MedicalResearch.com Interview with:
Dr. Molly Jarman PhD
Postdoctoral Research Fellow at
Brigham and Womens Hospital
MedicalResearch.com: What is the background for this study?
Response: Injuries are a leading cause of death and disability in the US, and there are well documented disparities in injury incidence and outcomes. Certain populations (i.e. rural, low income, people of color) experience more injury than others, and are more likely to die following and injury.
Past studies focused on individual health and socioeconomic characteristics as the primary driving force behind these disparities, along with variation in the time required to transport an injured patient to the hospital. We wondered if geographic features of an injury incident location contributed to variation in injury mortality that was not explained by differences in individual patient characteristics.
In other words, we know that who you are contributes to injury mortality, and we wanted to know if it also matters where you are when an injury occurs.
Response: We looked at the geographic characteristics of injury events in Maryland, and found several variables that were associated with injury mortality, even after controlling for the effect of an individual patient’s health and demographic characteristics.
Most notably, distance to the nearest trauma center was associated with an 8% increase in odds of death for every 5-mile increase in distance, in addition to the effect of increased time prehospital time. We also found an association between per capita income and median age of the ZIP code where an injury event occurred, with higher odds of death for people injured in neighborhoods with low income and/or older populations. Together, these findings suggest that environment at an injury event scene contributes to injury outcomes. One reason for this may be variation in the care people receive before they reach the hospital – for example, rural communities often have fewer resources for EMS care, including fewer paramedics who can perform advanced life support procedures in the field.
MedicalResearch.com: What should readers take away from your report?
Response: Where people spend their time – live, work, and play – impacts the care they receive and their outcomes following an injury.
We currently define access to trauma care as living within one hour of a trauma center, and we spend a lot of resources getting injured patients to the hospital as quickly as possible. Our findings suggest that getting people to a trauma center quickly is not enough. We also need to make sure they have the best possible care before they get to the hospital – including first aid from family and friends, and high quality care from EMS providers. This is especially important in rural and low income communities.
MedicalResearch.com: What recommendations do you have for future research as a result of this work?
Response: We need to examine the types of prehospital care people receive in different communities, and the impact this variation has on injury outcomes. We should also look at outcomes other than injury mortality, including long term functional status and quality of life following an injury.
MedicalResearch.com: Is there anything else you would like to add?
Response: I completed this work as part of my doctoral thesis at the Johns Hopkins Bloomberg School of Public Health, with funding support from the Agency for Healthcare Research and Quality (T32HS000029) and the Johns Hopkins Center for Injury Research and Policy (William Haddon Jr. Fellowship). I am currently a postdoctoral research fellow at the Center for Surgery and Public Health, Brigham and Women’s Hospital, and funded through a grant from the Committee for Orthopaedic Trauma Advancement.
Jarman MP, Curriero FC, Haut ER, Pollack Porter K, Castillo RC. Associations of Distance to Trauma Care, Community Income, and Neighborhood Median Age With Rates of Injury Mortality. JAMA Surg. Published online February 07, 2018. doi:10.1001/jamasurg.2017.6133
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