National Edition

Rural death: New study shows cities are safer than the country

Published: Monday, Aug. 5 2013 1:50 p.m. MDT

Rural areas have more injury deaths than urban areas many of which occur on the road.

Robin Monks, "Mozillaman" via flickr

If perception were reality, the most dangerous places to live would be major urban areas, where crimes like homicide are supposedly high.

Perception is not reality.

A new study in the Annals of Emergency Medicine shows that if people are going to die by an injury, they much more likely are in the country.

Sage Meyers, a pediatric emergency medicine physician and the lead author of the study at the University of Pennsylvania's Perelman School of Medicine, was surprised when she saw the results.

"The media tends to present injury deaths that are more sensational, and people tend to have a more emotional reaction to injuries that are intentional, especially homicide, and therefore hold these closer in their mind," she said. "Here we were able to look at all injury-related deaths together to realize that when you consider 'safety' to be the risk of serious injury to yourself, you are safer in an urban county than outside of an urban county, which tends to be contrary to what people would initially believe."

The study may make people think more about the safety of where they live, but it also may inform how emergency-care resources are allocated and how campaigns to reduced injuries can be targeted more effectively, Meyers said.

Rural death

By analyzing more than a million injury deaths that occurred between 1999 and 2006, the study showed that the risk of injury death was 22 percent higher in the most rural counties than in the most urban counties.

This is looking at all injury deaths together — intentional (such as homicide and suicide) and unintentional (such as motor vehicle crashes, falls and other accidents). But if you compare unintentional injury death to homicide, people are 15 times more likely to die because of an unintentional injury than be murdered. The risk of those unintentional deaths rests heavily in rural areas where the risk of injury death is 40 percent higher than the most urban areas.

"I think that we were … struck by how much higher the risk of unintentional injury death was as compared to homicide and suicide," Meyers says. "This really drove our findings, as unintentional injury rates are much higher in rural areas as compared to urban. Any differences in homicide and suicide are dwarfed by the risk of unintentional injury. "

Homicide rates were significantly higher in urban counties, according to the study. The more rural the county, the fewer homicides. Although suicide rates were higher in the most rural counties, the study said the differences were not significant.

The most common way people died from injuries involved automobile crashes. There were 27.61 deaths per 100,000 people in most rural areas and 10.58 per 100,000 in most urban areas.

Part of the reason automobile deaths may be higher in rural areas could be related to higher speeds, increased risk taking, disregarding of traffic laws and longer distances to medical care, the study says.

Initial analysis in the study, however, indicates that access to trauma care has little effect on the numbers of injury deaths.

Other dangers in rural settings include injury deaths by machinery and environmental injuries such as exposure to the elements. One area where rural areas do better than cities is in falls among the elderly. Older people are more likely to fall in cities and get hurt than in rural areas. The study did not look at the possible reasons for this difference.

Unexplained differences

As part of the study, the researchers looked at the differences in how various groups fared in urban versus rural areas.

Rural areas with the most educated people were less safe than rural areas with lower percentages of educated people.

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