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Rural Health Information Hub

Unintentional Injury in Rural Areas

While the gap between rural and urban populations for deaths from unintentional injuries has decreased over time, there remain substantial disparities in unintentional injury outcomes. A 2017 report from the Centers for Disease Control and Prevention (CDC) found the rural death rate from unintentional injuries was 50% greater than the urban rate. For children and adolescents in particular, injury rates are 55% higher in rural areas compared with urban, and the death rate is almost double that of metro areas. In addition, a 2019 CDC report found that 64% of these injuries in rural areas are preventable, compared with 48% of injuries in urban areas.

Several factors contribute to higher deaths from unintentional injuries in rural areas, including:

  • High speed motor vehicle traffic injuries
  • High rates of opioid misuse and overdose
  • Behavioral factors, such as rates of impaired driving, lower rates of seatbelt use and child safety seats, all-terrain vehicle (ATV) use, opioid prescribing, and higher prevalence of firearm ownership
  • Environmental factors, such as road conditions and decreased walkability
  • Policy factors, for example rural counties that allow ATV use on public roads
  • Limited access to trauma care and distance to treatment

In rural areas, certain occupations are more common, such as agriculture, construction, mining, and manufacturing, which can contribute to higher rates of fatal and nonfatal unintentional injury. These industries often involve physically demanding labor, heavy equipment and machinery, and hazardous environments that can cause injuries from accidents, falls, or contact with equipment. For example, farm workers experience a higher fatality rate, primarily due to agricultural transportation and tractor accidents. In some of these industries, such as farming, families may also live and work on site, which increases their exposure to injury hazards.

The rural landscape and environment can also facilitate activities that quickly turn dangerous without proper precautions. For example, a study of all ATV crashes found that individuals involved in rural ATV crashes were less likely to be wearing a helmet than individuals involved in urban ATV crashes. The death rate from rural ATV crashes is also higher than that of urban ATV crashes.

Large bodies of water, including rivers and lakes, can pose risks of drowning, especially for unsupervised youth. According to the CDC, most drownings involving people over the age of 15 occur in natural bodies of water.

These risk factors all contribute to higher death rates from unintentional injuries among children in rural areas. A 2021 study by the National Center for Health Statistics found that children in rural areas experience higher mortality from unintentional injuries than children in urban areas across all age groups. For example, unintentional drowning deaths are higher in rural areas compared with urban communities.

Resources to Learn More

Injury Prevention Day: A Spotlight on Rural Child Injuries
Describes types of unintentional injuries and causes of death among children, and includes resources offering prevention strategies.
Organization(s): University of Iowa Injury Prevention Research Center
Date: 11/2021