Online Program

Using geographic information systems to map trauma center accessibility for gunshot wound victims in Chicago

Tuesday, November 5, 2013

Marie Crandall, MD, MPH, FACS, Department of Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL
Jess Behrens, MS, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL
Renee Hsia, MD, MSc, Department of Emergency Medicine, University of California--San Francisco, San Francisco, CA
Background/Purpose: Over a decade of research has demonstrated that specialized trauma centers improve survival from serious injury. However, the distribution of trauma centers is not uniform, with many areas of the country being poorly covered and suffering worse mortality rates for equivalent injury severity, particularly in rural areas. We hypothesized that trauma center access disparities exist even in urban areas, and sought to demonstrate disparities in access to definitive care for gunshot wounds (GSWs) in Chicago. Methods: Scene address data from the Illinois State Trauma Registry from 1999-2009 was utilized to geocode all GSWs that presented to trauma centers in Chicago during the study period. GSW frequency was mapped using geographic regression with ArcGIS 10.0 to create a population weighted relative risk using U.S. Census demographic data. Finally, accessibility scores were calculated using modified FCA 2 Step methodology and Network Analyst-estimated 30 minute drive time to the nearest trauma center to identify areas of limited access and higher need. Results: A total of 11,744 GSWs were geocoded. 48.9% of the city of Chicago and 36.1% of the population reside in census tracts with poor accessibility to a trauma center. 23.3% of the most at-risk population resides in these less-accessible areas, and 59.5% of the total African American population lives in areas with low accessibility, regardless of risk. Conclusions: We found that risk of GSWs did not correlate perfectly with accessibility to trauma centers. Given the frequent need for prompt surgical intervention for GSWs, this may contribute to location-based outcome disparities.

Learning Areas:

Advocacy for health and health education
Diversity and culture
Provision of health care to the public
Public health or related public policy

Learning Objectives:
Describe in a visual context risk-weighted access to trauma centers for gunshot wound victims in Chicago.

Keyword(s): Access to Care, Firearms

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I've been working in Public Health for over 10 years & have an MS in Ecology. My experiences include working with GIS for the CDC, the State of Missouri's DHSS, the University of Nebraska Medical Center, & Northwestern University. In addition to this experience, I've worked as a Public Health Investigator for Los Angeles County & worked with syndromic surveillance systems for the State of Missouri.
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.