An evaluation of the variability in the number of high-level trauma centers per million people across the United States.

INTRODUCTION: The number of High-Level Trauma Centers (HLTCs) (Level I or II) per million people across the United States (US) is variable. The purpose of this study was to describe that variability and to determine if it was correlated with state characteristics. METHODS: A cross-sectional study of the US was performed utilizing census data. The number of HLTCs per million people in each state was calculated. The correlation between the number of HLTCs per million and the following variables was evaluated for: population density, black and white race, land area, median household income, employment rate, uninsured rate, poverty rate, and public health insurance coverage rate. RESULTS: All fifty states were included. The median number of HLTCs per million was 1.58 (IQR 1.14-2.45) and ranged from 0.47 in New Mexico to 6.28 in North Dakota. The median ratio of level 1 to level 2 trauma centers located in each area was 0.51 (IQR 0.25-1.0) and ranged from 0.0 to 4.0. HLTCs per million was positively correlated with white race (R=0.41, p = 0.002) and employment rate (R=0.32, p = 0.02) and negatively correlated with population density (R=-0.31, p = 0.02) and black race (R=-0.37, p = 0.008). No statistically significant correlations were observed between HLTCs per million and land area, median household income, uninsured rate, poverty rate, disability rate, or public health insurance coverage rate (p > 0.05). CONCLUSIONS: The number of HLTCs per million across the United States varied widely and was positively correlated with white race and employment rate and negatively correlated with black race and population density.