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Features for Senior Citizens

Most People Safer in Big U.S. Cities But More Seniors Murdered in Rural Areas

‘Cars, guns and drugs are the unholy trinity causing the majority of injury deaths in the U.S.’

July 23, 2013 – A report released today reports the surprising conclusion that in the U.S. cities are a safer place to live than are the suburbs or rural communities. There is, however, a notable exception – although overall homicide rates are lower in rural areas they are higher for senior citizens.

Researchers from the Perelman School of Medicine at the University of Pennsylvania and the Children's Hospital of Philadelphia (CHOP),analyzing 1,295,919 injury deaths that occurred between 1999 and 2006, determined that the risk of injury death was 22 percent higher in the most rural counties than in the most urban.

The most common causes of injury death were motor vehicle crashes, leading to 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 showed no difference across the rural-urban spectrum in the entire population as a whole, when age subgroups were studied, firearm-related deaths were found 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.

The new study overturning the common belief that cities are the most dangerous communities in American appears online ahead of print in the Annals of Emergency Medicine.

"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 lead study author, Sage R. Myers, MD, MSCE, assistant professor of Pediatrics, Perelman School of Medicine and attending physician, Department of Emergency Medicine at CHOP.

"Cars, guns and drugs are the unholy trinity causing the majority of injury deaths in the U.S. 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. And overall, the rate of unintentional injury dwarfs the risk of homicide, with the rate of unintentional injury more than 15 times that of homicide among the entire population.

"This has important implications about staffing of emergency departments and trauma care systems in rural areas, which tend to be underserved as it is." - lead study author Sage Myers, MD, MSCE, University of Pennsylvania

"These findings may lead people who are considering leaving cities for non-urban areas due to safety concerns to re-examine their motivations for moving. And we hope the findings could also lead us to re-evaluate our rural health care system and more appropriately equip it to both prevent and treat the health threats that actually exist."

The study examined county-level data on all injury deaths across the U.S. from 1999-2006 (because of their unusual nature, deaths from the 9-11 terrorist attacks were excluded).

Findings from the study support prior work showing that overall homicide rates are lower in rural areas than urban areas. This was found to be true in all age groups, except the oldest adults (over 65 years old).

Suicide rates, on the other hand, showed an increase with rurality, but the increased rate of suicide death in rural areas only reached statistical significance for the two youngest age groups: 0-14 years and 15-19 years.

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 areas.

Specifically, the rate of unintentional-injury death is over 15 times that of homicide for the entire population and the risk of unintentional-injury death is 40 percent higher in the nation's most rural counties compared to the most urban.

 

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The research team found that the bulk of unintentional injury deaths result from motor vehicle crashes, with motor vehicle injury-related deaths occurring at a rate that is more than 1.4 times higher than the next leading mechanism of injury death.

In rural areas, this difference is even more pronounced, where motor vehicle injury-related death rates are twice that of the next leading injury mechanism. Across the rural-urban continuum, the risk of motor vehicle-related injury death is 2 times more likely in rural areas as compared to the most urban.

"We think our work serves as a reminder that injury is an important health issue for Americans, wherever they live. Our findings can inform both targeted prevention efforts and strategic efforts to improve trauma care in the U.S. This work provides a real opportunity to build systems of medical care that are positioned to best care for the populations that depend upon them for life and limb saving treatment in their time of need," said senior study author, Brendan G. Carr, MD, MSHP, assistant professor Emergency Medicine and Biostatistics and Epidemiology at Penn.

Race was also a factor. Rural counties with large black populations had significantly lower risk of injury death than those with small black populations. The opposite was true for Latino populations: Rural counties with large Latino populations had significantly higher risk of injury death than rural counties with small Latino populations.

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

The researchers note that next steps in this line of research should focus on creating local injury priority scores – a relatively simple and objective tool that uses data available in trauma center registries to rank injury causes according to both frequency and severity – and considering innovative ways to continue to develop the U.S. emergency and trauma care system to assure that all Americans receive the best emergency and trauma care possible.

"Trauma has been a leader in planning for care from the population perspective," says Carr, referencing the interactive trauma system mapping tool created at Penn, "but we've still got work to do."

Additional Penn authors are Charles C. Branas, PhD; Benjamin C. French, PhD; Michael L. Nance, MD; Michael J. Kallan, MS; and Douglas J. Wiebe, PhD.

The research was funded by the Agency for Healthcare Research & Quality, the Centers for Disease Control & Prevention, the National Institutes of Health.

Annals of Emergency Medicine is the peer-reviewed scientific journal for the American College of Emergency Physicians, the national medical society representing emergency medicine; visit http://www.acep.org.

Penn Medicine consists of the Raymond and Ruth Perelman School of Medicine at the University of Pennsylvania (founded in 1765 as the nation's first medical school) and the University of Pennsylvania Health System, which together form a $4.3 billion enterprise.

The Perelman School of Medicine has been ranked among the top five medical schools in the United States for the past 16 years, according to U.S. News & World Report's survey of research-oriented medical schools.

The University of Pennsylvania Health System's patient care facilities include: The Hospital of the University of Pennsylvania; Penn Presbyterian Medical Center; and Pennsylvania Hospital - the nation's first hospital, founded in 1751.

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