- Black majority census tracts are the only racial/ethnic group associated with disparity in geographic access to trauma care, according to a new study from JAMA Open analyzing the three largest U.S. cities: New York, Chicago and Los Angeles.
- The study defined "trauma deserts" as areas where the distance to the nearest adult level I or II trauma center is greater than 8 kilometers, or 5 miles. Census tracts were classified by race/ethnicity and poverty categories.
- In New York, class disparity is more prominent than race/ethnicity within trauma deserts, suggesting New York's "expansive" trauma network limits the scope of the effect.
Similar studies have been done on race, ethnicity, poverty and geographic access to care in the past, but as the authors of this paper note, many tend to position the research as a comparison between urban and rural areas. That comparison can be problematic when considering the magnitude and types of trauma found in urban centers and rural areas, such as differences in transportation and violent crime rates.
This particular study focused on Chicago, Los Angeles and New York, and honed in on racial/ethnic differences in geographic access, pinpointing whether minority populations disproportionately live in urban trauma centers.
In Chicago and Los Angeles, black majority communities are more likely to be located in a trauma desert than white communities. The authors found that in New York, racial and ethnic disparities were "not significant" until models were adjusted to account for poverty and "race-poverty interaction effects." Once adjusted, Hispanic/Latino communities were found to be less likely to be located in a trauma desert in New York and Los Angeles, but more likely in Chicago.
The authors concluded that black-majority census tracts are the only racial/ethnic group consistently associated with disparities in geographic access to trauma centers, due to a deep history of racist policies that have fueled generational poverty.
"It is possible that stark racial disparities in access reflect economic and social policies established during the early to mid-20th century — a period of racial segregation in healthcare that continued long after civic victory over enforced segregation under Jim Crow laws," the authors write.
Additionally, low-access black neighborhoods are vastly non-white, with over 90% of residents identifying as a racial/ethnic minority. Low-access neighborhoods also correspond with regions where trauma centers have shut down in the recent past: Over one-quarter of U.S. trauma centers closed between 1990 and 2005, according to the authors.
In Chicago and Los Angeles, 50% of census tracts are located in an urban trauma desert. In New York, that percentage is fewer than 15%.
Free-standing EDs have come under scrutiny lately, as many are located in wealthy areas and don't serve to fill care gaps. A UnitedHealth study published this week found that the vast majority of FSEDs don't provide emergency care, yet cost 22 times more than similar procedures done at a physicians' office. A 2017 Health Affairs report suggested policymakers regulate where FSEDs can be built "to prevent the exacerbation of disparities involving the medically underserved."