Do big cities have an undeserved reputation for danger? A new study says when all types of fatal injuries are considered, you're 20 percent more likely to die from injury in most rural areas than in urban ones.
"Perceptions have long existed that cities were innately more dangerous than areas outside of cities, but our study shows this is not the case” said Dr. Sage Myers, the lead author.
The study, published Tuesday in The Annals of Emergency Medicine, reviewed data from every U.S. county and encompassed more than 1.2 million injury death cases spanning 1999 - 2006 to see where the most deaths from accidents are happening.
The city and the countryside have competing public health scourges: gun violence and car crashes, which are the two top categories for injury deaths (followed by poisoning) -- but car crashes are more common. And people in rural areas are more likely to die in a car crash than people in a city are likely to die from a bullet.
Although the study doesn't speculate on causes, the traffic death disparity has been studied before: people in rural areas drive more --and drive faster. That's partly why rural two-lane highways have the highest proportion of fatal crashes of any kind of U.S. roadway. People in the city tend to take shorter trips and use transit, which, despite high profile coverage of the occasional fatal accident, is much safer than driving a car.
According to the study, the risk of motor vehicle-related injury death is twice as likely in rural areas as compared to the most urban.
And guns turn out to be essentially a wash -- the study finds that gun deaths are equally likely in rural and urban counties.
"Overall, ﬁrearm deaths showed no signiﬁcant differences in risk of death between the most rural and most urban counties. However, within the age subgroups, ﬁrearm deaths showed very different patterns across the rural-urban landscape," the researchers write. Overall, homicide rates are higher in urban areas, while suicides are higher in rural.
"However, the magnitude of homicide- and suicide-related deaths, even in urban areas, is far outweighed by the magnitude of unintentional-injury deaths – such as those from car crashes and falls – in nonurban areas, especially in rural nonurban areas,"
For kids under 14 and adults over 45, the risk of a firearms death is higher in rural areas, while 20-to-44 year olds face a higher risk in cities. Overall, the risk balances out and so, guns don't tip the scale of safety toward the suburbs or countryside.
In the end, in the most rural areas, people have a 22 percent higher chance of dying by injury than people in cities. Suburbs fall in between.
The study calls for better trauma care in the U.S.