Original Article

Rates of Unemployment and Penetrating Trauma Are Correlated

Authors: Justin A. Reed, MD, R. Stephen Smith, MD, Stephen D. Helmer, PHD, Brent A. Lancaster, MD, Claudia G. Carman

Abstract

Background Trauma surgeons have observed an increased rate of penetrating trauma during periods of increased unemployment. Methods During a 10-year period, the rate of unemployment in a metropolitan area was compared with the rate of intentional penetrating trauma at two Level I trauma centers. The total number of trauma cases was recorded. Assaults, derived from police records, were examined as an additional indicator of violent behavior. Pearson correlation coefficients were calculated to identify significant correlation between study variables. Stepwise maximum-likelihood estimation was used to derive a model predicting percent penetrating trauma. Results The rate of unemployment and percent penetrating trauma of individuals presenting to the emergency department were significantly correlated (P = 0.014). After stepwise estimation, a model was derived (r2 = 0.846, P = 0.014) that estimated percent penetrating trauma on the basis of percent unemployment and total number of trauma admissions. Conclusion This long-term ecological study confirms that rates of penetrating trauma increase with increasing unemployment rates. This should inspire further research to identify areas of greatest need to improve delivery of resources and current public policy with the ultimate goal of decreasing the incidence of penetrating trauma.

This content is limited to qualifying members.

Existing members, please login first

If you have an existing account please login now to access this article or view purchase options.

Purchase only this article ($25)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Sims DW, Bivins BA, Obeid FN, Horst HM, Sorensen VJ, Fath JJ. Urban trauma: a chronic recurrent disease. J Trauma 1989; 29: 940–947.
 
2. Godbold DT, Grant M, Rydman R, Smith R, Johnson T. Young black males and trauma: Predisposing factors to presentation in an urban trauma unit. J Natl Med Assoc 1996; 88: 273–275.
 
3. Yancey AH II, Gabel-Hughes KS, Ezell S, Zalkind DL. The relationship between violent trauma and nonemployment in Washington, DC. J Natl Med Assoc 1994; 86: 661–666.
 
4. Harries K. Social stress and trauma: Synthesis and spatial analysis. Soc Sci Med 1997; 45: 1251–1264.
 
5. Shepherd JP. Surgical, socioeconomic and forensic aspects of assault: A review. Br J Oral Maxillofac Surg 1989; 27: 89–98.
 
6. Poole GV, Lewis JL, Devidas M, Hauser CJ, Martin RW, Thomae KR. Psychopathologic risk factors for intentional and nonintentional injury. J Trauma 1997; 42: 711–715.
 
7. Redeker NS, Smeltzer SC, Kirkpatrick J, Parchment S. Risk factors of adolescent and young adult trauma victims. Am J Crit Care 1995; 4: 370–378.
 
8. Vila B. A general paradigm for understanding criminal behavior: Extending evolutionary ecological theory. Criminology 1994; 32: 311–359.
 
9. Susser M. The logic in ecological: Part I. The logic of analysis. Am J Public Health 1993; 84: 825–829.
10. Susser M. The logic in ecological: Part II. The logic of design. Am J Public Health 1993; 84: 830–835.
 
11. Schwartz S. The fallacy of the ecological fallacy: The potential misuse of a concept and the consequences. Am J Public Health 1994; 84: 819–824.
 
12. Campbell SD. Trauma subcommittee addresses injury prevention in the 21st century. Bull Am Coll Surg 2000; 85: 11–13.
 
13. Kyriacou DN, Hutson HR, Anglin D, Peek-Asa C, Kraus JF. The relationship between socioeconomic factors and gang violence in the City of Los Angeles. J Trauma 1999; 46: 334–339.
 
14. The Violence Prevention Task Force of the Eastern Association for the Surgery of Trauma. Violence in America: A public health crisis—the role of firearms. J Trauma 1995; 38: 163–168.