Citation

Byrne JP, Seamon MJ. JAMA Surg. 2023; ePub(ePub): ePub.

Copyright

(Copyright © 2023, American Medical Association)

DOI

10.1001/jamasurg.2022.8003

PMID

36790772

Abstract

In Reply We thank Cazes et al for their comments on our recently published study.1 We wish to respond to their concerns.

First, they raise concern for unmeasured confounding. We discuss this at length in our study. Foremost, while specific factors may be unknown (frequently the case in observational studies), this does not automatically render them a confounder. A confounder is defined as a factor associated both with the exposure (in our study, geospatial access to care) and the outcome (in our study, mortality). There is no evidence that injury severity or mode of transport differs across the spectrum of access to care within urban Philadelphia, Pennsylvania. Furthermore, our hierarchical model accounted for between-neighborhood variation in mortality that might conceivably arise due to other unmeasured differences.

Language: en