Do new trauma centers provide needed or redundant access? A nationwide analysis

Area of Science:

• Public Health
• Health Services Research
• Trauma Surgery

Background:

• Previous research indicates that increasing the number of trauma centers (TCs) does not consistently reduce state-level injury mortality.
• A hypothesis suggests new TCs often overlap with existing services rather than reaching unserved areas.
• An additional hypothesis posits that new TCs may be less accessible to economically disadvantaged populations.

Purpose of the Study:

• To evaluate the geographic distribution and patient population served by new trauma centers (TCs) in the United States.
• To determine if new TCs increase access to care in previously unserved or underserved areas.
• To assess the socioeconomic characteristics of populations served by new TCs.

Main Methods:

• State-designated adult TCs from 2014 and 2019 were mapped using ArcGIS Pro.
• Trauma centers were categorized as Level 1 or 2 (Lev12) or Level 3, 4, or 5 (Lev345).
• Census tract data, including poverty levels, were analyzed alongside 30-minute drive-time areas around each TC to determine service coverage.

Main Results:

• Between 2014 and 2019, 256 new TCs opened, increasing national coverage to 78.1% of tracts and 79.4% of the population.
• The majority of new TCs (87.3%) were located in areas already served by existing trauma care.
• Newly served tracts by Level 3, 4, or 5 TCs had a higher mean poverty percentage (15.7%) compared to those served by Level 1 or 2 TCs (13.2%).

Conclusions:

• While overall trauma care access improved, most new TCs were established in areas with existing access.
• The expansion of Level 3, 4, and 5 TCs played a significant role in reaching underserved populations.
• Future trauma center development should consider strategic placement to maximize access for unserved and disadvantaged communities.