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Marianne E. Cinat, MD; Samuel E. Wilson, MD; Stephanie Lush, MSN; Courtney Atkins, MHA

Arch Surg. 2004;139:1350-1355.

Hypothesis  Depressed economic conditions are associated with increased trauma and violent crime.

Design  Retrospective cohort study of prospectively collected data.

Setting and Interventions  Population and labor force data from 1992 to 2002 were obtained from the state Employment Development Department and the US Census Bureau. County data regarding the total number of trauma activations and mechanism of trauma were recorded. Crime statistics were obtained from the state Department of Justice and the Federal Bureau of Investigation. Correlation statistics were performed. Health care coverage for victims of penetrating trauma was also analyzed.

Main Outcome Measures  Correlation between unemployment rate, trauma epidemiology, and crime indexes.

Results  The correlation between the percentage penetrating trauma and the unemployment rate was R = 0.92 (Orange County, California) and R = 0.95 (Los Angeles County, California) (P<.001). The unemployment rate was also tightly correlated with Federal Bureau of Investigation crime indexes in both counties and in the state (P<.001). The overall county population was positively correlated with the total number of trauma occurrences in both counties (P<.001) but was negatively correlated with the number of penetrating traumas and crime indexes (P<.001). Seventy-five percent of penetrating trauma victims had no health care coverage or had state or county aid only.

Conclusions  The proportion of violent crime in a community is closely associated with the unemployment rate of that community and will vary longitudinally over time. The overall county population is less important. These data may be used for public policy initiatives regarding resource allocation to trauma centers, law enforcement planning, and programs aimed at crime prevention.

Author Affiliations: Department of Surgery, University of California Irvine Medical Center, Orange.

Correspondence: Marianne E. Cinat, MD, Department of Surgery, University of California Irvine Medical Center, 101 The City Dr, Bldg 53, Rte 81, Orange, CA 92868 (mecinat{at}uci.edu).