But those statistics aren't convincing the country that cities are getting safer: a 2011 Gallup poll found that most Americans continue to believe that the nation's crime rate is getting worse, even though there's been a sharp and sustained drop in murders and other violent assaults since the mid-1990s. Perception — no doubt fueled in part by the media — beats reality.
In fact, the rate of unintentional injury death is more than 15 times that of homicide among the entire population, with the risk resting heavily in rural areas such that the risk of unintentional injury death is 40% higher in the most rural counties compared with the most urban.
Motor vehicle crash deaths drive this finding as the top mechanism of injury death, occurring at a rate that is more than 1.4 times higher than the next leading mechanism of injury death overall and twice the next leading mechanism in rural areas (Figure 2). 49,50 By comparison, the risk of motor vehicle crash death in the most rural areas is 2 times that in the most urban areas. Factors likely to contribute to this elevated rural risk include speed
of travel, 51 increased risk taking, 52 adherence to traffic laws, 53 and distance to medical care.54
It is thus reasonable to consider access to specialized care, or lack thereof, as a mediator of the relationship between the rural nature of a county and its level of injury-related mortality.To address this issue, we introduced a variable related to access to trauma center care into our model as a covariate to determine whether it would erase the increased injury-related mortality risk that we observed to be associated with the most rural counties. In fact, we observed very little change in the rural-urban relationship when we accounted for “access” to trauma center care. This would argue against access to specialized care being the driving force behind the disparity in injury related mortality found for rural areas. We were able to use only a simple count of trauma centers per county as our determination of access to care, and it is possible that a more sophisticated model of trauma center access, using true distances and drive times, could have more influence on this relationship. However, given the very minor effect of our crude adjustment variable, it is unlikely that the addition of a more accurate access variable would account for all of the increased risk of injury-related mortality found in the most rural counties compared with the most urban.
These findings can also be considered in the context of the ongoing ED workforce debate. Hospitals in rural areas are less frequently staffed by emergency physicians and have less access to on-call specialists, including trauma surgeons, neurosurgeons, and orthopedists. Although the emergency medicine–trained and board-certified workforce has the most direct training in the care of the severely injured patients among the physician types who may staff EDs, it is unlikely that the workforce pool of emergency medicine–trained physicians will be large enough to cover all EDs completely at any point in the near future The fact that the injury-related mortality risk is highest in the areas least likely to be covered by emergency physicians and least likely to have access to trauma care (http://www.traumamaps.org) could be used to support ongoing efforts to improve emergency and trauma care systems in the United States, using a population planning approach. Additional efforts should focus on expanding access to expert care by using less traditional methods, including certification or postresidency training programs for physicians who will be providing care in EDs from non–emergency medicine backgrounds and the continued examination of how technology-based solutions, including telemedicine, can expand the traditional reach of medical expertise into rural areas.
Where are incidents of homicide and muggings higher the city or the country? The city [...] So a safe responsible person living in the country is more likely to be safe than a safe responsible person living in the city all other things being equal.
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