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Howard BV, Metzger JS, Koller KR, Jolly SE, Asay ED, Wang H, Wolfe AW, Hopkins SE, Kaufmann C, Raymer TW, Trimble B, Provost EM, Ebbesson SOE, Austin MA, Howard WJ, Umans JG, Boyer BB. All-cause, cardiovascular, and cancer mortality in western Alaska Native people: western Alaska Tribal Collaborative for Health (WATCH). Am J Public Health 2014; 104:1334-40. [PMID: 24754623 DOI: 10.2105/ajph.2013.301614] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES We determined all-cause, cardiovascular disease (CVD), and cancer mortality in western Alaska Native people and examined agreement between death certificate information and adjudicated cause of deaths. METHODS Data from 4 cohort studies were consolidated. Death certificates and medical records were reviewed and adjudicated according to standard criteria. We compared adjudicated CVD and cancer deaths with death certificates by calculating sensitivity, specificity, predictive values, and κ statistics. RESULTS Men (n = 2116) and women (n = 2453), aged 18 to 95 years, were followed an average of 6.7 years. The major cause of death in men was trauma (25%), followed by CVD (19%) and cancer (13%). The major cause of death in women was CVD (24%), followed by cancer (19%) and trauma (8%). Stroke rates in both genders were higher than those of US Whites. Only 56% of deaths classified as CVD by death certificate were classified as CVD by standard criteria; discordance was higher among men (55%) than women (32%; κs = 0.4 and 0.7). CONCLUSIONS We found lower rates for coronary heart disease death but high rates of stroke mortality. Death certificates overestimated CVD mortality; concordance between the 2 methods is better for cancer mortality. The results point to the importance of cohort studies in this population in providing data to assist in health care planning.
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Affiliation(s)
- Barbara V Howard
- Barbara V. Howard, Hong Wang, and Jason G. Umans are with the MedStar Health Research Institute, Hyattsville, MD. Jesse S. Metzger is with the University of Alaska, Anchorage. Kathryn R. Koller, Elvin D. Asay, Abbie W. Wolfe, and Ellen M. Provost are with the Alaska Native Tribal Health Consortium Division of Community Health Services, Anchorage. Stacey E. Jolly is with the Cleveland Clinic Medicine Institute, Cleveland, OH. Scarlett E. Hopkins, Cristiane Kaufmann, and Bert B. Boyer are with the University of Alaska Fairbanks Center for Alaska Native Health Research. Terry W. Raymer and Brian Trimble are with the Alaska Native Medical Center, Anchorage. Sven O. E. Ebbesson is with the Norton Sound Health Corporation, Nome, AK. Melissa A. Austin is with the Department of Epidemiology, University of Washington, Seattle. William James Howard is with the MedStar Washington Hospital Center, Washington, DC
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Zhu M, Zhao S, Gurka KK, Kandati S, Coben JH. Appalachian versus non-Appalachian U.S. traffic fatalities, 2008-2010. Ann Epidemiol 2013; 23:377-80. [PMID: 23619016 DOI: 10.1016/j.annepidem.2013.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2012] [Revised: 03/14/2013] [Accepted: 04/01/2013] [Indexed: 12/01/2022]
Abstract
PURPOSE Although myriad health disparities exist in Appalachia, limited research has examined traffic fatalities in the region. This study compared traffic fatality rates in Appalachia and the non-Appalachian United States. METHODS Fatality Analysis Reporting System and Census data from 2008 through 2010 were used to calculate traffic fatality rates. Poisson models were used to estimate unadjusted (rate ratio [RR]) and adjusted rate ratios, controlling for age, gender, and county-specific population density levels. RESULTS The Appalachian traffic fatality rate was 45% (95% confidence interval [CI], 1.42-1.47) higher than the non-Appalachian rate. Although only 29% of fatalities occur in rural counties in non-Appalachia versus 48% in Appalachia, rates in rural counties were similar (RR, 0.97; 95% CI, 0.95-1.00). However, the rate for urban, Appalachian counties was 42% (95% CI, 1.38-1.45) higher than among urban, non-Appalachian counties. Appalachian rates were higher for passenger vehicle drivers, motorcyclists, and all terrain vehicle riders, regardless of rurality, as well as for passenger vehicle passengers overall and for urban counties. Conversely, Appalachia experienced lower rates among pedestrians and bicyclists, regardless of rurality. CONCLUSIONS Disparities in traffic fatality rates exist in Appalachia. Although elevated rates are partially explained by the proportion of residents living in rural settings, overall rates in urban Appalachia were consistently higher than in urban non-Appalachia.
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Affiliation(s)
- Motao Zhu
- Department of Epidemiology, West Virginia University, Morgantown; Injury Control Research Center, West Virginia University, Morgantown, WV, USA.
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Bell N, Simons R, Hameed SM, Schuurman N, Wheeler S. Does direct transport to provincial burn centres improve outcomes? A spatial epidemiology of severe burn injury in British Columbia, 2001-2006. Can J Surg 2012; 55:110-6. [PMID: 22564514 DOI: 10.1503/cjs.014708] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
BACKGROUND In Canada and the United States, research has shown that injured patients initially treated at smaller emergency departments before transfer to larger regional facilities are more likely to require longer stays in hospital or suffer greater mortality. It remains unknown whether transport status is an independent predictor of adverse health events among persons requiring care from provincial burn centres. METHODS We obtained case records from the British Columbia Trauma Registry for adult patients (age ≥ 18 yr) referred or transported directly to the Vancouver General Hospital and Royal Jubilee Hospital burn centres between Jan. 1, 2001, and Mar. 31, 2006. Prehospital and in-transit deaths and deaths in other facilities were identified using the provincial Coroner Service database. Place of injury was identified through data linkage with census records. We performed bivariate analysis for continuous and discrete variables. Relative risk (RR) of prehospital and in-hospital mortality and hospital stay by transport status were analyzed using a Poisson regression model. RESULTS After controlling for patient and injury characteristics, indirect referral did not influence RR of in-facility death (RR 1.32, 95% confidence interval [CI] 0.54- 3.22) or hospital stay (RR 0.96, 95% CI 0.65-1.42). Rural populations experienced an increased risk of total mortality (RR 1.22, 95% CI 1.00-1.48). CONCLUSION Transfer status is not a significant indicator of RR of death or hospital stay among patients who received care at primary care facilities before transport to regional burn centres. However, significant differences in prehospital mortality show that improvements in rural mortality can still be made.
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Affiliation(s)
- Nathaniel Bell
- Department of Surgery, University of British Columbia, Vancouver, BC.
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Muelleman RL, Wadman MC, Tran TP, Ullrich F, Anderson JR. Rural Motor Vehicle Crash Risk of Death is Higher After Controlling for Injury Severity. ACTA ACUST UNITED AC 2007; 62:221-5; discussion 225-6. [PMID: 17215759 DOI: 10.1097/01.ta.0000231696.65548.06] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Motor vehicle crash (MVC) mortality rates are inversely related to population density. The purpose of this study was to analyze if there is a regional variation in the risk of MVC death after controlling for injury severity. METHODS The study utilized the Crash Outcome Data Evaluation System (CODES) data set in Nebraska. All fatal or injury-related crashes during a 4-year period (1996 through 1999) were analyzed. Injury Severity Scores (ISSs) were calculated from the CODES listed International Classification of Diseases diagnoses. Logistic regression analysis was performed to analyze the odds ratio for death in three rural county groupings compared with urban locations. RESULTS During the 4-year period, 56,727 people were injured and 1,237 were killed in 38,493 MVCs. Of these, 45,222 (78%) records had complete information on variables of interest. In addition, 28,859 (50%) records had enough information to calculate an ISS. A total of 22,181 (39%) records had complete information on the variables of interest and ISSs. After adjusting for the effects of speed limit, age, and alcohol involvement (but not ISS), the odds of death were 1.24 (1.01-1.53) higher in the large, non-adjacent and 1.38 (1.14-1.66) small, non-adjacent rural counties. After adjusting for the effect of ISS, the odds of death were 1.98 (1.18-3.31) higher in the small, non-adjacent rural counties. CONCLUSION After controlling for ISS, the risk of MVC death is nearly twice as high in the most rural counties in Nebraska. This finding suggests that variation in medical care may contribute to this regional variation.
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Borgialli DA, Hill EM, Maio RF, Compton CP, Gregor MA. Effects of alcohol on the geographic variation of driver fatalities in motor vehicle crashes. Acad Emerg Med 2000; 7:7-13. [PMID: 10894236 DOI: 10.1111/j.1553-2712.2000.tb01882.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine whether the increased risk of dying in a rural vs nonrural motor vehicle crash (MVC) can be attributed to driver demographics, crash characteristics, or police-reported alcohol use. METHODS A retrospective cohort study was conducted, comparing all rural (116,242) and a 20% random sample of nonrural (104,197) Michigan drivers involved in an MVC during 1994-1996. Data consisted of all police-reported traffic crashes on public roadways. A logistic regression model was created, using survival as the dependent variable and gender, age, crash characteristics, and rural or nonrural county as independent variables. Driver alcohol use, as reported by the investigating officer, was introduced into the model, and the effect was analyzed. RESULTS Nonsurvivors represented 0.2% of the total; 99.8% were survivors. Police-reported alcohol use was reported for 3.9% of drivers. Drivers in rural MVCs were more likely to be male, to be more than 50 years of age, to have been drinking alcohol, and to have more severe vehicle deformation as a result of the MVC. The relative risk (RR) for MVC nonsurvivors was 1.69 [95% confidence interval (CI) = 1.3 to 2.1] times higher for drivers in rural than nonrural counties. After adjusting for demographic and crash characteristics, the RR was 1.56 (95% CI = 1.2 to 1.9). Controlling for alcohol and its interactions decreased the RR to 1.26 (95% CI = 0.6 to 2.4), a nonsignificant difference between rural and nonrural MVC mortalities. CONCLUSIONS Alcohol use by drivers in Michigan was a significant contributor for nonsurvivors of rural crashes. Efforts to decrease rural MVC mortality must address alcohol use.
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Affiliation(s)
- D A Borgialli
- Michigan State University, College of Osteopathic Medicine, East Lansing, USA
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Richardson JD, Cross T, Lee D, Shively E, Bentley E, Weiss D, Brock K, Petrocelli J, Miller FB, Polk HC. Impact of level III verification on trauma admissions and transfer: comparisons of two rural hospitals. THE JOURNAL OF TRAUMA 1997; 42:498-502; discussion 502-3. [PMID: 9095118 DOI: 10.1097/00005373-199703000-00018] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To study the impact of Level III verification and other changes in rural hospitals on trauma delivery and to examine factors affecting transfer to a Level I trauma center. SETTING Two rural Kentucky hospitals and a Level I trauma center. METHOD OF REVIEW Concurrent review of all trauma patients in 1988 and re-review of the same parameters in 1995. FINDINGS In 1988, both hospitals had similar management practices in trauma care. A significant number of patients were transferred for (a) patient choice, (b) serious and/or multiple trauma, (c) specialty care in non-life threatening situations, and (d) to exclude a potentially serious problem seen on radiologic evaluation (usually questionable cervical spine or widened mediastinum). Both hospitals had major changes in trauma delivery. One hospital received Level III verification, and the other had changes that lessened the general surgeon's involvement with initial evaluation and treatment. A re-review in 1995 disclosed major changes at both institutions. Transfers to exclude radiologic abnormalities had virtually disappeared. The Level III status had increased the surgical involvement in that hospital; there was actually an increase in patients transferred to the Level I hospital and an increase in patient acuity. More operations were performed locally, and the care was more efficiently delivered. The other hospital had a large increase in transfers and decreased admissions locally as general surgical involvement decreased. CONCLUSIONS The factors related to patient transfer for trauma care are complex and require careful elucidation to improve care. The development of a Level III trauma service appeared to increase the number of seriously injured patients treated in the rural hospital and the efficiency of the care delivered.
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Affiliation(s)
- J D Richardson
- Department of Surgery, University of Louisville School of Medicine, Kentucky 40292, USA
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Riley AW, Harris SK, Ensminger ME, Ryan S, Alexander C, Green B, Starfield B. Behavior and injury in urban and rural adolescents. Inj Prev 1996; 2:266-73. [PMID: 9346106 PMCID: PMC1067732 DOI: 10.1136/ip.2.4.266] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVES This study investigates the consistency of factors associated with adolescent injury in separate urban and rural samples. SAMPLES Adolescents, 11-17 years old, in public schools in urban and rural Maryland (n = 2,712). METHODS Separate bivariate and logistic regression analyses were conducted for each sample to determine individual and environmental factors associated with major and minor injuries experienced in the previous year. RESULTS Multivariate analyses revealed that, for both samples, the probability of a major injury was highest for boys and, among both boys and girls, for those who played several team sports. Among rural youth, other significant covariates of both major and minor injuries were a tendency to engage in risky behavior and to use alcohol. For urban youth, being white, carrying a weapon for protection, attending an unsafe school, and working for pay were also significant covariates. Interactions were important and complex. CONCLUSIONS The consistency of predictive factors, such as multiple sports team participation and risky and aggressive behaviors in completely different physical environments, underscores the need to address the contexts of heightened injury risk that some adolescents create wherever they live by playing sports and/or behaving in an antisocial, aggressive manner. Moreover, the perception of lack of safety in schools and neighborhoods is associated with increased injury rates, suggesting the need for policy interventions to target social environments as well as behavior.
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Affiliation(s)
- A W Riley
- School of Hygiene and Public Health, Johns Hopkins University, Baltimore, Maryland 21205, USA
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Maio RF, Burney RE, Gregor MA, Baranski MG. A study of preventable trauma mortality in rural Michigan. THE JOURNAL OF TRAUMA 1996; 41:83-90. [PMID: 8676428 DOI: 10.1097/00005373-199607000-00013] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To determine the preventable death rate (PDR) and the frequency and types of inappropriate medical care in a large, rural region of Michigan. DESIGN A prospective study of all deaths caused by injury during a 1-year period. METHODS Preventability of death and appropriateness of care were determined using a structured implicit review process and expert panel. A second panel was convened to confirm the reliability of the review process. MAIN RESULTS One hundred fifty-five injury-related deaths underwent panel review. Four deaths (2.6%) were found to be definitely preventable and 16 (10.3%) possibly preventable, for a combined preventable death rate of 12.9%. Sixty-five deaths (41.9%) occurred in the emergency department or hospital; 18 of these (27.7%) were judged to be definitely preventable or possibly preventable. Forty-three episodes of inappropriate care were identified in 27 (17.4%) of the 155 cases reviewed. These occurred primarily in the emergency department and hospital rather than during prehospital care or transfer. CONCLUSIONS A relatively small percentage of trauma fatalities in rural Michigan could have been prevented by more appropriate or timely medical care. Efforts to improve the care of injured persons in rural Michigan should be directed primarily at the emergency department and inpatient phases of trauma system care.
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Affiliation(s)
- R F Maio
- Section of Emergency Medicine, University of Michigan Medical Center, Ann Arbor 48109-0303, USA
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Chen B, Maio RF, Green PE, Burney RE. Geographic variation in preventable deaths from motor vehicle crashes. THE JOURNAL OF TRAUMA 1995; 38:228-32. [PMID: 7869441 DOI: 10.1097/00005373-199502000-00014] [Citation(s) in RCA: 36] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE In Michigan, drivers in rural motor vehicle crashes (MVCs) are twice as likely to die as nonrural drivers: this could be due to variation in the quality of acute trauma care. This study tests the hypothesis that the preventable death rate (PDR) is higher and that anatomic injury severity is lower for rural compared to nonrural MVC fatalities. DESIGN Retrospective cohort study. METHODS Autopsy results from MVC victims of three rural counties and one nonrural county were reviewed. The time period was 1986-1991. Using the Abbreviated Injury Scale, 1985 version (AIS-85), Injury Severity Scores (ISSs) and Anatomical Profile G scores were calculated. Preventability was determined based on ISSs (< 59) and AIS scores in the head region (< 5). Student's t test and the chi-squared test were used for analysis; a p value of < 0.05 was considered statistically significant. RESULTS 143 rural and 306 nonrural fatalities were analyzed. The rural PDR was 37.1% and nonrural 48.0% (p < 0.05). ISSs and also G scores were significantly different between rural (54.8; -2.1) and nonrural (50.2; -1.2) areas. CONCLUSION This study suggests that regional variation in the quality of acute trauma care is not a significant factor in regional variation in MVC mortality.
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Affiliation(s)
- B Chen
- Department of Surgery, University of Michigan, Ann Arbor
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