Equity of Access to Care in an Urban Trauma System

Introduction: Every minute of prehospital transport-time (TT) is critical to survival. Our objective was to assess granular urban community-level access to trauma centers. Methods: We utilized 2020 Decennial Census data at the block group (BG) level. BG centroids were calculated and a network analysis of historic traffic data was used to determine the predicted TT to the nearest trauma center. Results: A total of 581 Boston BGs with 273,188 households and 675,647 individuals were identified. Five hundred sixty-six (97%) met inclusion criteria. Of households, 48,711 (17.8%) received cash/food assistance. Furthermore, 278 (49%) of BGs had a White non-Hispanic majority, 80 (14%) had a Black non-Hispanic majority and 27 (5%) had a Hispanic majority population. Household income quartiles ranged from $32,394 to $157,283 and White non-Hispanic majority BGs had more than double the median income of other BGs. Relative to the highest income BGs, TT increased as income decreased for the middle quartiles (β 1.7, 95% confidence interval [CI] 0.48 to 2.90, P < 0.01) and (β 2.6 95% CI 1.4 to 3.8, P < 0.01 respectively) but not in the lowest income quartile BGs. Public assistance was not associated with TT. An increased proportion of the population that was Black (β 0.10, 95% CI 0.07 to 0.11, P < 0.01) or Hispanic (β 0.04, 95% CI 0.01 to 0.07, P < 0.01) related to increased TT. Majority White communities had TTs nearly half that of majority Black communities (8.8 min vs. 15.6 min; P < 0.01). Conclusions: Communities with higher non-White populations have reduced access to trauma care while some available poverty metrics relate to TT (household income) and others do not.