Geographical disparity and traumatic brain injury in America: Rural areas suffer poorer outcomes

Abstract

Introduction:Significant heterogeneity exists in traumatic brain injury (TBI) outcomes. In the United States, TBI remains a primary driver of injury-related mortality and morbidity. Prior work has suggested that disparity exists in rural areas; our objective was to evaluate potential differences in TBI mortality across urban and rural areas on a national scale.Methods:Age-adjusted TBI fatality rates were obtained at the county level across the U.S. from 2008 to 2014. To evaluate geography, urban influence codes (UIC) were also obtained at the county level. UIC codes range from 1 (most urban) to 12 (most rural). Metropolitan counties are defined as those with an UIC ≤2, while nonmetropolitan counties are defined as an UIC ≥3. County-level fatality rates and UIC classification were geospatially mapped. Linear regression was used to evaluate the change in TBI fatality rate at each category of UIC. The median TBI fatality rate was also compared between metropolitan and nonmetropolitan counties.Results:Geospatial analysis demonstrated higher fatality rates distributed among nonmetropolitan counties across the United States. The TBI fatality rate was 13.00 deaths per 100,000 persons higher in the most rural UIC category compared to the most urban UIC category (95% confidence interval 12.15, 13.86; P < 0.001). The median TBI rate for nonmetropolitan counties was significantly higher than metropolitan counties (22.32 vs. 18.22 deaths per 100,000 persons, P < 0.001).Conclusions:TBI fatality rates are higher in rural areas of the United States. Additional studies to evaluate the mechanisms and solutions to this disparity are warranted and may have implications for lower-and middle-income countries.

A Geospatial Examination of Specialist Care Accessibility and Impact on Health Outcomes for Patients With Acute Traumatic Spinal Cord Injury in Nsw, Australia: A Whole&nbsp;&nbsp;Population Record Linkage Study

“…Speci cally, in the most rural areas, TBI fatality rates were 13 deaths per 100,000 persons higher than those in the most urban area (95% con dence interval 12.15-13.86; P < 0.001) (12). A similar analysis across the NSW trauma system demonstrated a signi cantly higher adjusted mortality rate for patients with any traumatic injury treated in regional services compared with metropolitan major trauma services (17).…”

“…Similar modelling (without geospatial data) showed that optimizing patientcare pathways can achieve signi cant health system cost reductions from direct in comparison with indirect admissions to SCIU (16). Studying individuals with acute traumatic brain injury (TBI), Brown et al (12) found signi cant disparity in survival rates between rural and urban areas using geospatial analysis.…”

“…Epidemiological, health services studies are increasingly using geospatial methods (11)(12)(13) to better understand and target both injury prevention and post-injury care (14). Triage optimisation using geospatial data and scenario modelling has demonstrated signi cantly reduced time to SCIU admission in a Canadian study (15).…”

Mental Health Care Delivery for Older Adults in Rural Greece: Unmet Needs

“…For instance, a recent study in the United States reported that patients who sustain traumatic brain injury in rural, predominantly low-resource environments have a significantly higher risk of poor outcome (i.e., death) than those in urban, high-resource environments. 14 All these notions may be even more relevant in older rural residents.…”

Recommendations of the Colombian Consensus Committee for the Management of Traumatic Brain Injury in Prehospital, Emergency Department, Surgery, and Intensive Care (Beyond One Option for Treatment of Traumatic Brain Injury: A Stratified Protocol [BOOTStraP])

“…3,4 This higher mortality and disability associated with TBI in the areas of lower income groups are associated with the lack of prevention, less control of risk factors, and lower capacity for acute care and rehabilitation. 5 The WHO Global Report of Road Safety for the year 2015 states that 90% of deaths from RTAs occurs in LMICs. 6 However, while LMICs account for 82% of the world's population, only 54% of the world's registered vehicles are in LMICs, indicating a disproportionate number of road traffic deaths.…”