Geographical disparity and traumatic brain injury in America: Rural areas suffer poorer outcomes

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dc.contributor.authorBrown, Joshua B
dc.contributor.authorKheng, Marin
dc.contributor.authorCarney, Nancy A
dc.contributor.authorPuyana, Juan Carlos
dc.contributor.authorRubiano, Andrés M.
dc.contributor.orcidRubiano, Andrés M. [0000-0001-8931-3254]
dc.date.accessioned2019-09-13T14:48:26Z
dc.date.available2019-09-13T14:48:26Z
dc.date.issued2019
dc.description.abstractenglishSignificant heterogeneity exists in traumatic brain injury (TBI) outcomes. In the United States, TBI remains a primary driver of injury‐related mortality and morbidity. Prior work has suggested that disparity exists in rural areas; our objective was to evaluate potential differences in TBI mortality across urban and rural areas on a national scale. Methods: Age‐adjusted TBI fatality rates were obtained at the county level across the U.S. from 2008 to 2014. To evaluate geography, urban influence codes (UIC) were also obtained at the county level. UIC codes range from 1 (most urban) to 12 (most rural). Metropolitan counties are defined as those with an UIC ≤2, while nonmetropolitan counties are defined as an UIC ≥3. County‐level fatality rates and UIC classification were geospatially mapped. Linear regression was used to evaluate the change in TBI fatality rate at each category of UIC. The median TBI fatality rate was also compared between metropolitan and nonmetropolitan counties. Results: Geospatial analysis demonstrated higher fatality rates distributed among nonmetropolitan counties across the United States. The TBI fatality rate was 13.00 deaths per 100,000 persons higher in the most rural UIC category compared to the most urban UIC category (95% confidence interval 12.15, 13.86; P < 0.001). The median TBI rate for nonmetropolitan counties was significantly higher than metropolitan counties (22.32 vs. 18.22 deaths per 100,000 persons, P < 0.001). Conclusions: TBI fatality rates are higher in rural areas of the United States. Additional studies to evaluate the mechanisms and solutions to this disparity are warranted and may have implications for lower‐and middle‐income countries.eng
dc.format.mimetypeapplication/pdf
dc.identifier.doihttps://doi.org/10.4103/jnrp.jnrp_310_18
dc.identifier.instnameinstname:Universidad El Bosquespa
dc.identifier.issn0976-3147
dc.identifier.reponamereponame:Repositorio Institucional Universidad El Bosquespa
dc.identifier.repourlrepourl:https://repositorio.unbosque.edu.co
dc.identifier.urihttps://hdl.handle.net/20.500.12495/1682
dc.language.isoeng
dc.publisherThiemespa
dc.publisher.journalJournal of Neurosciences in Rural Practicespa
dc.relation.ispartofseriesJournal of Neurosciences in Rural Practice, 0976-3147, Vol. 10, Nro. 1, 2019, p. 10-15spa
dc.relation.urihttps://www.thieme-connect.de/products/ejournals/abstract/10.4103/jnrp.jnrp_310_18
dc.rightsAttribution-NonCommercial-ShareAlike 4.0 International*
dc.rights.accessrightsinfo:eu-repo/semantics/openAccess
dc.rights.accessrightshttps://purl.org/coar/access_right/c_abf41
dc.rights.creativecommons2019
dc.rights.localAcceso abiertospa
dc.rights.urihttps://creativecommons.org/licenses/by-nc-sa/4.0/*
dc.subject.decsLesiones traumáticas del encéfalospa
dc.subject.decsRegistros de mortalidadspa
dc.subject.decsPoblación ruralspa
dc.subject.decsTraumatismos craneocerebralesspa
dc.subject.keywordsDisparityspa
dc.subject.keywordsGeographicspa
dc.subject.keywordsLower-middle-income countriesspa
dc.subject.keywordsTraumatic brain injuryspa
dc.titleGeographical disparity and traumatic brain injury in America: Rural areas suffer poorer outcomesspa
dc.typearticlespa
dc.type.hasversioninfo:eu-repo/semantics/publishedVersion
dc.type.localartículospa

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