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Beiriger J, Silver D, Lu L, Guyette FX, Wisniewski S, Moore EE, Schreiber M, Joseph B, Wilson CT, Cotton B, Ostermayer D, Harbrecht BG, Patel M, Sperry JL, Brown JB. The Geography of Injuries in Trauma Systems: Using Home as a Proxy for Incident Location. J Surg Res 2023; 290:36-44. [PMID: 37178558 DOI: 10.1016/j.jss.2023.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 03/29/2023] [Accepted: 04/11/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Effective trauma system organization is crucial to timely access to care and requires accurate understanding of injury and resource locations. Many systems rely on home zip codes to evaluate geographic distribution of injury; however, few studies have evaluated the reliability of home as a proxy for incident location after injury. METHODS We analyzed data from a multicenter prospective cohort collected from 2017 to 2021. Injured patients with both home and incident zip codes were included. Outcomes included discordance and differential distance between home and incident zip code. Associations of discordance with patient characteristics were determined by logistic regression. We also assessed trauma center catchment areas based on home versus incident zip codes and variation regionally at each center. RESULTS Fifty thousand one hundred seventy-five patients were included in the analysis. Home and incident zip codes were discordant in 21,635 patients (43.1%). Injuries related to motor vehicles (aOR: 4.76 [95% CI 4.50-5.04]) and younger adults 16-64 (aOR: 2.46 [95% CI 2.28-2.65]) were most likely to be discordant. Additionally, as injury severity score increased, discordance increased. Trauma center catchment area differed up to two-thirds of zip codes when using home versus incident location. Discordance rate, discordant distance, and catchment area overlap between home and incident zip codes all varied significantly by geographic region. CONCLUSIONS Home location as proxy for injury location should be used with caution and may impact trauma system planning and policy, especially in certain populations. More accurate geolocation data are warranted to further optimize trauma system design.
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Affiliation(s)
- Jamison Beiriger
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - David Silver
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Liling Lu
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Francis X Guyette
- Department of Emergency Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Stephen Wisniewski
- Graduate School of Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Ernest E Moore
- Department of Surgery, Ernest E Moore Shock Trauma Center at Denver Health, University of Colorado Denver, Denver, Colorado
| | - Martin Schreiber
- Division of Trauma, Critical Care, & Acute Care Surgery, Oregon Health & Science University, Portland, Oregon
| | - Bellal Joseph
- Division of Trauma, Surgical Critical Care, Burns, and Acute Care Surgery, Department of Surgery, University of Arizona, Tucson, Arizona
| | - Chad T Wilson
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Bryan Cotton
- Division of Acute Care Surgery and Center for Translational Injury Research, Department of Surgery, McGovern Medical School at the University of Texas Health Science Center, Houston, Texas
| | - Daniel Ostermayer
- Department of Emergency Medicine, University of Texas Health Science Center, McGovern Medical School, Houston, Texas
| | - Brian G Harbrecht
- Department of Surgery, University of Louisville, Louisville, Kentucky
| | - Mayur Patel
- Department of Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jason L Sperry
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Joshua B Brown
- Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.
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Barrios RE, Lim C, Kelley MS, Li X. SARS-CoV-2 concentrations in a wastewater collection system indicated potential COVID-19 hotspots at the zip code level. Sci Total Environ 2021; 800:149480. [PMID: 34392211 PMCID: PMC8330136 DOI: 10.1016/j.scitotenv.2021.149480] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/31/2021] [Accepted: 08/01/2021] [Indexed: 05/03/2023]
Abstract
Wastewater based epidemiology (WBE) has been successfully applied for SARS-CoV-2 surveillance at the city and building levels. However, sampling at the city level does not provide sufficient spatial granularity to identify COVID-19 hotspots, while data from building-level sampling are too narrow in scope for broader public health application. The objective of this study was to examine the feasibility of using wastewater from wastewater collection systems (WCSs) to monitor COVID-19 hotspots at the zip code level. In this study, 24-h composite wastewater samples were collected from five manholes and two wastewater treatment plants (WWTPs) in the City of Lincoln, Nebraska. By comparing to the reported weekly COVID-19 case numbers, we identified different hotspots responsible for two COVID-19 surges during the study period. One zip code was the only sampling locations that was consistently tested positive during the first COVID-19 surge. In comparison, nearly all the zip codes tested exhibited virus concentration increases that overlapped with the second COVID-19 surge, suggesting broader spread of the virus at that time. These findings demonstrate the feasibility of using WBE to monitor COVID-19 at the zip code level. Highly localized disease surveillance methods can improve public health prevention and mitigation measures at the community level.
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Affiliation(s)
- Renys E Barrios
- Department of Civil and Environmental Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, United States
| | - Chin Lim
- City of Lincoln Transportation and Utilities, Lincoln, NE 68521, United States
| | - Megan S Kelley
- Department of Nutrition and Health Sciences, University of Nebraska-Lincoln, 68583, United States.
| | - Xu Li
- Department of Civil and Environmental Engineering, University of Nebraska-Lincoln, Lincoln, NE 68588, United States.
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Abstract
Based on the data from the Behavioral Risk Factor Surveillance System (BRFSS) in 2007, 2009 and 2011 in Utah, this research uses multilevel modeling (MLM) to examine the associations between neighborhood built environments and individual odds of overweight and obesity after controlling for individual risk factors. The BRFSS data include information on 21,961 individuals geocoded to zip code areas. Individual variables include BMI (body mass index) and socio-demographic attributes such as age, gender, race, marital status, education attainment, employment status, and whether an individual smokes. Neighborhood built environment factors measured at both zip code and county levels include street connectivity, walk score, distance to parks, and food environment. Two additional neighborhood variables, namely the poverty rate and urbanicity, are also included as control variables. MLM results show that at the zip code level, poverty rate and distance to parks are significant and negative covariates of the odds of overweight and obesity; and at the county level, food environment is the sole significant factor with stronger fast food presence linked to higher odds of overweight and obesity. These findings suggest that obesity risk factors lie in multiple neighborhood levels and built environment features need to be defined at a neighborhood size relevant to residents' activity space.
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Affiliation(s)
- Yanqing Xu
- Department of Geography & Anthropology, Louisiana State University, USA
| | - Ming Wen
- Department of Sociology, University of Utah, USA
| | - Fahui Wang
- Department of Geography & Anthropology, Louisiana State University, USA ; School of Urban and Environmental Studies, Yunnan University of Finance and Economics, Kunming, Yunnan 650221, China
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Otaluka ON, Corrado R, Brooks DE, Nelson DB. A survey of poison center knowledge and utilization among urban and rural residents of Arizona. Toxicol Rep 2014; 2:203-204. [PMID: 28962352 PMCID: PMC5598223 DOI: 10.1016/j.toxrep.2014.12.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 12/01/2014] [Accepted: 12/01/2014] [Indexed: 11/28/2022] Open
Abstract
Background Poison control centers (PCCs) hold great potential for saving health care resources particularly by preventing unnecessary medical evaluations. We developed a survey to better identify the needs and experiences of our service community. We hope to use these data to improve PCC outreach education and overall use of our services. Method A written questionnaire was developed in English and then translated into Spanish. Subjects agreeing to participate were then asked two verbal questions in English: are you at least 18 years of age? And; in what language would you like to complete the questionnaire; English or Spanish? All questionnaires completed by subjects ≥18 years of age were included. Questionnaires with missing responses, other than zip code, were included. Data collected include gender, age, zip code, primary language, ethnicity, education, health insurance status and experiences with the PCC. Subjects were not compensated for participation. Arizona zip codes were divided into “rural” or “urban” based on a census data website. Percentages and odds ratios were determined based on completed responses. Smaller subgroups, for some variables, were combined to increase sample sizes and improve statistical relevance. Results Overall, women and subjects with children at home (regardless of ethnicity) were significantly more likely to have heard of the PCC although Blacks and Spanish-speakers were significantly less likely to have heard of the PCC. Similarly, respondents with children at home and those reporting a prior home poisoning (regardless of ethnicity) were significantly more likely to have called the PCC. Blacks were significantly less likely to have called the PCC. These findings were similar among people living in urban zip codes but not statistically significant among rural responders. Conclusions Based on a small survey, race and language spoken at home were variables identified as being associated with decreased awareness of poison centers. Focusing on these specific groups may assist in efforts to increase PCC penetrance, particularly among urban communities.
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Affiliation(s)
- Onyinye N Otaluka
- University of Arizona College of Public Health, Phoenix, AZ, United States
| | - Rachel Corrado
- Department of Public Health, Temple University, Philadelphia, PA, United States
| | - Daniel E Brooks
- Banner Good Samaritan Poison and Drug Information Center, Phoenix, AZ, United States
| | - Deborah B Nelson
- Department of Public Health, Temple University, Philadelphia, PA, United States
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