Rural risk: Geographic disparities in trauma mortality

BACKGROUND: Barriers to trauma care for rural populations are well documented, but little is known about the magnitude of urban-rural disparities in injury mortality. This study sought to quantify differences in injury mortality comparing rural and non-rural residents with traumatic injuries. METHODS: Using data from the 2009–2010 Nationwide Emergency Department Sample, multiple logistic regression analyses were conducted to estimate odds of death following traumatic injury for rural residents compared to non-rural residents, while controlling for age, sex, injury type and severity, comorbidities, trauma designation and Census region. RESULTS: Rural residents were 14% more likely to die, compared to non-rural residents (p < 0.001). Increased odds of death for rural residents were observed at Level I (OR = 1.20, p < 0.001), Level II (OR = 1.34, p < 0.001), and Level IV/non-trauma centers (OR = 1.23, p < 0.001). The disparity was greatest for injuries occurring in the South and Midwest (OR = 1.54, p < 0.001 and OR = 2.06, p < 0.001, respectively), and for cases with an injury severity scores less than nine, or unknown severity (OR = 2.09, <0.001 and OR = 1.31, p < 0.001, respectively). CONCLUSIONS: Rural residents are significantly more likely than non-rural residents to die following traumatic injury. This disparity varies by trauma center designation, injury severity, and US Census region. Distance and time to treatment likely play a role in rural injury outcomes, along with regional differences in pre-hospital care and trauma system organization