(Recasts, adds details, context, interviews)
By Julie Steenhuysen
CHICAGO, July 23 Contrary to what many believe,
the risk of dying from an injury is far less in the city than in
the country, U.S. researchers said on Tuesday.
Although homicides in cities far outpace those in rural
areas, overall the risk of dying from some form of accident or
injury is 20 percent greater in the most rural counties of the
United States than in the nation's biggest cities.
The findings may give pause to people tempted to flee cities
for the bucolic ideal of rural life, says Dr. Sage Myers, a
pediatric emergency medicine specialist at the University of
Pennsylvania and the Children's Hospital of Philadelphia.
"As you moved further and further away from cities you got
less and less safe. Even going into the suburbs dropped your
safety a little bit," said Myers, whose study was published in
the Annals of Emergency Medicine. "It's a little
Myers said when people think of their personal safety, they
tend to think about intentionally inflicted injuries, such as
being attacked or shot. But the researchers found that the risk
of dying from an accidental injury is 40 percent higher in the
nation's most rural counties than in its most urban.
"It turns out unintentional injuries dwarf intentional
injuries," Myers said, and those types of injuries occur much
more often in rural areas.
Part of the differences in the study may reflect reduced
access to trauma centers, which are staffed with doctors who are
trained to handle life-threatening injuries. Since most trauma
centers are clustered near large cities, rural dwellers may be
more at risk of dying from life-threatening injuries.
CAR CRASHES, HOMICIDES
Myers and colleagues studied government data on all
injury-related deaths from all 3,141 counties across the United
States from 1999 to 2006. They excluded deaths caused by the
Sept. 11, 2001, attacks, which the researchers deemed too
anomalous to be counted.
Of the nearly 1.3 million deaths during the study period,
the overall rate of deaths caused by accidents was 37.5 per
100,000, compared with 17 per 100,000 for homicide and suicides.
The most common causes of injury-related deaths were motor
vehicle crashes, which occurred at more than twice the rate in
rural areas than in cities. Overall, car crashes caused 27.61
deaths per 100,000 people in most rural areas and 10.58 per
100,000 in most urban areas.
That may be because people in rural areas are more prone to
drive on highways at high speeds and some studies have shown
people in rural areas are less likely to comply with seatbelt
and child restraint laws than are individuals in urban areas.
When the team looked at firearm-related deaths, they found
no significant difference in the overall risk of death between
urban counties and rural counties but there were significant
differences in the trends by age.
In rural areas, for example, children aged up to 14 and
adults over 45 had the highest risk of dying from a firearm
injury, but among adults aged 20 to 44, the risk of a
firearm-related death was much higher in urban areas. The risk
was about the same for youths aged 15 to 19, regardless of where
The study did not look at the number of people who were
injured but survived their car crashes or gunshot wounds, which
might reflect whether people in urban areas simply have better
access to trauma centers than people in rural areas.
Ian Weston, executive director of the American Trauma
Society, a group that represents trauma centers and emergency
experts, said when people sustain a life-threatening injury,
there is "what we call the golden hour - that first hour
post-injury is really the life or death hour."
That is where proximity to a trauma center makes a
difference. "In rural areas, it's common that you are seeing
transport times of over half hour to an hour to a trauma
center," he said, noting that in South Dakota, there are just
one or two trauma centers covering the whole state.
That contrasts with a state like New York, where there are
nearly 50 trauma centers in the state, he said.
But Tom Smith of the University of Chicago's national
opinion research group NORC said while the findings may
accurately reflect access to trauma care in the United States,
the notion of personal safety goes far beyond whether a person
survives a life-threatening injury.
"There's a lot of other components to safety than deaths.
What about crimes you weren't injured in?" said Smith, pointing
to the two people in his own neighborhood in Chicago who were
robbed at gunpoint the previous night. "There were no injuries,
but I'm sure they don't feel very safe."
Smith said a survey his group did found many people in
cities feel less safe taking a stroll around the block at night
than do people in the suburbs, and much less safe than do rural
Myers said more study is needed to tease out the differences
in risks between urban and rural areas, but she said such
studies should be taken into account as health policy experts
consider the placement of new trauma centers.
The study was funded by the Agency for Healthcare Research &
Quality, the Centers for Disease Control & Prevention and the
National Institutes of Health.
(Editing by Eric Walsh and Bill Trott)