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Cities safer than country for avoiding death from injury

Wednesday July 24, 2013
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Large cities in the U.S. are significantly safer than their rural counterparts, with the risk of death from injury more than 20% higher in the country, according to a study.

The study’s lead author, Sage Myers, MD, MSCE, of the University in Pennsylvania in Philadelphia, noted that although "the risk of homicide is higher in big cities, the risk of unintentional injury death is 40% higher in the most rural areas than in the most urban. And overall, the rate of unintentional injury dwarfs the risk of homicide, with the rate of unintentional injury more than 15 times that of homicide among the entire population.

"This has important implications about the staffing of emergency departments and trauma care systems in rural areas, which tend to be underserved as it is," Myers said in a news release.

Analyzing 1,295,919 injury deaths that occurred between 1999 and 2006, researchers determined that the risk of injury death was 22% higher in the most rural counties than in the most urban. The most common causes of injury death were motor vehicle crashes, leading to 27.61 deaths per 100,000 people in most rural areas and 10.58 per 100,000 in most urban areas, according to the study, which is scheduled for publication in the Annals of Emergency Medicine.

Although the risk of firearm-related death showed no difference across the rural-urban spectrum in the population as a whole, when age subgroups were studied, firearm-related deaths were found to be significantly higher in rural areas for children and people ages 45 and older; and significantly lower in rural areas for people ages 20 to 44.

Race appeared to be a factor in the data. Rural counties with large black populations had a significantly lower risk of injury death than those with small black populations, the researchers reported. The opposite was true for Latino populations: Rural counties with large Latino populations had a significantly higher risk of injury death than rural counties with small Latino populations.

Surprisingly, the researchers said, rural counties with the highest levels of college-educated inhabitants and median income had a significantly increased risk of injury death compared to rural counties with the lowest levels of each.

"By digging deep into the data, we may be able to tailor injury prevention efforts to the populations that need them, such as seniors in cities who are more likely to fall and rural children who are more likely to drown," Myers said.

"This data is relevant to staffing issues as well. Injury-related mortality risk is highest in the areas least likely to be covered by emergency physicians and least likely to have access to trauma care, which argues for using a population-planning approach to improve emergency and trauma care systems in the U.S."


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