Increased population density of neurosurgeons associated with decreased risk of death from motor vehicle accidents in the United States

Clinical article

Atman Desai M.D.1, Kimon Bekelis M.D.1, Wenyan Zhao Ph.D.2, and Perry A. Ball M.D.1
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  • 1 Section of Neurosurgery, and
  • | 2 Department of Orthopaedics, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire
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Object

Motor vehicle accidents (MVAs) are a leading cause of death and disability in young people. Given that a major cause of death from MVAs is traumatic brain injury, and neurosurgeons hold special expertise in this area relative to other members of a trauma team, the authors hypothesized that neurosurgeon population density would be related to reduced mortality from MVAs across US counties.

Methods

The Area Resource File (2009–2010), a national health resource information database, was retrospectively analyzed. The primary outcome variable was the 3-year (2004–2006) average in MVA deaths per million population for each county. The primary independent variable was the density of neurosurgeons per million population in the year 2006. Multiple regression analysis was performed, adjusting for population density of general practitioners, urbanicity of the county, and socioeconomic status of the county.

Results

The median number of annual MVA deaths per million population, in the 3141 counties analyzed, was 226 (interquartile range [IQR] 151–323). The median number of neurosurgeons per million population was 0 (IQR 0–0), while the median number of general practitioners per million population was 274 (IQR 175–410). Using an unadjusted analysis, each increase of 1 neurosurgeon per million population was associated with 1.90 fewer MVA deaths per million population (p < 0.001). On multivariate adjusted analysis, each increase of 1 neurosurgeon per million population was associated with 1.01 fewer MVA deaths per million population (p < 0.001), with a respective decrease in MVA deaths of 0.03 per million population for an increase in 1 general practitioner (p = 0.007). Rural location, persistent poverty, and low educational level were all associated with significant increases in the rate of MVA deaths.

Conclusions

A higher population density of neurosurgeons is associated with a significant reduction in deaths from MVAs, a major cause of death nationally. This suggests that the availability of local neurosurgeons is an important factor in the overall likelihood of survival from an MVA, and therefore indicates the importance of promoting neurosurgical education and practice throughout the country.

Abbreviations used in this paper:

IQR = interquartile range; MVA = motor vehicle accident; TBI = traumatic brain injury.

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  • 1

    Baker SP, , Whitfield RA, & O'Neill B: County mapping of injury mortality. J Trauma 28:741745, 1988

  • 2

    Baker SP, , Whitfield RA, & O'Neill B: Geographic variations in mortality from motor vehicle crashes. N Engl J Med 316:13841387, 1987

  • 3

    Center for the Evaluative Clinical Sciences: Spine Surgery. A Report by the Dartmouth Atlas of Health Care CMSFDA Collaborative Chicago, American Hospital Association Press, 2006. (http://www.dartmouthatlas.org/downloads/reports/Spine_Surgery_2006.pdf) [Accessed June 7, 2012]

    • Search Google Scholar
    • Export Citation
  • 4

    Centers for Disease Control and Prevention: Motor vehicle-related death rates—United States, 1999–2005. MMWR Morb Mortal Wkly Rep 58:161165, 2009

    • Search Google Scholar
    • Export Citation
  • 5

    Chang DC, , Eastman B, , Talamini MA, , Osen HB, , Tran Cao HS, & Coimbra R: Density of surgeons is significantly associated with reduced risk of deaths from motor vehicle crashes in US counties. J Am Coll Surg 212:862866, 2011

    • Search Google Scholar
    • Export Citation
  • 6

    Clark DE, & Cushing BM: Predicting regional variations in mortality from motor vehicle crashes. Acad Emerg Med 6:125130, 1999

  • 7

    Committee on Trauma Research: Injury in America: A Continuing Public Health Problem Washington, DC, National Academy Press, 1985

  • 8

    Crompton JG, , Pollack KM, , Oyetunji T, , Chang DC, , Efron DT, & Haut ER, et al.: Racial disparities in motorcycle-related mortality: an analysis of the National Trauma Data Bank. Am J Surg 200:191196, 2010

    • Search Google Scholar
    • Export Citation
  • 9

    Dartmouth Atlas Working Group: Dartmouth Atlas of Musculoskeletal Health Care Chicago, American Hospital Association Press, 2000

  • 10

    Donaldson AE, , Cook LJ, , Hutchings CB, & Dean JM: Crossing county lines: the impact of crash location and driver's residence on motor vehicle crash fatality. Accid Anal Prev 38:723727, 2006

    • Search Google Scholar
    • Export Citation
  • 11

    Fingerhut LA, & Warner M: Injury Chartbook: Health, United States, 1996–1997 Hyattsville, MD, National Center for Health Statistics, 1997. (http://www.cdc.gov/nchs/data/hus/hus96_97.pdf) [Accessed June 7, 2012]

    • Search Google Scholar
    • Export Citation
  • 12

    Gardner R, , Smith GA, , Chany AM, , Fernandez SA, & McKenzie LB: Factors associated with hospital length of stay and hospital charges of motor vehicle crash related hospitalizations among children in the United States. Arch Pediatr Adolesc Med 161:889895, 2007

    • Search Google Scholar
    • Export Citation
  • 13

    Gonzalez RP, , Cummings G, , Mulekar M, & Rodning CB: Increased mortality in rural vehicular trauma: identifying contributing factors through data linkage. J Trauma 61:404409, 2006

    • Search Google Scholar
    • Export Citation
  • 14

    Gonzalez RP, , Cummings GR, , Phelan HA, , Mulekar MS, & Rodning CB: Does increased emergency medical services prehospital time affect patient mortality in rural motor vehicle crashes? A statewide analysis. Am J Surg 197:3034, 2009

    • Search Google Scholar
    • Export Citation
  • 15

    Li MD, , Doong JL, , Chang KK, , Lu TH, & Jeng MC: Differences in urban and rural accident characteristics and medical service utilization for traffic fatalities in less-motorized societies. J Safety Res 39:623630, 2008

    • Search Google Scholar
    • Export Citation
  • 16

    Maio RF, , Burney RE, , Gregor MA, & Baranski MG: A study of preventable trauma mortality in rural Michigan. J Trauma 41:8390, 1996

  • 17

    Mann NC, , Mullins RJ, , MacKenzie EJ, , Jurkovich GJ, & Mock CN: Systematic review of published evidence regarding trauma system effectiveness. J Trauma 47:3 Suppl S25S33, 1999

    • Search Google Scholar
    • Export Citation
  • 18

    Marson AC, & Thomson JC: The influence of prehospital trauma care on motor vehicle crash mortality. J Trauma 50:917921, 2001

  • 19

    Melton SM, , McGwin GJ Jr, , Abernathy JH III, , MacLennan P, , Cross JM, & Rue LW III: Motor vehicle crash-related mortality is associated with prehospital and hospital-based resource availability. J Trauma 54:273279, 2003

    • Search Google Scholar
    • Export Citation
  • 20

    Mokdad AH, , Marks JS, , Stroup DF, & Gerberding JL: Actual causes of death in the United States, 2000. JAMA 291:12381245, 2004

  • 21

    Nathens AB, , Brunet FP, & Maier RV: Development of trauma systems and effect on outcomes after injury. Lancet 363:17941801, 2004

  • 22

    Nathens AB, , Jurkovich GJ, , Rivara FP, & Maier RV: Effectiveness of state trauma systems in reducing injury-related mortality: a national evaluation. J Trauma 48:2531, 2000

    • Search Google Scholar
    • Export Citation
  • 23

    Rice DP, , MacKenzie EJ, , Jones AS, , Kaufman SR, , deLissovoy GV, & Max W, et al.: Cost of Injury in the United States: A Report to Congress San Francisco, Institute for Health and Aging, University of California and Injury Prevention Center, The Johns Hopkins University, 1989

    • Search Google Scholar
    • Export Citation
  • 24

    Shafi S, , Nathens AB, , Elliott AC, & Gentilello L: Effect of trauma systems on motor vehicle occupant mortality: a comparison between states with and without a formal system. J Trauma 61:13741379, 2006

    • Search Google Scholar
    • Export Citation
  • 25

    Yoganandan N, , Baisden JL, , Maiman DJ, , Gennarelli TA, , Guan Y, & Pintar FA, et al.: Severe-to-fatal head injuries in motor vehicle impacts. Accid Anal Prev 42:13701378, 2010

    • Search Google Scholar
    • Export Citation

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