geographic access to trauma care have emphasized differences between urban and rural regions in the United States. Researchers examined more than 200 000 block groups and found that rural populations were less likely than urban populations to have access to a trauma center within 60 minutes.[2] The study concluded that, because racial/ethnic minority populations appeared to be clustered in urban regions, these populations were more likely to have access to trauma care.[2] urban and rural geographies are different in both the magnitude and types of trauma encountered, making direct comparisons limited. Travel time estimates in rural regions are consistent across time, estimates in urban regions often reflect averages across time and do not account for differences in travel time reliability.[4]
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