The findings showed that black-majority neighborhoods were eight times more likely to be located in a trauma care desert in Chicago and five times more likely in Los Angeles. They also were nearly twice as likely in New York City to be in a trauma care desert, in models adjusting for poverty and race.
Interestingly, Hispanic-majority neighborhoods did not consistently have the same problem. They were actually less likely to be located in a trauma care desert in New York City and Los Angeles, and slightly more likely in Chicago, according to the report.
Many “safety net” trauma hospitals in poorer urban areas have shut down or scaled back operations over the years, as welfare and Medicaid funding have tightened, Tung said. This makes emergency care less available to people in those neighborhoods.
Examples include Michael Reese Hospital on the south side of Chicago, which closed in 1991 due to economic hardship, and Martin Luther King Jr. Hospital in Los Angeles, which lost its trauma center designation in 2004, the researchers noted.
On the other hand, activists in New York City rallied around Harlem Hospital and headed off its closure twice, which could explain why the Big Apple’s black communities are not as likely to be in a trauma care desert, Tung said.
It’s not cheap to operate a trauma center, said Dr. Lisa Marie Knowlton, an assistant professor of surgery at Stanford University Medical Center.
“The process of accreditation and maintenance of certification for level I trauma hospitals is a rigorous and costly process, and although many safety-net hospitals in urban settings provide level I care, they are already at financial risk,” said Knowlton, who wrote an editorial accompanying the new study.
“The tremendous cost to the hospital and system for providing care to vulnerable uninsured patients who lack adequate post-discharge resources places any hospital in these urban environments at risk,” Knowlton explained.
Physical proximity isn’t the only measure used to assess an area’s access to emergency care, said Dr. Rade Vukmir, a critical care specialist in Traverse City, Mich., who is also a fellow of the American College of Emergency Physicians.