Lower death rate from car crashes in areas where more neurosurgeons practice
Researchers at Dartmouth-Hitchcock Medical Center (DHMC) have identified an association between increasing the distribution of neurosurgeons throughout the United States and decreasing the risk of death from motor-vehicle accidents (MVAs).
Neurosurgery resident Atman Desai, MB, BChir, led the study, which the Journal of Neurosurgery published online this week. In reviewing case studies of MVAs – the leading cause of death in the United States among people ages one to 34 – the DHMC team found that the primary cause of death arising from MVAs is traumatic brain injury, whose treatment is generally handled by neurosurgeons. Residents of rural areas are more likely to die of injuries from motor vehicle accidents, which some attribute to a slow medical response time and reduced access to trauma resources.
For the most part, neurosurgeons cluster in and around cities that house tertiary care hospitals, leading to an uneven distribution of this specialty throughout the United States. Bearing these facts in mind, the authors hypothesize that increasing the density of the neurosurgeon population would decrease the risk of death from an MVA.
“The results from this study suggest a certain effectiveness of neurosurgeons in reducing mortality from MVAs across the country,” Desai says. “More broadly, these findings demonstrate that specialist providers can contribute significantly to improving public health outcomes, and therefore add to the continued discussion of optimal resource allocation within healthcare.”
Desai and colleagues – including D-H neurosurgeon Perry A. Ball, MD, as principal investigator and Desai’s fellow neurosurgery resident Kimon Bekelis, MD as a co-author – analyzed data from the Area Resource File (2009–2010), which contains county-level information on health care facilities and their use and expenditures; health care professionals and their training; and socioeconomic and environmental characteristics. Of the 3,141 US counties they analyzed, 2,051 of these counties qualified as rural. The primary outcome variable was the average number of deaths due to MVAs per million population for each county during the period of 2004 through 2006.The primary independent variable was the number of neurosurgeons per million population in 2006.
In the 3,141 US counties the researchers examined, the mean number of MVA-related deaths per million persons was 226. The average number of neurosurgeons per county was six. The greatest number of neurosurgeons in a county was 372; most counties had none. In an unadjusted analysis, the authors found that adding one neurosurgeon per million residents led to 1.9 fewer deaths from MVAs per million population.
In a multivariate analysis, making adjustments for how urban a county is, socioeconomic conditions, and density of primary care providers, an increase of one neurosurgeon was associated with 1.01 fewer deaths from MVAs per million residents. This association stayed true regardless of whether the county was rural or urban.
In comparing the association between deaths from MVAs and the distribution of other medical specialties, Desai and colleagues found that an equivalent reduction in MVA-related deaths (one less death) would require an addition of 33 primary care providers; according to another study, a county would need to add six general surgeons per million population to achieve the same impact. Rural setting, persistent poverty, and low level of education were all associated with significant increases in MVA-related deaths.
Given the association found between the distribution of neurosurgeons and MVA-related deaths, Desai and colleagues conclude that the availability of local neurosurgeons may be important for the overall likelihood of surviving an MVA, and thus neurosurgical education and practice throughout the US should be promoted.
ABOUT DARTMOUTH-HITCHCOCK: Dartmouth-Hitchcock is a national leader in evidence-based and patient-centered health care. The system includes hundreds of physicians, specialists, and other providers who work together at different locations to meet the health care needs of patients in northern New England. In addition to primary care services at local community practices, Dartmouth-Hitchcock patients have access to specialists in almost every area of medicine, as well as world-class research at the Audrey and Theodor Geisel School of Medicine at Dartmouth and centers of excellence including The Dartmouth Institute for Health Policy & Clinical Practice (TDI).
Source: D-H 7.25.2012