Population density and mortality among individuals in motor vehicle crashes

Gedeborg, Rolf; Thiblin, Ingemar; Byberg, Liisa; Melhus, Håkan; Lindbäck, Johan; Michaëlsson, Karl

doi:10.1136/ip.2009.024414

Cited by 22 publications

(11 citation statements)

References 33 publications

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“…In all three of the models presented, the risk of an adverse outcome increased as rurality increased, as seen in previous research (Baker et al, 1987; Brown et al, 2000; Gedeborg et al, 2010; Goldstein et al, 2011; Muelleman et al, 2007). In particular, individuals with severe injuries were more likely to die in rural counties, validating previous studies (Brodsky and Hakkert, 1983; Brown, 1979; Muelleman et al, 2007; Travis et al, 2012).…”

Section: Discussionsupporting

confidence: 82%

Evaluating adverse rural crash outcomes using the NHTSA State Data System

Peura

Kilch

Clark

2015

Accident Analysis & Prevention

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Introduction The population-based rate of motor vehicle crash mortality is consistently higher in rural locations, but it is unclear how much of this disparity might be due to geographic barriers or deficiencies in emergency medical services (EMS). We sought to analyze separately factors associated with the occurrence of a severe injury and those associated with death after injury had occurred. Methods Data from all police-reported crashes in 11 states from 2005–2007 were obtained through the National Highway Traffic Safety Administration (NHTSA) State Data System (SDS). Logistic regression was used to estimate factors associated with (1) death; (2) severe (incapacitating or fatal) injury; and (3) death given severe injury. Models included covariates related to the person, vehicle, and event; county location was specified using Rural–Urban Continuum Codes (RUCC). Results Older age, not wearing a belt, ejection, alcohol involvement, high speed, and early morning times were associated with increased risk of both severe injury and death. Controlling for these factors, and restricting analysis to persons who had suffered a severe injury, the adjusted odds ratio (aOR) associated with death was higher for counties classified rural (RUCC 6–7, aOR 1.23, 95% CI 1.16–1.31) or very rural (RUCC 8–9, aOR 1.31, 95% CI 1.18–1.46). Conclusions Persons severely injured in crashes are more likely to die if they are in rural locations, possibly due to EMS constraints. As NHTSA-SDS data become more available and more uniform, they may be useful to explore specific factors contributing to this increased risk.

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Section: Discussionsupporting

confidence: 82%

Evaluating adverse rural crash outcomes using the NHTSA State Data System

Peura

Kilch

Clark

2015

Accident Analysis & Prevention

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“…Each SRR is equal to the proportion of patients who survived with a specific ICD-code in a reference population. In studies with large samples, the study sample is often used as the reference population [35], [36]. Smaller studies may use published SRRs from a larger, similar, reference population [37].…”

Section: Methodsmentioning

confidence: 99%

Early Hospital Mortality among Adult Trauma Patients Significantly Declined between 1998-2011: Three Single-Centre Cohorts from Mumbai, India

et al. 2014

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BackgroundTraumatic injury causes more than five million deaths each year of which about 90% occur in low- and middle-income countries (LMIC). Hospital trauma mortality has been significantly reduced in high-income countries, but to what extent similar results have been achieved in LMIC has not been studied in detail. Here, we assessed if early hospital mortality in patients with trauma has changed over time in an urban lower middle-income setting.MethodsWe conducted a retrospective study of patients admitted due to trauma in 1998, 2002, and 2011 to a large public hospital in Mumbai, India. Our outcome measure was early hospital mortality, defined as death between admission and 24-hours. We used multivariate logistic regression to assess the association between time and early hospital mortality, adjusting for patient case-mix. Injury severity was quantified using International Classification of Diseases-derived Injury Severity Score (ICISS). Major trauma was defined as ICISS<0.90.ResultsWe analysed data on 4189 patients out of which 86.5% were males. A majority of patients were between 15 and 55 years old and 36.5% had major trauma. Overall early hospital mortality was 8.9% in 1998, 6.0% in 2002, and 8.1% in 2011. Among major trauma patients, early hospital mortality was 13.4%, in 1998, 11.3% in 2002, and 10.9% in 2011. Compared to trauma patients admitted in 1998, those admitted in 2011 had lower odds for early hospital mortality (OR = 0.56, 95% CI = 0.41–0.76) including those with major trauma (OR = 0.57, 95% CI = 0.41–0.78).ConclusionsWe observed a significant reduction in early hospital mortality among patients with major trauma between 1998 and 2011. Improved survival was evident only after we adjusted for patient case-mix. This finding highlights the importance of risk-adjustment when studying longitudinal mortality trends.

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“…Maio, Green, Becker, Burney, and Compton (1992) and Chen, Maio, Green, and Burney (1995) found evidence that the increased rural mortality might be due to older age, more use of alcohol, higher speeds, or other pre-crash factors, but no evidence that the quality of medical care in rural areas is inferior to that in urban areas. Muelleman, Wadman, Tran, Ullrich, and Anderson (2007) found that the rural risk in Nebraska was higher even after controlling for injury severity, but Gedeborg et al(2010) found no increased rural risk in Sweden after controlling for injury severity.…”

Section: Discussionmentioning

confidence: 98%