International Journal of Public Health

, Volume 63, Issue 7, pp 847–854 | Cite as

Changes in trauma admission rates and mechanisms during recession and recovery: evidence from the Detroit metropolitan area

  • Kimberly CoughlinEmail author
  • R. David Hayward
  • Mary Fessler
  • Elango Edhayan
Original Article



Although individual socioeconomic status has been linked with risk of traumatic injury, there has been relatively little research into the question of how economic changes may impact trauma admission rates in neighborhoods with different socioeconomic backgrounds.


This study pairs ZIP code-level data on trauma admissions with county-level data on unemployment to assess differences in the type of changes experienced in more and less affluent neighborhoods of the Detroit metropolitan area between 2006 and 2014.


Conditional linear growth curve modeling results indicate that trauma admission rates decreased during the “great recession” of 2008–2010 in neighborhoods with the highest unemployment levels, but increased during the same period of time in neighborhoods with lower unemployment. Consequently, citywide disparities in trauma incidence decreased during the recession and widened again as the economy began to improve.


Trauma risks and demand for trauma care may shift geographically in relation to broader economic changes. Health care policy and planning should consider these dynamics when anticipating changing demands and needs for efforts at prevention.


Traumatic injury Health disparities Unemployment Growth curve modeling 


Compliance with ethical standards

Conflict of interest

None-all authors declare that they have no conflicts of interest.


  1. Audirac I (2017) Shrinking Cities from marginal to mainstream: views from North America and Europe. Cities. CrossRefGoogle Scholar
  2. Berger RP, Fromkin JB, Stutz H et al (2011) Abusive head trauma during a time of increased unemployment: a multicenter analysis. Pediatrics 128:637. CrossRefPubMedGoogle Scholar
  3. Bureau of Labor Statistics (2017) Local area unemployment statistics: seasonally adjusted metropolitan area estimates. US Department of Labor, Washington, DCGoogle Scholar
  4. Cicchino JB (2015) Why have fatality rates among older drivers declined? The relative contributions of changes in survivability and crash involvement. Accid Anal Prev 83:67–73. CrossRefPubMedGoogle Scholar
  5. Connaughton JE (2010) Local economic impact of the great recession of 2008/2009. Rev Reg Stud 40:1CrossRefGoogle Scholar
  6. Cothren CC, Moore EE, Hedegaard HB, Meng K (2007) Epidemiology of urban trauma deaths: a comprehensive reassessment 10 years later. World J Surg 31:1507–1511. CrossRefPubMedGoogle Scholar
  7. Cubbin C, LeClere FB, Smith GS (2000a) Socioeconomic status and the occurrence of fatal and nonfatal injury in the United States. Am J Public Health 90:70–77CrossRefPubMedPubMedCentralGoogle Scholar
  8. Cubbin C, LeClere FB, Smith GS (2000b) Socioeconomic status and injury mortality: individual and neighbourhood determinants. J Epidemiol Commun Health 54:517–524. CrossRefGoogle Scholar
  9. Darden J, Rahbar M, Jezierski L et al (2010) The measurement of neighborhood socioeconomic characteristics and black and white residential segregation in Metropolitan Detroit: implications for the Study of Social Disparities in Health. Ann Assoc Am Geogr 100:137–158. CrossRefGoogle Scholar
  10. Duncan TE, Duncan SC, Strycker LA (2006) An introduction to latent variable growth curve modeling: concepts, issues, and applications. Lawrence Erlbaum, MahwahGoogle Scholar
  11. Guzman A, Garcia-Rodriguez O, Ramos-Melendez E et al (2017) The impact of unemployment on the admission rate secondary to intentional penetrating trauma in Puerto Rico. P R Health Sci J 36:118Google Scholar
  12. Haeusler J-MC, Tobler B, Arnet B et al (2006) Pilot study on the comprehensive economic costs of major trauma: consequential costs are well in excess of medical costs. J Trauma Acute Care Surg 61:723–731Google Scholar
  13. Harris CR, Jenkins M, Glaser D (2006) Gender differences in risk assessment: why do women take fewer risks than men? Judgm Decis Mak 1:48Google Scholar
  14. Hasnain-Wynia R, Baker Nerenz D et al (2007) Disparities in health care are driven by where minority patients seek care: examination of the hospital quality alliance measures. Arch Intern Med 167:1233–1239. CrossRefPubMedGoogle Scholar
  15. Huang MI, O’Riordan MA, Fitzenrider E et al (2011) Increased incidence of nonaccidental head trauma in infants associated with the economic recession. J Neurosurg Pediatr 8:171–176. CrossRefPubMedGoogle Scholar
  16. Islam SS, Velilla AM, Doyle EJ, Ducatman AM (2001) Gender differences in work-related injury/illness: analysis of workers compensation claims. Am J Ind Med 39:84–91CrossRefPubMedGoogle Scholar
  17. Kinkead D (2016) Detroit case study. In: Remaking post-industrial cities: lessons from North America and Europe, pp 46–65Google Scholar
  18. Kramarow E, Chen L-H, Hedegaard H, Warner M (2015) Deaths from unintentional injury among adults aged 65 and over: United States, 2000–2013. NCHS Data Brief 199:1–8Google Scholar
  19. Madan AK, Sapozhnik J, Tillou A et al (2007) Unemployment rates and trauma admissions. World J Surg 31:1930–1933. CrossRefPubMedGoogle Scholar
  20. Mathes T, Mosch C, Eikermann M (2016) Economic aspects of trauma care. In: Pape H-C, Sanders R, Joseph Borrelli J (eds) The poly-traumatized patient with fractures: a multi-disciplinary approach. Springer, Berlin, pp 9–14CrossRefGoogle Scholar
  21. Reed JA, Smith RS, Helmer SD et al (2003) Rates of unemployment and penetrating trauma are correlated. South Med J 96:772–774CrossRefPubMedGoogle Scholar
  22. Reese LA, Sands G, Skidmore M (2014) Memo from Motown: is austerity here to stay? Camb J Reg Econ Soc 7:99–118. CrossRefGoogle Scholar
  23. Rubenstein LZ (2006) Falls in older people: epidemiology, risk factors and strategies for prevention. Age Ageing 35:ii37–ii41. CrossRefPubMedGoogle Scholar
  24. Shraim M, Cifuentes M, Willetts JL et al (2017) Regional socioeconomic disparities in outcomes for workers with low back pain in the United States. Am J Ind Med 60:472–483. CrossRefPubMedPubMedCentralGoogle Scholar
  25. Silverman RM (2005) Community socioeconomic status and disparities in mortgage lending: an analysis of Metropolitan Detroit. Soc Sci J 42:479–486. CrossRefGoogle Scholar
  26. Wintemute GJ (2015) The epidemiology of firearm violence in the twenty-first century United States. Annu Rev Public Health 36:5–19CrossRefPubMedGoogle Scholar
  27. World Health Organization (2010) Injuries and violence: the facts. World Health Organization, GenevaGoogle Scholar

Copyright information

© Swiss School of Public Health (SSPH+) 2018

Authors and Affiliations

  • Kimberly Coughlin
    • 1
    Email author
  • R. David Hayward
    • 1
  • Mary Fessler
    • 1
  • Elango Edhayan
    • 1
  1. 1.Department of SurgerySt. John Hospital and Medical CenterDetroitUSA

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