Geospatial characteristics of non-motor vehicle and assault-related trauma events in greater Phoenix, Arizona

Abstract

Background: Injury-causing events are not randomly distributed across a landscape, but how they are associated with the features and characteristics of the places where they occur in Arizona (AZ) remains understudied. Clustering of trauma events and associations with areal sociodemographic characteristics in the greater Phoenix (PHX), AZ region can promote understanding and inform efforts to ameliorate a leading cause of death and disability for Arizonans. The outcomes of interest are trauma events unrelated to motor vehicle crashes (MVC) and the subgroup of trauma events due to interpersonal assaults. Methods: A retrospective, ecological study was performed incorporating data from state and national sources for the years 2013-2017. Geographically weighted regression models explored associations between the rates of non-MVC trauma events (n/10,000 population) and the subgroup of assaultive trauma events per 1000 and areal characteristics of socioeconomic deprivation (areal deprivation index [ADI]), the density of retail alcohol outlets for offsite consumption, while controlling for race/ethnicity, population density, and the percentage urban population. Results: The 63,451 non-MVC traumas within a 3761 mile 2 study area encompassing PHX and 22 surrounding communities, an area with nearly 60% of the state's population and 54% of the trauma events in the AZ State Trauma Registry for the years 2013-2017. Adjusting for confounders, ADI was associated with the rates of non-MVC and assaultive traumas in all census block groups studied (mean coefficients 0.05 sd. 0.001 and 0.07 sd. 0.002 for non-MVC and assaultive trauma, respectively). Alcohol retail outlet density was also associated with non-MVC and assaultive traumas in fewer block groups compared to ADI. Conclusion: Socioeconomic deprivation and alcohol outlet density were associated with injury producing events in the greater PHX area. These features persist in the environment before and after the traumas occur. Ongoing research is warranted to identify the most influential areal predictors of traumatic injury-causing events in the greater PHX area to inform and geographically target prevention initiatives.

The Impact of Relocating a Trauma Center: Retrospective Observations on Payer Demographics and Cost-Analysis

“…Furthermore, the decrease in penetrating trauma is attributed to penetrating traumas occurring more frequently in more urban communities, and the post-move location is more suburban. 9 In addition, assaults happen more frequently in the Hispanic/Latino and black patient populations, 20 and the center saw a decrease in these post-move. Blunt injuries have been found to accrue more hospital charges than penetrating trauma, due to the longer length of stay patients often experience which can lead to more medications, radiographs, and accessory costs from the admission.…”

The Impact of Relocating a Trauma Center: Observations on Patient Injury Demographics and Resident Volumes

“…For example, mechanisms such as gunshot wounds have the highest per capita incidence in resource-deprived counties, and patients tend to be non-white males, under the age of 40, and involved in an assault [1,2]. Unfortunately, patient outcomes also suffer disparities based on race, as white patients tend to have lower mortality and morbidity following a traumatic event [3][4][5]. Trauma centers tend to be placed in geographic locations based on the community's needs, which can also influence resident caseload.…”

Neighborhood Socioeconomic Disadvantage and the Neurobiology of Uncertainty in Traumatically Injured Adults

“…Studies suggest that neighborhood disadvantage is associated with decreased volume of brain regions, widespread alteration of resting-state connectivity patterns, and changes to activation patterns during tasks (e.g., response inhibition, fear learning) ( 4 – 8 ). Although individuals living in more disadvantaged neighborhoods are faced with high levels of uncertainty ( 2 , 9 ) and greater exposure to trauma-related or injury-causing events ( 10 ), it remains unclear how neighborhood disadvantage may be impacting the neurobiological correlates of uncertainty, particularly in the aftermath of traumatic injury.…”

“…These tendencies are well documented: living in disadvantaged neighborhoods is associated with hypervigilance and heightened reactivity to stimuli ( 20 ). The continuous deployment of cognitive resources and engagement in hypervigilant behaviors, which may be transiently adaptive, is further compounded by disproportionately elevated exposure to trauma in disadvantaged neighborhoods ( 10 ). A consequence of trauma exposure is posttraumatic stress disorder (PTSD), which is characterized by symptoms also linked to neighborhood disadvantage (e.g., hyperarousal) ( 16 ).…”