By AARON GETTINGER
Before the University of Chicago Level 1 Trauma Center opened last year, Chicagoans living in predominantly Black census tracks were 8.5 times more likely to live in “trauma deserts,” far from advanced medical care for serious injuries, than those in majority-White neighborhoods.
That disparity still exists, but it has decreased to just 1.6 times as likely, according to research published Friday in the American Medical Association’s JAMA Network Open journal.
“Even though we had a sense that this was a racially divided issue, the data confirmed that this was the case in a significant way,” said Monica Peak, a U. of C. professor of medicine and one of the co-authors in a statement. “It was pretty startling.”
The research considers the intersection of race and ethnicity, location and trauma care in New York City, Los Angeles and Chicago and defines trauma deserts to be urban areas five miles from advanced trauma care. Only 14 percent of Black neighborhoods in New York City were located in trauma deserts; the researchers also found that majority Hispanic and Latino communities in Chicago are likely to be far from trauma centers as well.
One-quarter of U.S. trauma centers closed between 1990 and 2005. When Martin Luther King Jr. Hospital in South LA closed its trauma center in 2004, mortality from gunshot wounds increased, even though the city’s violent crime rate declined. The researchers suggest that low-access Black neighborhoods in New York City are more affluent than in LA or Chicago.
“The survivor of Harlem Hospital, a longstanding public trauma center serving Black neighborhoods in northern Manhattan, may be the counterfactual to trauma centers in Chicago and LA,” the researchers wrote, adding that local activism saved the Harlem unit from threatened closure in the 1990s.
The researchers said that New York City’s decentralized public health care system may also explain that city’s success, noting that public Cook County Hospital in the Illinois Medical District “provides the bulk of its services at a consolidated location.”
Activists had lobbied the U. of C., whose “single, private academic hospital” is “the primary existing infrastructure” on the South Side, to resume trauma care since its previous program closed in 1988. In 2015, the U. of C. announced that the $270 million Trauma Center would reopen to serve patients suffering from injuries from vehicle accidents, falls, shootings, stabbings and other traumatic incidents. It has treated over 2,000 patients since last May.
“Despite this positive outcome, the economic challenges remain evident and illustrate an unfortunate narrative about health care financing in the United States: need and economic incentive are often fundamentally misaligned,” the researchers wrote.
“Black-majority neighborhoods appear to be associated with consistent disparities in geographic access to trauma centers. The distribution of trauma centers along racially disparate lines may raise concerns about the legacy of structural inequality that places Black lives at higher risk in U.S. cities,” they concluded. “Trauma care planning should explicitly address racial equity in the financing of life-saving resources.”