重症外傷患者における一次医療へのアクセスと長期生存率の関連性

Survivors of severe traumatic injury remain at elevated risk of death in the years after injury. Little is known about how long-term mortality among injury survivors can be reduced. Given the importance of primary care to overall health, we hypothesized that access to primary care would be associated with improved long-term survival among injury survivors.

This population-based, retrospective cohort study (2010-2022) included community-dwelling adults (18 years or older) discharged alive after a severe traumatic injury (Injury Severity Score, >15). The exposure of interest was access to primary care, defined as either visiting or being enrolled with a primary care physician in the 2 years prior to injury. The primary outcome was 5-year all-cause mortality. Cox proportional hazards models were used to evaluate the relationship between access to primary care and mortality, adjusting for sociodemographic characteristics, comorbidity, and injury severity.

We identified 25,713 survivors of severe injury (mean age, 54 years; 32% female), of whom 92% (n = 23,720) had access to primary care. Five-year mortality was 13% (n = 3,265). Adjusting for patient characteristics, access to primary care was associated with a 20% lower hazard of death (hazard ratio, 0.80; 95% confidence interval, 0.68-0.93) at 5 years. The relationship between access to primary care and mortality was preserved across subgroups of age, sex, and comorbidity.

Survivors of severe traumatic injury without access to primary care were more likely to die in the 5 years after discharge, identifying a vulnerable subset of the survivor population. Primary care physicians may represent key partners to trauma care providers in developing strategies that improve long-term outcomes in the years after injury.

Therapeutic/Care Management; Level IV.