Opening of South Side Trauma Center Linked to 3.9% Drop in Firearm Mortality

The 2018 opening of a Level 1 trauma center at the University of Chicago Medical Center was associated with a significant reduction in firearm-related mortality in a long-standing urban “trauma desert,” according to a new cohort study analyzing more than a decade of shooting incidents in Chicago.¹

Trauma deserts, or areas with limited access to timely trauma care, disproportionately affect marginalized and racial and ethnic minority communities. The authors pointed to the decentralized US trauma system in which centers have often proliferated based on hospitals’ capacity to provide care rather than community need.² Financial pressures in the 1990s led to the closure of trauma centers serving economically disadvantaged patients, followed by growth in centers located in more affluent areas—shifting payer mix, straining safety-net institutions, and in some cases contributing to higher mortality rates, particularly among victims of firearm violence.

To assess whether strategically expanding trauma care could alter outcomes, the investigators examined 45,150 shooting incidents in Chicago between 2010 and 2024, using an interrupted time-series design centered on the May 2018 designation of the University of Chicago as a Level 1 trauma center.¹

“Although gunshot wounds confer particularly high mortality rates and require rapid intervention at a trauma center, the same population at risk for these injuries remains the most at risk for reduced access to life-saving trauma care,” the authors wrote.

Of the total incidents, 19,065 occurred within the University of Chicago service area (UCSA), which includes much of the city’s South Side. Compared with areas outside the service area (non-UCSA), the UCSA had a markedly higher proportion of Black individuals among those shot (91.3% vs 68.1%; P < .001) and lower proportions of White (0.9% vs 3.1%; P < .001) and Hispanic individuals (5.5% vs 26.1%; P < .001). The neighborhoods surrounding the medical center account for roughly one-third of the city’s violent crime and lacked a Level 1 or 2 trauma center for nearly 30 years prior to 2018.

The primary outcomes were changes in drive time and distance to the nearest trauma center and changes in firearm mortality. Following the trauma center’s opening, mean travel time within the UCSA fell from 21.6 minutes to 13.1 minutes—a reduction of 9.5 minutes (95% CI, 8.8-10.1; P < .001). Mean travel distance declined from 8.39 miles to 4.91 miles, a decrease of 3.4 miles (95% CI, 3.18-3.65; P < .001).

By contrast, changes in the non-UCSA were minimal. Travel time decreased by just 0.62 minutes (95% CI, 0.12-1.12; P = .02), and there was no significant reduction in travel distance.

Most notably, the improved access to care was associated with a significant decline in mortality within the UCSA. At the intervention point in May 2018, researchers observed a 3.9% proportional decrease in firearm mortality (95% CI, 6.8%-1.1%; P = .007), with no significant change in slope before or after the intervention. In the non-UCSA, there was no significant change in mortality (−0.0041%; P = .68). A sensitivity analysis using balanced pre- and post periods (2012-2024) showed a similar 4.3% proportional mortality reduction in the UCSA (P = .008).

Importantly, the mortality decline occurred against a backdrop of rising mortality before the trauma center opened, without a corresponding increase in shooting incidents. Citywide shootings fluctuated over the study period, reaching a low of 2139 in 2013 and a peak of 4099 in 2016. Geographic hotspot analyses demonstrated persistent clustering of shootings on the South and West Sides both before and after 2018, underscoring the ongoing concentration of firearm violence in historically marginalized neighborhoods.

“Most importantly, we identified a 3.9% decrease in firearm mortality after the creation of the trauma center in what was previously a trauma desert,” the authors wrote. “For context, in a year with 2000 firearm injuries within the catchment area, this would yield about 79 lives saved. Importantly, this decrease in mortality occurred during a period of increasing mortality rates prior to the trauma center’s opening, making the demonstrated decrease even more significant.”

The study had limitations, including reliance on calculated rather than actual transport times and the inability to account for all potential confounding events. However, investigators found no major concurrent citywide changes that would plausibly explain the observed mortality shift.

Overall, the findings suggest that strategic placement of trauma centers in high-need urban areas can meaningfully reduce mortality from time-sensitive injuries. As firearm violence remains concentrated in structurally disadvantaged communities nationwide, the authors conclude that data-driven trauma system planning may be a critical lever for addressing geographic and racial disparities in trauma care access and outcomes.

References

1. Poulson MR, Benjamin A, Scantling DR. Firearm mortality and equitable access to trauma care in Chicago. JAMA Surg. Published online February 25, 2026. doi:10.1001/jamasurg.2026.0001
2. Smith S, Scantling DR. Improving care and equity in the American trauma system: past, present and future. Trauma Surg Acute Care Open. 2025;10(2):e001729. doi:10.1136/tsaco-2024-001729