Is Country Mouse or City Mouse Safer?

City dwellers safer than rural townsfolk in deaths related to injuries

(RxWiki News) If rural roads and cornfields beckon your soul, you may think the usually slower pace of life in the country is a safer place to live than in the bustling city. But you might be surprised.

A recent study found that deaths from injuries are actually lower in cities than in rural areas.

The leading cause of injury-related death was car accidents, which caused more than twice as many deaths in rural areas than in urban ones each year.

Even looking at all types of injuries combined together, fewer people were felled by accidents and injuries in the city than in the country.

"Be careful. Wear your seatbelt."

This study, led by Sage R. Myers, MD, of the Division of Pediatric Emergency Medicine at Children's Hospital of Philadelphia, compared risks of injuries in urban areas with those in suburban and rural areas.

The researchers analyzed approximately 1.3 million deaths caused by different injuries between 1999 and 2006.

The deaths came from all 3,141 US counties and were mapped out geographically in terms of how rural or urban the persons were.

Injury is the leading cause of death for people aged 1 to 44 in the US. Injury deaths can be caused by car accidents, poisoning, cuts, drowning, falls, fire, suffocation and other incidents.

This study's results revealed that the overall rate of death from injuries is 56 people per 100,000 per year in the US.

Accidental injury accounted for 37.5 deaths per 100,000 people each year. Intentional injury (murder and suicide) accounted for 17 deaths per 100,000 people.

The two most common methods of injury causing death were car accidents (15 deaths per 100,000) and firearm-related deaths (10 deaths per 100,000). Poisoning was the third most common.

Among children under age 14, the three most common causes were car accidents, suffocation and drowning. Among adults aged 65 and older, the most common causes were falls, car accidents and firearms.

The researchers found that the more rural an area a person lived in, the higher the risk that person had for dying from an injury.

In fact, people living in the country died from injuries at an average rate of 24 more deaths per 100,000 people per year than those in cities.

For example, car accidents which caused death were also more common in rural areas. While 10.6 deaths per 100,000 people occurred in cities as a result of car accidents, the rate in rural areas was more than double that, at 27.6 deaths per 100,000 people.

The relative increase in risk for overall injury-related deaths was modest. A person living in rural areas was at about 1.2 times higher risk for an injury death than a person living in urban areas.

These numbers are based on averages across the US. They do not refer to specific rural areas or specific US cities, where the injury rates will vary based on different factors.

"This research is a testament to the advances made in trauma care over the past decades and coordination of care within EMS systems," said Chris Galloway, MD, a dailyRx Contributing Expert specializing in emergency medicine.

"Unfortunately, proximity to a critical care facility is sometimes the most crucial factor in the chance of survivability," Dr. Galloway added.

"Living in rural areas means significantly longer EMS response times, and severe injuries would likely exceed the capability of a small local hospital," he said. "This often requires patients to be transferred to regional trauma centers and all of these steps require time before definitive care is received."

More time before receiving care decreases a patient's risk of survival for serious injuries.

"Time is of the essence in trauma care where the first hour is often termed the 'golden hour' during which patients have the highest likelihood of survival if they receive prompt medical treatment," Dr. Galloway said.

This study was published July 23 in the Annals of Emergency Medicine.

The research was funded by the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention National Center for Injury Prevention and Control and the Eunice Kennedy Shriver National Institute of Child Health and Human Development. The authors declared no conflicts of interest.

Review Date: 
July 24, 2013