Association of 30-ft US-Mexico Border Wall in San Diego With Increased Migrant Deaths, Trauma Center Admissions, and Injury Severity

Abstract

This observational study assesses the changes in morbidity and mortality of border wall injuries after construction of the 30-ft border wall in San Diego and Imperial Counties, California.

On January 24, 2017, the executive order Border Security and Immigration Enforcement Improvements was signed by President Trump. This resulted in replacement of 406 miles of existing 6- to 17-ft barriers with a 30-ft-tall (9.1 m) steel barrier. An additional 49 miles of new barrier were also added.

The new 30-ft border wall was reported in lay media to be unclimbable. However, our level 1 trauma center experienced significant increases in the number and severity of patients with border wall fall injuries starting in 2019, as new wall construction concluded.^1,2,3,4,5 We sought to characterize the changes in morbidity and mortality of border wall fall injuries after construction of the 30-ft border wall in San Diego and Imperial Counties, California.

Methods

This is a retrospective trauma registry study of the University of California, San Diego level 1 trauma center, which receives patients with border wall injuries from San Diego County and Imperial County in California. The study was determined exempt from institutional review board review by institutional policy. Border wall fall admissions for 2016 to 2021 were collected. To normalize for changing migration rates, we calculated admissions per 100 000 US Customs and Border Protection (CBP) apprehensions. The period 2016-2018 was defined as before construction of the 30-ft border wall and 2019-2021 was defined as after. Hospital mortality, Injury Severity Score (ISS), head/face Abbreviated Injury Scale, length of stay (LOS), and inflation-adjusted hospital costs were collected. On-scene mortality of border wall falls was obtained from the San Diego County Medical Examiner.

Results

During the before period, there were 67 fall admissions from the border wall compared with 375 during the after period. This increase of more than 5 times is still significant when admissions were normalized per CBP apprehensions (Figure). Mean ISS, median head/face Abbreviated Injury Scale codes, median hospital LOS, intensive care unit LOS, and hospital and scene mortality all increased significantly in the after period (Table). The median hospital inflation-adjusted costs per admission increased significantly. The increased hospital costs of the surge in admissions exceeded $13 million in 2021 dollars.

Figure. University of California, San Diego Jump/Fall Major Trauma Admits From Border Fence by Year.

CBP indicates Customs and Border Protection; UCSDH, University of California, San Diego Health.

Table. Outcomes Before and After Completion of 30-ft Border Wall.

Variable	Before 18- to 30-ft border wall (2016-2018)	After 18- to 30-ft border wall (2019-2021)	Statistical test	P value
Border wall fall admissions	67	375	NA	NA
ISS, mean (SD)	8.3 (5.0)	10.4 (7.9)	ANOVA	.02
Head/face AIS, mean (SD)	1.9 (4.4)	2.4 (8.8)	ANOVA	.03
ICU LOS, mean (SD), d	0.51 (1.1)	2.1 (3.7)	ANOVA	<.001
LOS, median (IQR), d	4.0 (1.0-10.0)	6.0 (3.0-11.0)	Mann-Whitney U	.02
Hospital inflation-adjusted costs, median (IQR), $	30 714 (16 541-59 732)	44 786 (26 069-77 273)	Mann-Whitney U	.002
Hospital mortality, No. (%)	0	2 (0.6)	χ2	<.001
San Diego–Imperial County CBP apprehensions	159 175	15 9614	No test done	No test done
Scene mortality (rate per 100 000 San Diego–Imperial County CBP apprehensions)	0 (0)	14 (8.8)	χ2	<.001

Abbreviations: AIS, Abbreviated Injury Score; ANOVA, analysis of variance; CBP, US Customs and Border Protection; ICU, intensive care unit; ISS, Injury Severity Score; LOS, length of stay; NA, not applicable.

Discussion

Raising the US border wall to 30 ft is associated with increased deaths, increased ISS, and increased health care costs. It increased the burden of complex injured patients at a level 1 trauma center already dealing with a trauma surge and respiratory surge during the COVID-19 pandemic. The care of these injured immigrants is not only a humanitarian problem but also a public health crisis that further worsened trauma center bed capacity, staff shortages, and professionals’ moral injury. Most of these patients had significant brain and facial injuries or complex fractures of the extremities or spine, with many requiring intensive care and staged operative reconstructions. Lack of health insurance made most patients ineligible for rehabilitation facilities or postdischarge physical therapy, further lengthening prolonged hospital stays.

This study is limited by lack of a specific denominator for total numbers crossing the border, which required use of CBP apprehensions as a surrogate. However, the appearance of scene deaths was a new phenomenon with a strong temporal association after the increase in border height.

This surge of preventable border wall injuries increased unfunded costs to our hospital system. In March 2020, President Trump ordered adoption of Title 42, allowing CBP to expel certain migrants without asylum screening. This may have increased the numbers and desperation of persons crossing the border away from ports of entry and increased the number of falls. Future border barrier policy decisions should include assessment of the impact of increased injuries on local health care systems as well as humanitarian consequences. We seek collaborators to prevent and mitigate the injuries and resultant suffering of those immigrants crossing the southern border.