MOTOR-VEHICLE DEATHS - A RURAL EPIDEMIC

Objective: To determine the magnitude of the discrepancy in injury dea th rates between urban and rural counties and which types of injury de aths contribute most to this discrepancy. Design: A review of Nebraska death certificates over the period 1985-1989 was undertaken. Counties were divided into four groups according to population. Group I: urban counties (n = 3); group II: counties with a town of greater than 10,0 00 (n = 9); group III: counties with a total population of greater tha n 10,000 (n = 19); group IV: counties with a total population of less than 10,000 (n = 62). Age-adjusted death rates for heart disease, canc er, cerebrovascular disease, pneumonia, and injury were tabulated. Inj ury deaths were further categorized by intentional injury (homicide, s uicide), and unintentional injury (motor vehicle-related, falls, drown ings, poisoning, farm machinery-related, choking, firearms-related, fi re-related and burns). Interventions: None. Results: Age-adjusted deat h rates per 100,000 population (with 95% confidence intervals) in grou p IV were lower than in group I for heart disease: 209 (193.9-224.1) v s. 227.4 (216.3-238.5); cancer: 135.9 (123.7-148.1) vs. 176.3 (166.6-1 86.0); cerebrovascular disease: 39.9 (33.3-46.5) vs. 44.6 (39.7-49.5); pneumonia: 19.6 (15.0-24.2) vs. 23.4 (19.8-27.0); and intentional inj ury deaths: 13.3 (9.5-17.0) vs. 15.1 (12.2-18.0). However, age-adjuste d unintentional injury death rates were 54.2% higher in group IV than in group I: 42.7 (35.9-49.5) vs. 27.7 (23.8-31.6). Motor vehicle-relat ed death rates were 93% higher: 23.3 (18.2-28.4) vs. 12.1 (9.5-14.7); and farm machinery-related deaths were 1250% higher: 2.7 (1.0-4.4) vs. 0.2 (-0.1-0.5). Conclusion: Age-adjusted unintentional injury death r ates are higher in the rural counties of Nebraska, even though death r ates for the four other leading causes of death (heart disease, cancer , cerebral vascular disease, and pneumonia) and intentional injury are lower. Although farm machinery-related deaths have the largest percen tage difference between rural and urban counties, motor vehicle-relate d deaths are the major contributor to the unintentional injury death r ate discrepancy in rural Nebraska.