Access to primary care is associated with improved long-term survival after severe traumatic injury

Background — Survivors of severe traumatic injury remain at elevated risk of death in the years after injury. Little is known about how long-term mortality among injury survivors can be reduced. Given the importance of primary care to overall health, we hypothesized that access to primary care would be associated with improved long-term survival among injury survivors.

Methods — This population-based, retrospective cohort study (2010–2022) included community-dwelling adults (18 years or older) discharged alive after a severe traumatic injury (Injury Severity Score, >15). The exposure of interest was access to primary care, defined as either visiting or being enrolled with a primary care physician in the 2 years prior to injury. The primary outcome was 5-year all-cause mortality. Cox proportional hazards models were used to evaluate the relationship between access to primary care and mortality, adjusting for sociodemographic characteristics, comorbidity, and injury severity.

Results — We identified 25,713 survivors of severe injury (mean age, 54 years; 32% female), of whom 92% (n = 23,720) had access to primary care. Five-year mortality was 13% (n = 3,265). Adjusting for patient characteristics, access to primary care was associated with a 20% lower hazard of death (hazard ratio, 0.80; 95% confidence interval, 0.68–0.93) at 5 years. The relationship between access to primary care and mortality was preserved across subgroups of age, sex, and comorbidity.

Conclusion — Survivors of severe traumatic injury without access to primary care were more likely to die in the 5 years after discharge, identifying a vulnerable subset of the survivor population. Primary care physicians may represent key partners to trauma care providers in developing strategies that improve long-term outcomes in the years after injury.