City Life Safer Than Life in the Countryside When it Comes to Injury-related Deaths

City life in the United States is significantly safer than life lived in the countryside when it comes to the risk of injury-related death, a new study published in the journal Annals of Emergency Medicine found.

The researchers behind it reported that, all told, the risk of death by unintentional injury was 40 percent higher when comparing the nation's most rural cities to its most urban.

"Cars, guns and drugs are the unholy trinity causing the majority of injury deaths in the U.S.," lead author Dr. Sage Myers of the University of Pennsylvania in Philadelphia said in a press release. However, while the risk of homicides is higher in big cities, Myers explained that the rate of unintentional injury "dwarfs the risk of homicide" by more than 15 times.

Knowing this, she said, "has important implications about staffing of emergency departments and trauma care systems in rural areas, which tend to be underserved as it is."

In all, Myers and her team analyzed nearly 1.3 million injury-related deaths that occurred between 1999 and 2006.

In doing so, they found that the most common causes were motor vehicle crashes at 27.61 deaths per 100,000 people in most rural areas and 10.58 per 100,000 in most urban areas.

Though the risk of firearm-related death remained the same across the rural-urban spectrum in the entire population as a whole, when age subgroups were studied, firearm-related deaths turned out to be significantly higher in rural areas for children and people 45 years and older. However, for people age 20 to 44, the risk of firearm-related death was significantly lower in rural areas.

Race was also a factor, the researchers found, with rural counties with large black populations showing a significantly lower risk of injury-related death than those with small black populations while the opposite was true for Latino populations.

Surprisingly, rural counties with the highest levels of college-educated inhabitants and median income had significantly increased risk of injury-related deaths when compared to rural counties with the lowest levels of each.

Knowing this, Myers said, could make way for better prevention and treatment.

"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," she 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."