Contrary to what many believe, living in the city is far less risky than in the country, according to a study released on Tuesday that takes into account all major forms of death from injuries.
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, whose study was published in the Annals of Emergency Medicine
“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,” she said.
“It's a little counterintuitive,” she said.
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. And 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 9-11 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 as they did 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, and the risk was about the same for youths aged 15 to 19, regardless of where they lived.
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 healthcare than people in rural areas who have life-threatening injuries.
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.