National Geographic Daily News
A wrecked car in Somerset, England.

There are more car deaths per person in rural areas than cities, a new study says.

Photograph by Rachel Husband, Alamy

Brian Clark Howard

National Geographic

Published July 24, 2013

For years, people have moved to the country to escape the dangers of big city life. But new research suggests that they may be better off staying put.

A study called "Safety in Numbers: Are Major Cities the Safest Places in the United States?" was published this week by the American College of Emergency Physicians. The researchers, led by Sage R. Myers of the Children's Hospital of Philadelphia, noted that until their work, the overall injury risk in urban areas versus suburban and rural areas had not been fully described.

So Myers's team attempted to classify deaths from injuries "across the rural-urban continuum." They looked at data on 1,295,919 deaths from injuries in 3,141 U.S. counties from 1999 to 2006. These deaths were caused by car accidents, shootings, falls, drowning, suffocation, and more.

"Injury mortality increased with increasing rurality," the scientists wrote. "Urban counties demonstrated the lowest death rates, significantly less than rural counties."

The researchers found that the risk of death from injury was 1.22 times higher in the most rural counties, compared with the most urban ones.

Five surprising facts from the study:

1. Cities Aren't Statistically More Dangerous.

In the paper's introduction, the authors note that overall deaths from injury have historically been higher in cities. But they noted that since 2008, more than half of the world's people have lived in urban areas. In the U.S., as in many other countries, urban counties have more people than rural ones. And when the number of deaths from injuries are averaged out across that higher population, it turns out that the risk to any given individual looks lower for urban dwellers.

In addition to that statistical effect, the researchers noted, "Paradoxically, research also exists suggesting that rural areas bear a disproportionately high level of risk for certain serious injuries such as suicide and motor vehicle injuries, raising the possibility of increased safety threats to rural inhabitants."

The paper also noted that trauma physicians tend to be more accessible and better trained and equipped in urban areas, which may contribute to lower death rates from all kinds of injuries.

People in rural areas also tend to spend more time doing what the researchers deemed the most dangerous activity: riding in cars. In the time period of the study, death from motor vehicle accidents occurred at a rate of 14.9 people per 100,000.

The next most common cause of death by injury, guns, occurred at a rate of 10.4 people per 100,000. Further down the list were poisoning, drowning, suffocation, and falls.

Overall, the injury death rate was 56.2 people per 100,000. The rate for unintentional injury was 37.5 per 100,000, while the rate for intentional injury (homicide and suicide) was 17 per 100,000.

2. Deaths From Injuries Ticked Up, Not Down.

With advancements in emergency medicine and motor vehicle safety, plus years of public awareness campaigns around issues of driving, gun safety, and suicide and violence prevention, you might get the idea that injury-related deaths are on the decline.

Not so, according to the paper—at least during the years between 1999 and 2006. In that period, the rate of injury-related deaths increased by about one percent.

3. Rural Areas See More Car Deaths Than Suburbs or Cities Do.

It may come as a surprise to anyone who has suffered a fender bender in a mall parking lot, at a busy intersection, or along a jammed expressway, but the researchers found that, statistically, death from auto accidents increased sharply the more rural a county was. They found this to be true across all age groups they sampled.

Although rural areas have fewer cars, there may be differences in driving behaviors, as well as restricted access to medical assistance.

4. Race Correlates to Injury Rates in Surprising Ways.

The paper reported that rural counties with the highest percentage of black inhabitants showed a significantly lower risk of death from injury, compared with rural counties with the lowest percentage of black inhabitants. But urban counties with the highest number of black residents showed no difference in risk of injury death, compared with urban counties with the lowest number of African-Americans.

Rural counties with the highest percentage of Latinos had a significantly increased risk of injury death, compared with urban counties with the highest percentage of Latinos. Rural counties with a larger Latino population also had a higher risk of injury death than rural counties with a smaller Latino population.

When it comes to what the study called the "protective" effect of black residents in rural areas, the authors said the factor needs more research. But they suggested that possible causes may include the relatively low suicide rate among African-Americans, and the location farther from highways of some historically black rural neighborhoods, which may decrease the rate of traffic accidents.

The authors did not comment on the findings about Latinos.

5. Higher Education and Income Equals More Deaths.

The researchers reported that rural counties with the highest percentage of college-educated residents showed a significantly increased risk of injury death, compared with urban counties with the highest number of college-educated residents. Rural areas with the most educated inhabitants also showed higher risk than rural areas with the least educated inhabitants. In contrast, there was no difference in risk of injury death between urban areas with highly educated versus less educated inhabitants. Rural counties with the highest median income showed more risk than urban counties with the highest median income. Rural counties with the highest income showed more risk than rural counties with the lowest income.

The researchers wrote that more information is needed to explain these surprising trends regarding education, though they suggested that they might have to do with access to health care and other services.

Are you surprised by these results? Share your thoughts in comments.

Follow Brian Clark Howard on Twitter and Google+.

41 comments
june kay
june kay

Why were the race finding more surprising than lets say the higher education? What was the p-value for this study. Cause does not equate effect.

aimee Harris
aimee Harris

Sure.  The elite do not want you living in rural areas.  You have freedom and space and you are far less likely to be harassed by police. Plus you have the right to protect your property with force. (City police are finding every way possible to disarm citizens.

Bobby H
Bobby H

Statistics can be rather blind when describing  danger. Most of the traffic accidents I see are on rural stretches of interstate highways with people driving from city to city and has very little to do with living in the area where these accidents would be reported. Also, while the national average of deaths from guns is at a rate of 10.4 people per 100,000, some cities have a gun death rate as high as 50 per 100,000 while rural area have very low rates. We might be horrified if we took a closer look at living in cities combined with traveling.

Paige Peterson
Paige Peterson

Funny that this article mentions guns being the 2nd highest cause of death by injury, but fails to relate it to what the study said about guns.  In case anyone was wondering, the study states:

"In this time-series analysis of 1,295,929 injury-related deaths in the United States, overall injury and vehicular trauma death rates were higher in rural areas. This pattern was not seen in firearm-related death rates."

Stewart Hurry
Stewart Hurry

In the rural area where I live, deer are involved in more than two thirds of the fatal car accidents. It is also standard to drive about 10 % faster than the limit, even in winter weather, and because we need the car to go anywhere at all, we are often alone in our vehicles. It is locally accepted that falling asleep at the wheel is not unusual.

Hard to find deer in Central park, or to fall asleep at the wheel on Broadway. I find it strange that none of these factors are mentioned. Interaction with wildlife is well recognized in most car accident studies.

Miriam Shelton
Miriam Shelton

I'm curious about the death rate of Latinos. Is this because in rural areas where Latinos are concentrated, there is more intense agriculture and more agricultural deaths, i.e. safety problems? or lifestyle problems? Does the study distinguish these?

Miriam Shelton
Miriam Shelton

I'm curious about the death rate of Latinos. Is this because in rural areas where Latinos are concentrated, there is more intense agriculture and more agricultural deaths, i.e. safety problems? or lifestyle problems? Does the study distinguish these?

Kilt Joy
Kilt Joy

I'm in charge of my own safety, I drive speed limits & adjust for dangerous conditions, and no current plans for suicide, so I'd rather statistic of danger from others as a proper indicator.

Trent Landers
Trent Landers

As someone who has lived in a rural area for the last 23 years, IMHO the one factor that remains on everyone's "danger" list is ROADS. Rural roads tend to be located in areas where the county does not provide adequate maintenance. Maintenance is left up to local general improvement districts that are allocated tax dollars according to population. Roads tend to be dirt and often of "washboard" quality, with high amounts of gravel shoulders and of narrow widths. As the voting population coincides with the low population, politicians and city bureaucrats who decide who gets what money tend to disregard the needs of these outlying areas until some corporation, usually an LLC, finds something of value to exploit with very little cost to the corporation and the rural population having to pay for decisions made by bureaucrats on the county commission boards. We pay the same taxes as urban dwellers per dwelling but do not see the full return of tax money due to low population. This may seem appropriate but it takes much more money to live here than in a over populated urban setting. With no road maintenance your car or more likely your truck, takes a beating, you have no schools, no fire protection other than volunteer, no medical facilities (one must use "Care Flight" to take emergencies to the hospital), no broadband for adequate computer usage, poor reception for television, no sewage disposal, no water treatment and the upkeep responsibilities for improvements on your property fall solely to the owner of the property (fire abatement, main road drainage culverts for rain dispersal, etc.) It takes a pioneer spirit to live in a rural area, devoid of urban improvements.

Rigal Atta
Rigal Atta

One of the big findings here seem to be a basic one, cars are deadly. The more time you spend in one and the faster the speed you are going (highways) the greater the risk.  

I wish the authors would had separated suicide from intentional homicide. Yes, I know suicide is homicide, but not many people move anywhere to avoid killing themselves.  One reason you hear for wanting to move away from cities, higher murder rates, that and many other crimes.

Rent Strike
Rent Strike

Re: 5, Bet that's educated city folk moving to the country and not knowing how to use a chain saw.

Ben Towne
Ben Towne

"When it comes to what the study called the "protective" effect of black residents in rural areas, the authors said..."

If they're calling it a protective effect, they are making statements and assumptions about causation that (at least by this write-up) do not appear to be supported by the correlation. 

John C.
John C.

Overall, the injury death rate was 56.2 people per 100,000. The rate for unintentional injury was 37.5 per 100,000, while the rate for intentional injury (homicide and suicide) was 17 per 100,000.

17 + 37.5 = 54.5

Diane Stepro
Diane Stepro

After reading the following statement, I found myself a bit confused.  Does this remark apply to rural areas, urban areas, or overall accidents?

Howard wrote,"The next most common cause of death by injury, guns, occurred at a rate of 10.4 people per 100,000. Further down the list were poisoning, drowning, suffocation, and falls."

Daren Nelson
Daren Nelson

Listen to what they say! Stay in your cities! Leave us rural folk alone, according to their stats we'll kill ourselves off & save all y'all a lot of worry. I kinda like the solitude I find out in the "sticks". The reality of the situation is that most of the vehicle accidents are from folks not familiar with the area, & not paying attention to what they're doing. The same goes with the shooting accidents, they're not familiar with weapons & gun safety.

Joseph Linzner
Joseph Linzner

Statistics can be bent and tailored to show anything you wish. I was a collision investigator for the California Department of transportation for nearly 12 years and the statistics, particularly on highway safety, are totally out of whack. The counties for which I was responsible had so few concentration locations and fatalities that factually belie the quoted statistics. Then to put some reality to those few collisions I investigated were 99% caused by drivers not local but either tourists, fishermen and or skiers. So the rural people did not face greater risk at all but people from Urban Areas brought their irresponsible habits along with them. Secondly, the collisions are generally (at least 99%) single car run off the road collisions. Rarely are the locals involved. Guns are another misrepresented statistics, one just has to ask the question if one would feel safer to walk down the streets in Detroit, Chicago, New York or a town of 300 people. and a single road through town. Then take that a step further, what is the definition of rural. Any time people gather together in groups or a community of how many are we to assume is urban or rural. By definition rural indicates a far flung collection of people without a central district. Urban is a collection of people around a central district . A clear definition of their definition of Urban is not given so statistics can be bent to suit the theory. Particularly the collision experience I personally witnessed disproves their conclusions. The problem with numbers is that they do not go far enough.... 

David Reynolds
David Reynolds

I am not surprised by the results, I am surprised by the conclusions drawn from the results. 

If the Authors of this study aren't careful with their findings, there will be people flocking to get their kids into Inner City Schools. 

E.C. Johnson
E.C. Johnson

This is so much crap....NG is part of Obama's socialist machine. His plan is to get everyone in the cities where they can be observed and controlled. All of us independent-minded, gun owning, do-it-yourself-ers hiding out in the country can't be allowed to exist off the land - we have to be made dependent like the rest of the government sucklings. Ridiculous!

Robb Murray
Robb Murray

This is a case of figures don't lie, but liars can figure. Most of those deaths that happen in rural areas and on rural roadways are city people who die in the country. Rural road deaths are higher because few cities have highways with the high speed limits and thus the higher rate fatal accidents. How many people die in accidents in a 35MPH zone? 


There are more suicides in the country because people like to come out from the city to kill themselves where they can get some privacy. Its the people from the city that make the country more hazardous. They are usually the ones that have the accidents on country roads in foul weather because they won't slow down and use good driving practices. The only reason the city is statistically safer because they have lower speed limits and a higher population density. Try doing those calculations with only the deaths of rural residents in rural areas.

Benjamin Steele
Benjamin Steele

@Paige Peterson I haven't looked at this study, but I've seen lots of this kind of data. Another distinction can be made besides just rural vs urban. The rural North doesn't have a high firearm-related death rate. The rural South does. On many types of data, there are differences between the North and South, whether in terms of rural or urban areas.

Benjamin Steele
Benjamin Steele

@Rigal Atta I'm sure most people don't think of suicide when they move somewhere, but maybe they should. In rural areas, you are more likely to be killed by someone you know, by family, friends, neighbors or yourself. That seems to imply some very important difference, but I'm not exactly sure what it means. This is particularly seen in the rural South where all types of rates for death and risky behaviors are higher.

Trent Landers
Trent Landers

@Rent Strike I have 3 PhD's living within a quarter mile of me and we all know how to use a chain saw and how to put out a fire that may be caused by that usage. We also know how to put in an irrigation system for 40 acres, tend to our live stock, which we butcher for food, and suture up a nasty cut on an animal or even one of the kids. We fix our own vehicles and confront our elected officials much more on a per capita basis than "city folk". It seems as though it is urban folk like you who are ignorant. Not all rural folk are toothless and live in the south.

Benjamin Steele
Benjamin Steele

@Ben Towne I doubt it is causal. Blacks have historically had low rates of suicide whereas whites have historically had high rates of suicide. There would only be a protective effect if it was caused by cultural differences which is possible. An area with a majority of blacks might have a different dominant culture which might alter the public attitude about suicide. It would be interesting to see the research about that hypothesis.

Benjamin Steele
Benjamin Steele

@Daren Nelson It is problematic if you generalization too much. I live in the Midwest. the rural North has lower rates of deaths, risky behaviors and social problems. The opposite is found in the rural South. So, a person would be safer to move to the rural North than to the rural South, except maybe for suicide with rural Southern communities with majority black populations.

Trent Landers
Trent Landers

@Joseph Linzner Now here's a man that knows how to read and think instead of making wise a** remarks about people he knows nothing about. Good on you Mr. Linzner!!

John C.
John C.

@Joseph Linzner 

True, they need to look at police reports to see if the victims are residents or transients instead of assuming they are residents.

Laird Popkin
Laird Popkin

@Joseph Linzner The article made the math sound more complicated than it actually was, by describing it as "statistical" rather than "division". It's actually pretty simple - if you take the number of deaths and divide it by the number of people, you get deaths per-person, and it turns out that deaths per-person in cities is lower than it is in more rural areas. For example, I recently moved from NYC to Florida, and the statistics were shocking - the murder rate per-person here is much, much higher than in NYC.

As for whether you feel safer in a town of 300 people or in NYC, well, that's hard to say. But if there was one murder every ten years in the town of 300 people, and NYC has one murder a year per 20,000 people (which was the number in 2012) then you would be 7x safer in NYC than in that small town. But as to whether you _feel_ safer in the small town, well, that's about emotion and not facts, and you might feel safer if you didn't know how to divide, or if you found urban areas threatening emotionally.

Rather than claiming that there weren't definitions of urban and rural, and asserting that the numbers "don't go far enough" perhaps you should read the study rather than a short summary.

Your theories about people from cities going out into the country to die are interesting, but is it based on any evidence? It rather sounds like you're trying to twist the data to suit your theory that rural areas are safer than cities. 

elaine smith
elaine smith

@E.C. Johnson 

How did YOU become so paranoid?  Also, when did President Obama become Superman?  Calm down!  YOU sound more threatening to ME than any city dweller.

B. Cogburn
B. Cogburn

@Robb Murray You were doing OK when you mentioned a lot of the traffic deaths were probably attributable to commuters not from the area.  But suggesting that people from the city flock to the country in order to off themselves just shows how desperate you are to avoid recognition that living in "the country" could have some downsides as well.  I'm from a small farming town, population ~2000.  This town was surrounded by similarly small farming towns.  Nearest "big city" was 18 miles away, and that was only 100K pop (IOW, a 'big city' to us was 100K).  However, we did live right on a major expressway corridor, I-75.  And there were traffic fatalities all the time in our area on I-75, most of them involving travelers and commuters who weren't from our local area, nor even those surrounding small towns.  So on that, I call shens.  But let me tell you, there is PLENTY of mental illness and suicide in 'the country".  Mental health services and, perhaps even more importantly, attitudes toward mental health problems, is MUCH worse.  There are folks suffering mightily here who either can't get the help they need, or even if they could, the general attitude and awareness toward mental illness is deplorable, so they don't seek help because they, too, have been "indoctrinated" to disbelieve in mental health as a real problem.  Alcoholism is rampant, its just that the local drunk can drive home from the bar without getting stopped or having an accident most of the time, due to the sparse law enforcement patrols and traffic density.  Alcoholism runs in both sides of my family, and BOTH sides are from a different state than I was raised, though similarly rural.  My hometown was pretty good, actually.  The economy was decent, and so were the schools (owing to the local economy).  But I've been to Appalachia.  I've seen very dysfunctional rural communities, where it seems the entire population is depressed and has been for many generations, have given up hope, where there is a 'hidden' despair among the people.  i.e. its why methamphetamine and oxycodone are positively rampant in many Appalachian communities, killing an entire generation like gun violence and gangs in the urban centers.  Their schools are often sh-t.  Their local colleges are often sh-t.  Their local/regional economy is often sh-t and depressing (i.e. you have a choice to go into the mines or the mills or Walmart, otherwise, you don't get a good job, and there aren't even enough of those jobs for 50% of the young persons).  As for gun violence, everyone knows by now that SUICIDE is usually lumped in with 'gun violence' statistics.  And there are MORE suicides annually than homicides.  There can be some positives and upsides to the country or smaller communities, but it ain't all Mayberry.

Queued Queuedington
Queued Queuedington

@Robb Murray This is a case of "I can cling to any belief despite any facts."  Is there any evidence -- or is it really even a rational thought -- that suicidal city dwellers would flock to rural areas to off themselves?

Joseph Linzner
Joseph Linzner

@Laird Popkin @Joseph Linzner I understand the math very well, for the very reason you mention, if you have 1000 murders in a city of one million in one year and if you have one murder in a town of 1000 people in one year the extrapulation result would be the same for the example I gave. Oh and my post said absolutely nothing about people from the cities going to rural areas to die?? The point I am trying to make is that the difference between rural and urban areas are definitions that I interpret differently than the authors. My reply aims at the story as presented by National Geographics based on the assumption that they represented the views of the study accurately, leaving chaff where it belongs. I also appreciate your personal admonishments knowing full well that they assert your personal superiority. Thanks again for your enlightened understanding.  I withdraw my opinions. Thanks for the reply...

Joseph Linzner
Joseph Linzner

@Trent Landers @Laird Popkin @Joseph Linzner That means that there are 9 years that would be murder free whereas in the city you have murders every year. Statistically via numbers the probability says there are fewer 1 in 300 vs 1 in 20,000 statisticall significant yet the exposure is yearly in one a 10 years in another. Funny isn't it, where is the common denominator. So you take that one over 300 times 10 you get 3,000 or 1 over 3000 but 1 in 20000 x 10  then what   apples and oranges I still say, manipulate and have fun.

Queued Queuedington
Queued Queuedington

@Joseph Linzner Are you ... clinically insane?  I'm not sure if you lost the point that people who live in the city don't get farm subsidies, because, they live in the city and not a farm.  My point is that the same type of twit who imagines that every city dweller is a welfare queen somehow forgets that the government directly bolsters farm income.

Laird Popkin
Laird Popkin

@John C. @Queued Queuedington @Robb Murray There have been several such studies. The large majority of traffic accidents and deaths happen within a few miles of people's homes. For the fairly obvious reason that's where people spend the large majority of their time.

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