Cities Safer Than Rural Areas, When It Comes To Injury-Related Deaths: Study

The concrete jungle is actually safer than you might think. A new study of hospital data finds that you are much less likely to die from an injury in the city than out in the country.

In a study forthcoming in the Annals of Emergency Medicine, University of Pennsylvania researcher Sage Meyers and colleagues analyzed 1.3 million injury deaths that occurred between 1999 and 2006. Most of these victims were under 45 and lived in urban areas, suggesting that it’s more dangerous to live in the city. But when the researchers looked a little closer at the proportion of the urbanites and country-dwellers, a surprising trend emerged: in urban areas, a person’s risk of injury-related death was about 20 percent lower than the same risk faced by his or her country cousin.

“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,” the authors wrote.

The primary factor in that finding? Car accidents. They're the top cause of injury-related deaths in the U.S. overall, and the data shows that a person's risk of death by car crash in rural areas was double the risk in cities. Meyers and her colleagues speculate that rural drivers may be more likely to die in car accidents because they tend to be traveling at higher speeds when crashes occur, and because rural accidents take place further from hospitals and trauma centers than ones in the heart of the city.

Overall, gun deaths did not significantly differ between cities and the countryside, but in rural areas, children under 14 years old and adults over 45 years old are much more likely to die from a gun than their counterparts in the city. But when the researchers looked a little closer at the number of injuries suffered by urbanites and country-dwellers in proportion to the surrounding population, a surprising trend emerged: in urban areas, a person’s risk of injury-related death was about 20 percent lower than the same risk faced by his or her country cousin. Fall-related injuries – a special concern for seniors -- were much more likely in urban areas.

"Cars, guns and drugs are the unholy trinity causing the majority of injury deaths in the U.S.," Meyers said in a statement. "Although the risk of homicide is higher in big cities, the risk of unintentional injury death is 40 percent higher in the most rural areas than in the most urban” areas.

When the scientists broke the numbers down by race and demographic factors, other patterns emerged. Rural counties populated mostly by black people were much safer than rural counties with the lowest percentage of black residents. Injury-related fatality rates were virtually the same in both heavily white and heavily black urban counties.

The researchers noted that there were some limitations to their study, the foremost being that nonfatal injuries could not be included. The study also does not factor in a person’s distance to a trauma center or the severity of an injury. The researchers also consciously chose to exclude deaths related to terrorism, given the infrequency of such attacks.

Nevertheless, the study “has important implications about staffing of emergency departments and trauma care systems in rural areas, which tend to be underserved as it is," Meyers says.

SOURCE: Myers et al. “Safety in Numbers: Are Major Cities the Safest Places in the United States?” Annals of Emergency Medicine, forthcoming.