Study Finds Increased Availability of Neurosurgeons Associated with Decreased Risk of Death From Motor Vehicle Accidents

For Immediate Release

Newswise — CHARLOTTESVILLE, Va. (July 24, 2012) — Researchers at Dartmouth-Hitchcock Medical Center in Lebanon, NH, have found an association between increasing the distribution of neurosurgeons throughout the United States and decreasing the risk of death from motor vehicle accidents (MVAs). The findings of their study are described in the article “Increased population density of neurosurgeons associated with decreased risk of death from MVAs in the United States. Clinical article,” by Atman Desai, M.D., and colleagues, published today online, ahead of print, in the Journal of Neurosurgery (http://thejns.org/doi/full/10.3171/2012.6.JNS111281).

The researchers reviewed some basics about MVAs, the leading cause of death in the United States among young persons (1 to 34 years of age). The primary cause of death arising from MVAs is traumatic brain injury, whose treatment is generally handled by neurosurgeons. MVAs are more likely to result in fatalities in rural settings, which some attribute to a slow medical response time and reduced access to trauma resources. For the most part, neurosurgeons are clustered in and around cities that house tertiary care hospitals, and thus there is an uneven distribution of this specialty throughout the U.S. Bearing these facts in mind, the authors hypothesized that an increased population density of neurosurgeons would decrease the risk of death from an MVA.

Desai and colleagues performed a retrospective analysis of data from the Area Resource File (2009–2010), a database containing county-level information on health-care facilities and their utilization and expenditures; health-care professionals and their training; and socioeconomic and environmental characteristics. Data from 3,141 U.S. counties were analyzed; 2,051 of these counties were classified as rural. The primary outcome variable was the average number of deaths due to MVAs per million population for each county during the three-year period 2004 through 2006.The primary independent variable was the density of neurosurgeons (number of neurosurgeons per million population) in 2006.

In the 3,141 U.S. counties that were 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 an increase of one neurosurgeon per million population was associated with 1.9 fewer deaths due to MVAs per million population.

In a multivariate analysis, in which adjustments were made for county urbanicity, socioeconomic conditions and density of general practitioners, an increase of one neurosurgeon was associated with 1.01 fewer deaths from MVAs per million population. This association was present regardless of whether the county was rural or urban. When Desai and colleagues compared the association between deaths from MVAs and the distribution of other medical specialties, the researchers found that an equivalent decrease in MVA-related deaths (one fewer death) would require an addition of 33 primary-care providers; according to another study, an addition of six general surgeons per million population would be needed for the same affect. 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 U.S. should be promoted.

Desai A, Bekelis K, Zhao W., Ball PA: “Increased population density of neurosurgeons associated with decreased risk of death from MVAs in the United States. Clinical Article.” Journal of Neurosurgery, published ahead of print July 24, 2012; DOI: 10.3171/2012.6.JNS111281.

Disclosure: The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

For additional information, please contact:Ms. Gillian Shasby, Director of Publications–OperationsJournal of Neurosurgery Publishing GroupOne Morton Drive, Suite 200Charlottesville, VA 22903E-mail: [email protected]Telephone (434) 924-5503Fax (434) 924-5782

For 68 years, the Journal of Neurosurgery has been recognized by neurosurgeons and other medical specialists the world over for its authoritative, clinical articles, cutting-edge laboratory research papers, renowned case reports, expert technical notes, and more. Each article is rigorously peer reviewed. The Journal of Neurosurgery is published monthly by the JNS Publishing Group, the scholarly journal division of the American Association of Neurological Surgeons (http://www.AANS.org), an association dedicated to advancing the specialty of neurological surgery in order to promote the highest quality of patient care. The Journal of Neurosurgery appears in print and on the Internet (http://www.thejns.org).

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with nearly 8,200 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves. For more information, visit www.AANS.org.