Avoid death by injury- Live in a city

The New York Times,Science Section today reported the result of a study, published in The Annals of Emergency Medicine, finding that deaths by injury are much lower in large cities versus rural areas. The study covered an analysis of 1.3 million deaths by injury, in more than 3,000 counties, nationwide from 1999 through 2006.

I told you guys that we city boys really did know how to lead "La Buena Vida" !

The quick availability of EMS, hospitals close by, or even bystanders to call 911 when something happens probably plays a large role in the higher mortality among rural folks.

I would assume they broke down the injuries by type. The kinds of injuries suffered in rural areas might be more severe than your typical urban injuries. Less heavy machinery or chemicals involved in the city, I would imagine.

DUI could be important. There are more options to get home after drinking in urban areas besides getting behind the wheel yourself and driving long distances.

The rural population is generally older than the general urban population in many locales. Older folks are more prone to various injuries and more likely to succumb to their injuries than younger people.

My two cents from a city boy.

Everybody has to die somehow. I wonder what the other stats are. For example, if deaths by cardiac arrest, cancer, or suicide are a higher rate in the city, that's not a desirable trade-off.

While living "la vida loca"...

I can't seem to find the study. Do you have the URL? I'm finding articles to read on monogamy, killer whales, standing water waves...

Knowing the risks are nice, but I'm afraid we're all going to pick our location based on many other factors, and I doubt this study will make anyone relocate. We seek pleasure, right? If there are risks, we try to manage them.

Bingley my friend , you are correct . That article is not on the NYT website. But it is in the 7/30 paper edition, on page D4 of the Science Section. Strange? However , if you Google "study, cities less injury prone", it does show-up on the NY Daily News website.

The comments offered to explain the test results are all plausible , but perhaps incomplete. City dwellers, due to density and rapidly changing micro environments, e.g. Trains, traffic, crime, crowds, dicey neighborhoods, etc. are more street savvy. They pay more attention. They actively teach "street smarts" to their kids. I think It makes a difference.

My wife and I both grew up and were educated in very dense working/ middle class urban neighborhoods. We can walk down an avenue, turn to walk up a street and just know its "wrong" an go on to a safer cross street. We ended up raising our kids in a leafy suburb, over my objection, based in part on an inability to convey that street smarts in the burb environment. I had to take the kids to the City and walk them around, repeatedly, to teach them some semblance of street smarts. It got better when they went to urban universities.


No flame intended, but in our rapidly urbanizing world, city survival skills are much more likely to be needed by John and Jane Doe, than wilderness skills. And to head off some criticism, I agree that some skills overlap, e. g. First aid, driving safety. But, your average Scout cannot read a train/ bus schedule, sense a bad block, evacuate a train tunnel, de-escalate a combative encounter with a drunk , etc.

Just my two cents. "Opinions differ."

This morning, I was skimming the actual study the news is based on. The authors conclude:

So, it's mostly car crashes that drive this urban/rural difference. They found that homicide risks were indeed higher in urban areas, but the motor vehicle risk for rural folks was much bigger and overshadowed the homicide risk.

If you look at numbers for all violent deaths (be it MV accidents or drive by shootings), I'll take my chances in a rural setting. The most violent predator out there is man and high concentrations of peeps seem to have an exponential impact on that violence factor.
$.02

Russ you might think that, but the actual data seems to suggest otherwise. From Country life riskier than city living, U.S. study shows:


You can read the actual study at http://www.annemergmed.com/webfiles/images/journals/ymem/FA-5548.pdf

Thanks, interesting study. I'll need to study it a bit more but taken at face value the only thing I can think of is proximity (time/distance) to emergency services. I cannot imagine how a rural setting itself would be more inherently dangerous than urban. Thanks again.

It's probably got something to do with human psychology that we're willing to put up with the risks of unintentional injuries and not with the those of violent crime, even though the former may be greater than the latter.

As for being "street smart," I suspect a lot of that may be somewhat local and period-dependent. Other than the obvious sort of guideline that anyone can follow ("avoid unlit, isolated alleys in the middle of the night"), much of what you need is based on recognizing certain patterns or patterns of behaviors, and knowing what kind of risks these patterns pose. Gang colors, guy looking to sell drugs, muggers casing potential victims, con artists trying to get money with a sob story, frauds trying to entrap you in a manufactured traffic accident, etc. But whereas wilderness survival skills can be codified in a book -- nature doesn't change that much -- this kind of urban stuff changes a lot. Perhaps the nature of crime doesn't change so much, but the specific details we need to pick out a pattern can change. So whereas Boy Scouts can learn to start a fire or canoe, maybe it's just harder to learn how to survive in the city.

People who aren't used to managing the risks of living in the city just may not have the skills to make themselves safer. They choose to blame the environment as dangerous, and they refuse to change their behavior to improve their own safety. Let's take a simple example. I had a roommate who drove me nuts because he didn't like locking the door, and didn't think it was that important. He got into the practice of locking doors for a few weeks when he heard about a rash of crimes in the neighborhood, but then he stopped -- because it was all safe again in his mind. I grew up in a city. I lock the front door reflexively even if I'm just going out to drop off the garbage at the dumpster. So I feel sad whenever a story comes up about attacks on tourists in big cities. Sometimes these guys put themselves at risk without ever realizing it, by going to places that I'd never go to at the wrong time of the day.

So I think some people just adopt the urban survival strategy of staying away from the city, because they just don't have the knowledge of surviving in the city. Some of them may even choose to regard wilderness survival as an inherently more valuable skill than urban street smarts. This sort of stuff can also be due to a cultural divide as well.

... and for those of us who were raised rural, lived and worked on a farm in our youth, the rural environment may be a safer choice simply because we know those risks just like folks raised in the inner city think they know those risks. Other than proximity to emergency services, I wonder how many of those rural accidents are urban folks out of their element???

Time and distance to emergency services might be part of it. Another factor might be that people tend to drive faster in rural areas. Lots more fender benders in the city, but those don't usually involve serious injury. High speed wrecks on roads and highways in the country tend to be lethal.

I found the quote on firearms interesting. There are probably more murders in urban areas. On the other hand, firearms are probably more common in rural homes, so there may be more accidental shootings? Certainly there are fewer hunters getting shot in the city.

Lots of people are injured in farming accidents (machinery, pesticides, etc).

Perception of danger doesn't always align with actual danger. Many people who are nervous about flying in an airliner think nothing of hopping in their car for a drive, but statistics show that auto travel is orders of magnitude more dangerous than flying on an airliner.

I haven't had time yet to do a detailed read of the original article, but it looks interesting.

Thanks for the link, AKSAR!

Is it just the reporting, or does the study equate "death by firearms" to homicide rate? It would seem to be that there are also stabbings, strangulations, and beating deaths in cities. These could contribute to urban mortality rate.

Another thing that occurred to me is that perhaps there is a higher gun ownership rate in rural area, increasing the chances for gun-related accidents. That would seem to be supported by the study, which says that children and old people are more likely to suffer firearm-related deaths in rural areas -- presumably because they have a greater chance of mishandling firearms. In urban areas, the gun-related deaths are perhaps the result of crime, given the age range of the victims.

Russ, you don't have to defend your choice of where to live. After all, we can't pick our life just by the dangers, but also by the pleasures. Right now I live in a relatively safe small town where the main threat is tornados. If I had my choice, I'd move to a certain expensive city prone to natural disasters, with a significant crime problem, a more stressful lifestyle, a corrupt government, etc. But it's got wonderful culture, natural beauty, great food, hot women (and probably hot men -- I should mention this for the sake of gender equality). I'll manage the bad if I can get the good.

Not defending my choice, I live in what's been referred to as the 5th largest city in the US and I can't imagine it's safer here than in the rural area where I grew up. Not only is this area urban/suburban, but it also has four different interstate highways crossing/merging and all sorts of state highways where people drive way too fast in heavy traffic -- people drive faster in SOCAL. I have just as many (actually mostly the same) firearms in SOCAL as I did in PNW and I've yet to see any of them have an accident, so it's not rural firearms per se.

So while the study may be valid, I "feel" there is something missing and that not all residents of a rural area are as susceptible to those rural dangers as are other residents/visitors.

Russ, keep in mind that the study uses data from the entire US. Thus a wide spectrum of urban areas were lumped, and likewise a wide range of rural areas were lumped. Some cities or parts of cities are without doubt more dangerous than others. Similarly, some rural areas are probably much safer than others. Your current area in SOCAL may well be more dangerous than the area you grew up in.

Also, depending on how long ago you moved from the country to the city, the rural area you grew up in might (or might not) be different than it was when you were there. For example, in the past, drugs were thought to be mostly a city problem. I don't think that is so true anymore. These days some rural areas seem to have a serious problem with meth and other drugs, and everthing that goes along with that.

I think the important take away message is not that all cites are safer than all rural areas. Rather the message is to not assume that just because you live out in the boondocks that you are automatically safer than in the city. We need to try to maintain situational awareness wherever we are, and evaluate each specific location on it's own local merits and hazards.

We all see things as they appear from where we sit. The rural area I was raised vs the urban/suburban areas of SOCAL and DC Metro are very limited and certainly not the entirety of the rural/urban comparison.

Another issue I have is that the county I grew up in was 90%+ rural by landmass, but I'd say 90%+ of the people lived in town. Is that a considered a rural county and do the stats separate the urban area from the rural in a county that's mixed? Again, I need to read the study in more depth. I'll try to keep an open mind.

The firearms accident fatality rate is very low in the US. The latest figures I have seen are for 2007, where there were 613 accidental firearms fatalities. I doubt that firearms ownership rates have a noticeable impact on accidental deaths.

I don't consider suicide to be an accident.

If you're addressing the study specifically then all firearms deaths would be included, not just "accidental" events, although most incidents would fall into categories like "homicide" and "suicide". The study is not about accidental deaths, but deaths related to injuries, i.e. deaths not related things like disease or other health conditions.

If I recall correctly, the article did mention that suicide deaths were higher in rural areas. I don't know if the rate of suicide attempts is any higher, considering the stress and dysfunctional environment of cities, but I imagine that ready access to firearms is higher in rural areas, and firearms-related suicide attempts are far more likely to be fatal, so the rural suicide fatality rate could be higher due to that.

As a former fire/rescue technician in a rural area, here's how it works:

2:04 AM - someone drives their Mustang GT into a tree in the middle of nowhere at 80 MPH, survives the crash, but is seriously injured and entrapped.

2:09 AM - someone comes upon the crash scene, tries to call 911 from their mobile phone, but T-Mobile has no coverage out here, so they can't get through.

2:11 AM - someone else with an AT&T or Verizon cell phone comes on the scene too, they call 911.

2:12 AM - my pager goes off, I crawl out of bed and get dressed and drive to the station to get the rescue truck. In daylight, on dry pavement, with excessive speed, I can make it to the station in 5 minutes. At night it takes longer, not just for me, for everyone.

2:18 AM - an ambulance arrives on scene. They don't have extrication crews or tools. they do what they can to evaluate the situation and stabilize the patient as much as possible. they call for a helicopter.

2:20 AM - we're wheels rolling to the scene. Helicopter LZ crew sets up about 1/2 mile from the scene of the accident in a field.

2:26 - Helicopter lands at LZ. Paramedic flight crew comes to scene.

2:27 AM - we're on-scene, we set up extrication tools, the PT's blood pressure is dropping fast, medics are working around us as we cut the car away from the PT.

2:39 AM - we have the PT out of the vehicle, but they have no pulse. I'm doing CPR as we load PT on a gurney to drive the Landing zone. Paramedics are doing all sorts of things to PT.

2:43 AM - PT is transferred with zero pulse and respiration to helo crew they do all possible and depart the scene.

3:06 AM - we are all packed up, drive back to station.

3:30 AM - I'm back in bed.

7:30 AM - I search local news sources to learn that the PT was pronounced dead on arrival.

Compare this to the under 10 minute response time of an urban area and you really have a good sense of why you're far more likely to bleed out from an accident in a cornfield than on a city street.

well I live in the city. and I've avoided "death by injury" for the whole of the last month. so I'm feeling pretty good about things. Quite perky, now that I consider it :-)

Pete2