252019 Eliminating health disparities through equitable care: The trauma system model

Monday, October 31, 2011

Fahim Habib, MD, FACS , Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL
Christine Stinson, BA , WalkSafe Program, University of Miami Miller School of Medicine, Miami, FL
Anabel Anon, BS , WalkSafe Program, University of Miami Miller School of Medicine, Miami, FL
Zara Khan, BA , Department of Surgery, University of Miami, Miami, FL
Sharyce Gonzalez, BS , Department of Surgery, University of Miami, Miami, FL
Carl Schulman, MD, MSPH, FACS , DeWitt Daughtry Family Department of Surgery, University of Miami Miller School of Medicine, Miami, FL
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.

Learning Areas:
Public health or related research

Learning Objectives:
1. Identify factors that contribute to risk of traumatic injury and injury outcome on a population level. 2. Describe the dose-response relationship between municipal poverty level and incidence of trauma. 3. Discuss how a broad application of the trauma system model to other aspects of healthcare could contribute to the elimination of health disparities.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a member of the Delta Omega Honor Society.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.