Abstract
BACKGROUND: Trauma mortality is strongly influenced by the distance between the trauma site and the hospital, as longer prehospital times delay definitive care and increase the risk of death. In cities like Cali, Colombia, with high rates of penetrating trauma due to systemic violence, geographic and socioeconomic disparities further hinder access to timely care. This study examines the association of not being treated at the nearest hospital on trauma in-hospital mortality, accounting for geographic and socioeconomic factors. METHODS: A prospective cohort study included 554 adults with moderate-to-severe trauma treated at three trauma centers in Cali, Colombia, between December 2012 and June 2013. Trauma sites were geocoded to calculate distances to the nearest hospital, with "nonproximal care" (NC) defined as treatment at a facility other than the closest one. Multivariable logistic regression evaluated mortality risk and predictors of NC care, whereas geospatial analyses examined socioeconomic associations using the multidimensional poverty index (MPI). RESULTS: NC care was identified in 47.8% of patients, who were more likely male, uninsured, or subsidized and sustained gunshot injuries. NC care was associated with higher in-hospital mortality (25.5% vs. 18.0%, p = 0.02). Adjusted analyses identified NC care (OR: 1.815, 95% CI: 1.052-3.173), higher injury severity score, and physiologic impairment as predictors of mortality. Socioeconomic and geographic disparities were evident, with high MPI linked to NC care. CONCLUSIONS: NC care is significantly associated with increased trauma mortality, compounded by socioeconomic and geographic inequities. Enhancing regionalized trauma systems, transportation networks, and equitable healthcare access is essential to reduce disparities and improve outcomes.