Rural areas of the U.S. boast much higher rates and severities of injuries needing hospitalization in most categories, compared to that country’s cities, according to a West Virginia University study.
WVU’s Injury Control Research Center on Monday announced the results of its findings in the January 2009 issue of the American Journal of Preventive Medicine, which shows rural safety issues are about much more than just quick or local access to care.
“The perception is that life in rural areas is peaceful, tranquil, serene,” said Dr. Jeffrey Coben, one of the study’s authors, in a WVU release Monday.
“If you just look at violence — person against person — the rates are higher in urban areas. But for virtually every other cause of trauma, the risks are substantially greater in rural areas.”
Out of about 1.9 million injury-related hospitalizations analyzed from a previous nationwide study of hospital inpatients from 2004 — the most recent year available — the WVU researchers found that the rates of hospitalization “generally increased with increasing rurality.”
Specifically, injury rates were 27 per cent higher in large rural counties and 35 per cent higher in small rural counties. Large urban counties showed the highest hospitalization rates for assaults, but rural populations showed higher rates from “unintentional” injuries including motor vehicle crashes, falls and poisonings, as well as higher rates for self-inflicted poison, firearm and blade injuries.
Policies and programs
“By demonstrating that there’s also a significantly higher injury rate in rural areas, we’re showing an increased incidence of injury is the problem — not just access to care or the promptness of care,” Coben said in Monday’s release.
For example, injuries from motor vehicle crashes are much more prevalent in rural areas because “not only are people more likely to drive longer distances for recreation and to work, but also seatbelt usage is lower,” the study authors said.
Also, “highway improvements such as barriers or dividers between opposing lanes are less likely to be in place, and roads that wind through mountainous areas are more likely to be treacherous.”
As well, the release noted, “previous studies have shown that people who live in rural areas are more likely to take part in risky behaviours such as recreational drug use, drunken driving or failing to use seatbelts. Plus a culture of self-reliance may cause people to undertake household fix-up chores that are inherently dangerous, such as roof repairs.”
The researchers found the average hospital bill per injury was US$27,000, not counting the costs of follow-up rehabilitation or long-term care related to the injury. Half the patients hospitalized with injuries were covered by U.S. public Medicare or Medicaid, so these costs fall upon the public, Coben said. On a per-capita basis, hospital charges were highest for rural populations.
Thus, states with large rural populations might want to consider “even greater” emphasis on policies and programs such as making child car-seats, household smoke detectors and bicycle helmets available. Such programs have been found to be effective in urban areas, he said.
“Many of these increased risks are potentially preventable or modifiable,” Coben said. Prevention and intervention efforts should focus on risk factors unique to rural populations, the study urged.
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