Urban/Rural disparities in Oregon pediatric traumatic brain injury

Abstract

BackgroundTraumatic brain injury (TBI) greatly contributes to morbidity and mortality in the pediatric population. We examined potential urban/rural disparities in mortality amongst Oregon pediatric patients with TBI treated in trauma hospitals.MethodsWe conducted a retrospective study of children ages 0–19 using the Oregon Trauma Registry for years 2009–2012. Geographic location of injury was classified using the National Center for Health Statistics Urban/Rural Classification Scheme. Incidence rates were calculated using Census data for denominators. Associations between urban/rural injury location and mortality were assessed using multivariable logistic regression, controlling for potential confounders. Generalized estimating equations were used to help account for clustering of data within hospitals.ResultsOf 2794 pediatric patients with TBI, 46.6 % were injured in large metropolitan locations, 24.8 % in medium/small metropolitan locations, and 28.6 % in non-metropolitan (rural) locations. Children with rural locations of injury had a greater annualized TBI incidence rate, at 107/100,000 children per year, than those from large metropolitan areas (71/100,000 per year). Compared to children injured in urban locations, those in rural locations had more than twice the crude odds of mortality (odds ratio [OR], 2.5; 95 % CI, 1.6–4.0). This association remained significant (OR, 1.8; 95 % CI, 1.04–3.3) while adjusting for age, gender, race, insurance status, injury severity, and type of TBI (blunt vs. penetrating).ConclusionWe observed higher rates of TBI and greater proportions of severe injury in rural compared to urban areas in Oregon. Rural children treated in the trauma system for TBI were more likely to die than urban children after controlling for demographic and injury factors associated with urban/rural residence. Further research is needed to examine treatment disparities by urban/rural location. Future work should also identify interventions that can reduce risk of TBI and TBI-related mortality among children, particularly those who live in rural areas.Electronic supplementary materialThe online version of this article (doi:10.1186/s40621-015-0063-2) contains supplementary material, which is available to authorized users.

Linkage of VA and State Prescription Drug Monitoring Program Data to Examine Concurrent Opioid and Sedative‐Hypnotic Prescriptions among Veterans

“…Many states' PDMP data are inaccessible for research due in part to privacy concerns (Brandeis University 2017). In our experience, the management of the Oregon PDMP by the Public Health Division, a shared interest in veterans' health, and a history of collaboration and partnership between institutions (e.g., Basham et al 2011;Kane et al 2014;Leonhard et al 2015) supported the development of a data use agreement that met both VA and state PDMP program requirements. This included negotiating the details of where and on what information technology system to bring the data together for linkage.…”

“…; Leonhard et al. ) supported the development of a data use agreement that met both VA and state PDMP program requirements. This included negotiating the details of where and on what information technology system to bring the data together for linkage.…”

Rural‐urban disparities in health care costs and health service utilization following pediatric mild traumatic brain injury

“…Evidence of rural‐urban disparities related to the incidence of pediatric mTBI is mixed. Oregon Trauma Registry data show higher incidence of TBI is greater among rural‐dwelling than urban‐dwelling children; however, other research has suggested a lower incidence rate of emergency department visits for concussions in rural areas compared to urban areas . It is possible that mTBI is underreported in rural areas, where more limited access to health care, including emergency departments, can contribute to different patterns of health service utilization .…”

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