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BACKGROUND: Timely transport to designated trauma centers impacts mortality following serious injury. We examined whether the distribution of trauma centers in Chicago has created disparities in access to trauma care. METHODS: Using the Illinois State Trauma Registry, locations of Chicago-area gunshot wounds (GSWs) from 1999 to 2009 were geocoded and transport times were analyzed for pediatric (age ≤ 15) and adult (age ≥ 16) GSWs. RESULTS: A total of 11,744 included pediatric and adult GSWs were analyzed. Adults experienced longer mean transport times (11.3 vs 10.2 minutes, P

OBJECTIVE A portion of patients with diabetes are repeatedly hospitalized for diabetic ketoacidosis (DKA), termed recurrent DKA, which is associated with poorer clinical outcomes. This study evaluated recurrent DKA, fragmentation of care, and mortality throughout six institutions in the Chicago area. RESEARCH DESIGN AND METHODS A deidentified Health Insurance Portability and Accountability Act–compliant data set from six institutions (HealthLNK) was used to identify 3,615 patients with DKA (ICD-9 250.1x) from 2006 to 2012, representing 5,591 inpatient admissions for DKA. Demographic and clinical data were queried. Recurrence was defined as more than one DKA episode, and fragmentation of health care was defined as admission at more than one site. RESULTS Of the 3,615 patients, 780 (21.6%) had recurrent DKA. Patients with four or more DKAs (n = 211) represented 5.8% of the total DKA group but accounted for 26.3% (n = 1,470) of the encounters. Of the 780 recurrent patients, 125 (16%) were hospitalized at more than one hospital. These patients were more likely to recur (odds ratio [OR] 2.96; 95% CI 1.99, 4.39; P < 0.0001) and had an average of 1.88-times the encounters than nonfragmented patients. Although only 13.6% of patients died of any cause during the study period, odds of death increased with age (OR 1.06; 95% CI 1.05, 1.07; P < 0.001) and number of DKA encounters (OR 1.28; 95% CI 1.04, 1.58; P = 0.02) after adjustment for age, sex, insurance, race, fragmentation, and DKA visit count. This study was limited by lack of medical record–level data, including comorbidities without ICD-9 codes. CONCLUSIONS Recurrent DKA was common and associated with increased fragmentation of health care and increased mortality. Further research is needed on potential interventions in this unique population.

Background The association between alcohol and interpersonal violence is well established. Up to 80% of homicide perpetrators and victims are known to have used alcohol before the incident. However, the association between proximity to a liquor-selling establishment and gun violence is more controversial. Methods Scene address data from the Illinois State Trauma Registry from 1999 to 2009 were used to geocode all gunshot wounds (GSWs) presenting to trauma centers in Chicago during the study period. These data were linked to publicly available US Census Demographic Data and City of Chicago Liquor Board data. A combination of ordinary least squares and geographically weighted regression was performed to identify “risk regions” throughout the study area. Logistic regression analysis was then performed to assess the independent effect of proximity to an establishment with a liquor license (LL) on trauma center admissions for GSWs. Results A total of 11,744 GSWs were geocoded. No association between LLs and GSWs was identified for the city overall (odds ratio [OR] .97, 95% confidence interval [CI] .96 to .99). However, 5 distinct regions of influence between LLs and GSWs were found. In regions with the highest association, likelihood of a GSW near a packaged LL was extraordinarily high (OR 518.08, 95% CI 10.23 to 1,000), and tavern LLs were also very significant (OR 21.51, 95% CI 1.81 to 255.53). Conclusions We found that proximity to an establishment with an LL was a strong independent predictor of GSW incidence for many areas of the city, even after controlling for neighborhood characteristics. However, this association was not demonstrable for the entire city, and, in fact, marked regional variation was apparent. These data may contribute to our understanding of the interplay between alcohol and violent injury disparities.

Introduction The Affordable Care Act (ACA) has expanded health coverage for thousands of Illinois residents. Expanded coverage, however, does not guarantee appropriate health care. Diabetes and its ocular complications serve as an example of how providers in underserved urban areas may not be able to keep up with new demand for labor- and technology-intensive health care unless changes in reimbursement policies are instituted. Methods A retrospective cohort study was conducted using medical encounter information from the Chicago HealthLNK Data Repository (HDR), an assembly of non-duplicated and de-identified patient medical records. We used a method of estimating the geographic distribution of undiagnosed diabetic retinopathy in the city of Chicago to illustrate the magnitude of potentially preventable eye disease. All rates were calculated for all ZIP Codes within Chicago (Cook County), and statistical differences between observed and geographically adjusted expected rates (p