Eliminating health disparities through equitable care: The trauma system model

Background: The constructs of political economy can affect access to services and quality of care, thereby influencing health outcomes. However, the influence of political economy on incidence and outcome of trauma remains largely undefined. In the US, trauma care is based on anatomical/physiological criteria that consider mechanism of injury, and is guided by evidence-based protocols independent of the patient's socioeconomic/insurance status or ability to pay. We hypothesized that while incidence of injury is related to political economy, advanced trauma care would negate outcome disparities induced by a weak political economy. Methods: Miami-Dade County municipalities were stratified into three groups according to poverty level using 2000 US Census data. Patient variables including municipality of residence, injury outcome, and injury severity were obtained for each patient treated at our urban level I trauma center in 2008 from the center's registry. Analyses were performed using linear and multiple regression techniques. Results: The sample included 3,676 adult trauma patients. Incidence of injury exhibited a strong linear correlation with poverty level (r=0.99), with high injury incidence associated with greater municipal poverty levels. In contradistinction, poverty level was a significantly weaker predictor of mortality (1=0.21), with injury severity explaining a considerably greater percentage of the variation in mortality following trauma (2=2.18). Conclusions: Municipal poverty levels significantly influence incidence of injury, however they did not significantly influence mortality. Thus, healthcare reform would maximize equitability through emulation of the trauma system model. Additionally, violence/injury prevention efforts should target lower-income populations as indicated by the disproportionate incidence of trauma.

As the principal investigator of the research project, my role included development of the research question and specific aims, management of data collection and analysis, and coordination of abstract development.