Longer trips to the ER, especially for minorities and poor

October 5, 2011, University of California, San Francisco

Closures of hospital trauma centers are disproportionately affecting poor, uninsured and African American populations, and nearly a fourth of Americans are now forced to travel farther than they once did.

In a new study led by the University of California, San Francisco (UCSF), researchers examined changes in driving time to trauma centers, which have increasingly been shuttered in recent years.

They found that by 2007, 69 million Americans – nearly one in four – had to travel farther to the nearest than they traveled in 2001. Most affected by the closures were African Americans, poor, uninsured and rural residents.

The study will be published in the October issue of Health Affairs.

"Trauma centers aren't just for 'certain' people – if you sustain a serious injury from a car accident or fall off your roof, you need a trauma center,'' said lead author Renee Y. Hsia, MD, an assistant professor of emergency medicine at UCSF. She is also an attending physician in the emergency department at San Francisco General Hospital & Trauma Center and a Robert Wood Johnson Foundation Physician Faculty Scholar.

"We found evidence that vulnerable communities have less geographic access to trauma care, adding to their health disparities,'' Hsia added. "This study will help us better understand how trauma center closures are affecting people.''

Hsia's research centers on illustrating inequalities in accessing trauma care as well as the decline of emergency care in the . She has documented that tens of millions of Americans do not have ready access to a certified trauma center, and that nearly a third of urban and suburban emergency rooms have closed in the last two decades.

For their new study, the researchers analyzed 31,475 ZIP codes in the United States, covering some 283 million people, nearly the entire nation.

Overall, nearly three-quarters of the U.S. lives within 10 miles of a trauma center. Of the remainder, 14 percent live more than 30 miles from a trauma center. Communities with a higher number of residents under the federal poverty level, black residents, uninsured residents and rural residents faced longer drives compared to communities with a low share of these vulnerable populations.

For nearly 16 million people, the extra driving time amounts to about 30 minutes – a critical period for people facing life-threatening injuries such as stroke and gunshot wounds.

Trauma services are not, as commonly believed, available in all hospitals. They are hospitals with emergency departments that provide specialty care for injured patients, regardless of ability to pay. As a result, trauma centers face greater financial jeopardy depending on the surrounding patient population.

In 1990 there were 1,125 trauma centers in the United States; by 2005, about 30 percent of them had closed primarily because of the high costs and fewer patients able to pay the bills. The majority of closures took place in urban areas but rural communities have also been affected.

The study's co-author is Yu-Chu Shen, an associate professor of economics at the Naval Postgraduate School in Monterey, CA.

The authors recommend that policy makers should subsidize trauma centers that treat a large number of African American, uninsured or poor people. In rural areas, they recommend that hospitals establish agreements with nearby trauma centers to ease transfers of seriously injured patients.

Explore further: Injured children may not be getting best possible care

Related Stories

Injured children may not be getting best possible care

May 2, 2011
Most injured children are not being treated at pediatric trauma centers, arguably the most appropriate location of care for young patients, according to a study to be presented Monday, May 2, at the Pediatric Academic Societies ...

Market factors affect closures of emergency departments nationwide

June 10, 2011
Despite a rise in the number of emergency room patients, the number of hospital-based emergency departments in the U.S. is in decline, according to a study led by Renee Hsia, MD, MSc, an emergency physician at San Francisco ...

Recommended for you

Number of older people with four or more diseases will double by 2035, say researchers

January 23, 2018
A study published today in Age and Ageing, the scientific journal of the British Geriatrics Society, reports that the number of older people diagnosed with four or more diseases will double between 2015 and 2035. A third ...

Placental accumulation of flame retardant chemical alters serotonin production in rats

January 22, 2018
A North Carolina State University-led research team has shown a connection between exposure to a widely used flame retardant chemical mixture and disruption of normal placental function in rats, leading to altered production ...

Marijuana use does not lower chances of getting pregnant

January 22, 2018
Marijuana use—by either men or women—does not appear to lower a couple's chances of getting pregnant, according to a new study led by Boston University School of Public Health (BUSPH) researchers.

Women run faster after taking newly developed supplement, study finds

January 19, 2018
A new study found that women who took a specially prepared blend of minerals and nutrients for a month saw their 3-mile run times drop by almost a minute.

Americans are getting more sleep

January 19, 2018
Although more than one in three Americans still don't get enough sleep, a new analysis shows first signs of success in the fight for more shut eye. According to data from 181,335 respondents aged 15 and older who participated ...

Wine is good for you—to a point

January 18, 2018
The Mediterranean diet has become synonymous with healthy eating, but there's one thing in it that stands out: It's cool to drink wine.


Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.