Bill Knight column for Mon., Tues. or Wed., Dec. 9, 10 or 11
The conventional wisdom is wrong.
According to the most comprehensive, quantitative report comparing the relative safety of different geographic areas, the risk of death is about 22 percent higher in the most rural counties compare to the most urban ones, considering all the ways people die prematurely by intentional or unintentional injury (as opposed to illness).
“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,” says the 2013 study “Safety in Numbers: Are Major Cities the Safest Places in the United States?” published in Annals of Emergency Medicine.
Researchers from Children’s Hospital of Philadelphia and the University of Pennsylvania looked at all 1,295,919 injury deaths in all 3,141 U.S. counties from 1999 to 2006, with counties classified on a 10-step continuum from urban to rural, and isolated terrorism deaths such as 9-11 excluded.
“When considering all mechanisms of injury death as an overall metric of safety,” the authors write, “large cities appear to be the safest counties in the United States – significantly safer than their rural counterparts.”
Overall, the more rural the area one lives in, the higher chance of dying by accident or intentionally (homicide or suicide).
In urban areas, the rate was 24 deaths per 100,000 people, while in rural areas it was 31.6 deaths per 100,000 — 31.7 percent higher.
“Although our findings support the belief that homicide rates and risk of homicide are significantly higher in urban areas compared with rural,” the researchers say, “we demonstrate that the magnitude of homicide-related deaths, even in urban areas, is outweighed by the magnitude of unintentional injury deaths.”
Rural residents were less likely to die from homicide than those in urbanized areas but more likely to commit suicide.
Car and truck crashes were the leading cause of injury death in both urban and rural areas. However, the number of deaths rises sharply with increasing rurality: 10.58 per 100,000 in most urban areas, 27.61 per 100,000 in the most rural areas — 161 percent higher.
The second most common cause was firearms, which resulted in 10.4 intentional and accidental deaths per 100,000. The most rural and most urban counties had similar overall risk factors, but the patterns of death varied. Firearm deaths are significantly higher in rural areas for children and people older than 45. In the city, they’re higher for people aged 20 to 44.
“In the youngest age group (0 to 14 years), as well as in the older age groups (45 to 64 years [and older]), the risk of firearm-related injury death was significantly higher in rural areas,” the study shows.
A related 2012 study found that the risk of unintentional firearm death more than doubled as one moved from urban to highly rural areas.
Overall, in urban areas, injury-related deaths peaked for those aged 45 to 65, at 57.66 per 100,000 people. In rural areas, the rate peaked for those 20 to 44 years old, with 96.28 per 100,000.
The study used data from the National Center for Health Statistics and looked only at fatalities, not just injuries (meaning no attempted homicides or suicides). The authors noted that examining only fatal injuries to evaluate “safety” may seem to be a limitation, but many injuries are nonfatal and aren’t consistently recorded and therefore not available to be examined.
Also, they said, “important variables that we are unable to adjust for are distance to a trauma center, injury severity, rates of alcohol and substance abuse, and estimates of motor vehicle use.”
Nevertheless, the research is firm in its conclusion.
“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,” its authors say. “Greater emphasis on elevated safety risks outside of large U.S. cities is in order, alongside a changed perception of urban living as a relatively safe experience.”
[PICTURED: Graphic from josephrome.com]