Geospatial access to care system helps reduce mortality in gunshot injury cases: JAMA

USA: A new study conducted by James P. Byrne and colleagues suggests that geospatial access to care may be a crucial trauma system indicator, and improvements to it may lead to a decrease in the number of gun violence-related fatalities in US communities. The findings of this study were published in the Journal of American Medical Association - Surgery.

Violence using firearms is becoming more prevalent in US cities. There has not been a thorough evaluation of the impact of access to trauma center care as a trauma system metric with implications for firearm injury mortality. This study was carried out in order to assess the relationship between geographic access to care and gunshot injury mortality in an urban trauma system.

All victims of interpersonal violence who were 15 years of age or older who were shot in Philadelphia, Pennsylvania, between January 1, 2015, and August 9, 2021, were included in this retrospective cohort analysis. The projected ground transit time for each individual shot to the closest trauma hospital, as determined by geospatial network analysis, is known as "geospatial access to care." Hierarchical logistic regression was used to estimate mortality that had been adjusted for risk. The proportion of mortality owing to differences in geographic access to care was calculated using the population attributable fraction.

The key findings of this study:

1. 10 105 people in Philadelphia were shot as a result of interpersonal violence throughout the research period.

2. The projected transit time ranged from 5.6 minutes in the median.

3. Each additional minute of anticipated ground travel time was linked to a higher chance of death after risk adjustment.

4. According to a calculation of the population attributable fraction utilizing mortality rate ratios for incremental 1-minute increments in projected ground transit time, 455 deaths during the research period, or 23% of gunshot fatalities, might be linked to disparities in access to care.

In conclusion, each extra minute of anticipated ground travel time to the nearest trauma center was linked to a higher fatality rate in this retrospective cohort analysis of people shot in an advanced urban trauma system. As a result of disparities in access to care, this connection was predicted to be responsible for 23% of fatalities. These findings suggest that geographic access to care may be a crucial trauma system indicator and that changes to it may lower the number of gun violence-related fatalities in US communities.

Reference: 

Byrne, J. P., Kaufman, E., Scantling, D., Tam, V., Martin, N., Raza, S., Cannon, J. W., Schwab, C. W., Reilly, P. M., & Seamon, M. J. (2022). Association Between Geospatial Access to Care and Firearm Injury Mortality in Philadelphia. In JAMA Surgery. American Medical Association (AMA).https://doi.org/10.1001/jamasurg.2022.3677