Rural–Urban Differences in Injury Hospitalizations in the U.S., 2004

Department of Emergency Medicine, School of Medicine, West Virginia University, Morgantown, West Virginia 26506-9151, USA.
American journal of preventive medicine (Impact Factor: 4.53). 02/2009; 36(1):49-55. DOI: 10.1016/j.amepre.2008.10.001
Source: PubMed


Despite prior research demonstrating higher injury-mortality rates among rural populations, few studies have examined the differences in nonfatal injury risk between rural and urban populations. The objective of this study was to compare injury-hospitalization rates between rural and urban populations using population-based national estimates derived from patient-encounter data.
A cross-sectional analysis of the 2004 Nationwide Inpatient Sample was conducted in 2007. Rural-urban classifications were determined based on residence. SUDAAN software and U.S. Census population estimates were used to calculate nationally representative injury-hospitalization rates. Injury rates between rural and urban categories were compared with rate ratios and 95% CIs.
An estimated 1.9 million (95% CI=1,800,250-1,997,801) injury-related hospitalizations were identified. Overall, injury-hospitalization rates generally increased with increasing rurality; rates were 27% higher in large rural counties (95% CI=10%, 44%) and 35% higher in small rural counties (95% CI=16%, 55%). While hospitalization rates for assaults were highest in large urban counties, the rates for unintentional injuries from motor vehicle traffic, falls, and poisonings were higher in rural populations. Rates for self-inflicted injuries from poisonings, cuttings, and firearms were higher in rural counties. The total estimated hospital charges for injuries were more than $50 billion. On a per-capita basis, hospital charges were highest for rural populations.
These findings highlight the substantial burden imposed by injury on the U.S. population and the significantly increased risk for those residing in rural locations. Prevention and intervention efforts in rural areas should be expanded and should focus on risk factors unique to these populations.

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Available from: Hope M Tiesman, Feb 24, 2015
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    • "There was a significant difference between Finnmark and the other areas in the data from Statistics Norway. This category did not follow an urban-rural gradient, which is in line with higher suicide rates being reported in rural communities [3,14,15], whereas other studies have identified this as an urban problem [16]. This study does not report suicides committed by poisoning, and thus the complete picture is not provided. "
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    ABSTRACT: Background Many studies indicate rural location as a separate risk for dying from injuries. For decades, Finnmark, the northernmost and most rural county in Norway, has topped the injury mortality statistics in Norway. The present study is an exploration of the impact of rurality, using a point-by-point comparison to another Norwegian county. Methods We identified all fatalities following injury occurring in Finnmark between 2000 and 2004, and in Hordaland, a mixed rural/urban county in western Norway between 2003 and 2004 using data from the Norwegian Cause of Death Registry. Intoxications and low-energy trauma in patients aged over 64 years were excluded. To assess the effect of a rural locale, Hordaland was divided into a rural and an urban group for comparison. In addition, data from Statistics Norway were analysed. Results Finnmark reported 207 deaths and Hordaland 217 deaths. Finnmark had an injury death rate of 33.1 per 100,000 inhabitants. Urban Hordaland had 18.8 deaths per 100,000 and rural Hordaland 23.7 deaths per 100,000. In Finnmark, more victims were male and were younger than in the other areas. Finnmark and rural Hordaland both had more fatal traffic accidents than urban Hordaland, but fewer non-fatal traffic accidents. Conclusions This study illustrates the disadvantages of the most rural trauma victims and suggests an urban-rural continuum. Rural victims seem to be younger, die mainly at the site of injury, and from road traffic accident injuries. In addition to injury prevention, the extent and possible impact of lay people’s first aid response should be explored.
    Scandinavian Journal of Trauma Resuscitation and Emergency Medicine 03/2013; 21(1):14. DOI:10.1186/1757-7241-21-14 · 2.03 Impact Factor
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    • "This rural county (48,000 km2) is comparable in size to Belgium but with a population of 72,500 [2]. Rural areas have a higher rate of injury-related deaths than urban areas [3–6], which has been attributed to longer travel distances, delayed surgical care, fewer personnel trained in advanced life support techniques, and behavioral patterns among the populace [7–11]. Finnmark has had an injury-related death rate well above the national average for decades (Fig. 1). "
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    ABSTRACT: Finnmark County is the northernmost county in Norway. For several decades, the rate of mortality after injury in this sparsely inhabited region has remained above the national average. Following documentation of this discrepancy for the period 1991-1995, improvements to the trauma system were implemented. The present study aims to assess whether trauma-related mortality rates have subsequently improved. All injury-associated fatalities in Finnmark from 1995-2004 were identified retrospectively from the National Registry of Death and reviewed. Low-energy trauma in elderly individuals and poisonings were excluded. A total of 453 cases of trauma-related death occurred during the study period, and 327 of those met the inclusion criteria. Information was retrievable for 266 cases. The majority of deaths (86%) occurred in the prehospital phase. The main causes of death were suicide (33%) and road traffic accidents (21%). Drowning and snowmobile injuries accounted for an unexpectedly high proportion (12 and 8%, respectively). The time of death did not show trimodal distribution. Compared to the previous study period, there was a significant overall decline in injury-related mortality, yet there was no change in place of death, mechanism of injury, or time from injury until death. Changes in injury-related mortality cannot be linked to improvements in the trauma system. There was no change in the epidemiological patterns of injury. The high rate of on-scene mortality indicates that any major improvement in the number of injury-related deaths lies in targeted prevention.
    World Journal of Surgery 05/2011; 35(7):1615-20. DOI:10.1007/s00268-011-1102-y · 2.64 Impact Factor
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    ABSTRACT: Rural residents generally experience a higher rate of injury than residents in urban settings. This article sought to identify and compare the pattern of injury mortality and hospitalised injury morbidity for urban and rural residents in New South Wales (NSW), Australia. Hospitalisation data for 1 July 2000 to 30 June 2005 and Australian Bureau of Statistics mortality data for 1 January 2000 to 31 December 2004 were obtained for NSW residents. The enhanced Accessibility/Remoteness Index of Australia (ARIA+) was used to define urban and rural locations. Standardised hospital admission ratios (SAR) and standardised mortality ratios (SMR) compared urban and rural injury hospitalised morbidity and mortality, respectively. The rate of hospitalised injury (1755 vs 2482 per 100,000) and injury mortality (33.2 vs 48.1 per 100,000) was 1.5 times as high for rural compared with urban residents. Rural males aged 70 years and over and 20-34 years had particularly high injury mortality rates. There was variation in the ratio of injury mortality and hospitalised injury between rural and urban residents by injury mechanism, with rural residents experiencing higher SMRs for machinery (4.84), firearms (4.20), struck by/struck against (3.52), fire and burns (2.08), natural and environmental factors (1.91), motor vehicle crashes (1.88), interpersonal violence (1.58), suffocation (1.51) and self-harm (1.36) injuries and higher SARs for all mechanisms, except drowning-related admissions. Differences exist in the injury hospitalisation and mortality rates between rural and urban residents, with rural injury rates higher than urban injury rates. Mechanisms of injury that have demonstrably higher SMRs and SARs in rural compared with urban locations should be targeted for injury prevention activity in NSW.
    Rural and remote health 01/2010; 10(1):1326. · 0.88 Impact Factor
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