Urban counties have lower risk of death from injuries compared to suburban and rural living
For the first time in history more than half of the U.S. population was living in urban areas. However, in the past couple of decades many of the largest U.S. cities have seen a reduction in population due to several factors including job relocation, educational differences and crime that may be the most publicized and significant.
From 1999 to 2006, almost 1.3 million people died of injuries in the United States with most of them being younger than 45 years and living in urban areas. This could suggest that young urbanities have the greatest burden of injury-related risk of death in the United States, and by extension the large U.S. cities are not safe to live and work. Previous studies on U.S. Homicides and crime victimization also supports the theory that injury risk is mainly in large cities.
Researchers from the Perelman School of Medicine at the University of Pennsylvania and the Children’s Hospital of Philadelphia (CHOP) conducted a cross-sectional time series analysis of all injury deaths that occurred in the United States during 1999 through 2006 (because of their unusual nature, deaths from the 9-11 terrorist attacks were excluded). The analysis included all 3,141 counties that had 1,295,919 injury deaths during the study period.
The results showed the overall death rate was 56.2 per 100,000 persons in the population and the overall death rate for unintentional injury (homicides and suicide) was 17.0 per 100,000.
The most common unintentional injury deaths were motor vehicle related occurring at a rate that is more than 1.4 times higher than the next leading mechanism of injury death. In rural areas, this difference is even more pronounced, where motor vehicle injury-related death rates are twice that of the next leading injury mechanism. Across the rural-urban continuum, the risk of motor vehicle-related injury death is 2 times more likely in rural areas as compared to the most urban. Firearm injury related deaths occurred at a rate of 10.4 per 100,000.
In their discussion the researchers write “Despite public perception to the contrary, when all types of injuries are considered together, rural areas, not urban, bear a disproportionate amount of injury-related mortality risk in the United States.
Dr. Sage R. Myers, MD, MSCE, Attending Physician, Assistant Professor Of Pediatrics, Perelman School of Medicine at the University of Pennsylvania and lead author of study stated “Perceptions have long existed that cities were innately more dangerous than areas outside of cities, but our study shows this is not the case.” “These findings may lead people who are considering leaving cities for non-urban areas due to safety concerns to re-examine their motivations for moving. And we hope the findings could also lead us to re-evaluate our rural health care system and more appropriately equip it to both prevent and treat the health threats that actually exist.”
Dr. Brendan G. Carr, MD, MA, MSHP, assistant professor Emergency Medicine and Biostatistics and Epidemiology at Penn. And senior study author commented about the study “We think our work serves as a reminder that injury is an important health issue for Americans, wherever they live. Our findings can inform both targeted prevention efforts and strategic efforts to improve trauma care in the U.S. This work provides a real opportunity to build systems of medical care that are positioned to best care for the populations that depend upon them for life and limb saving treatment in their time of need.”
According to the researchers “when considering all mechanisms of injury death as an overall metric of safety, large cities appear to be the safest counties in the United States, significantly safer than their rural counterparts.”
In conclusion they write “Using total injury death rate as an overall safety metric, US urban counties were safer than their rural counterparts, and injury death risk increased steadily as counties became more rural. Greater emphasis on elevated injury-related mortality risk outside of large cities, attention to locality-specific injury prevention priorities, and an increased focus on matching emergency care needs to emergency care resources are in order.”
This new study appears online ahead of print in the Annals of Emergency Medicine.