Background
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.
Methods
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.
Results
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.
Conclusions
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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© 2009 Published by Elsevier Inc.
