Crossing county lines: the impact of crash location and driver's residence on motor vehicle crash fatality.
BACKGROUND
Studies have demonstrated that the fatality risk for motor vehicle crashes (MVCs) is higher in rural than urban areas. The purpose of this study was to quantify the risk of a fatal outcome associated with a crash by the urban/rural classification of the driver's county of residence and the county of crash before and after adjusting for potentially confounding factors.


METHODS
County of crash and driver's county of residence were classified as urban or rural for 514,648 Utah crash participants. Multivariate regression analysis was used to assess the impact of rural versus urban crash location on fatality outcomes for both urban and rural drivers.


RESULTS
Before adjusting for confounding factors the relative risk of fatality in a rural versus urban crash was 9.7 (95% CI: 8.0-11.7) for urban drivers and their passengers compared to 1.8 (95% CI: 1.3-2.6) for rural residents. Adjustment for behavioral, road, and crash characteristics reduced risk estimates to 2.8 (95% CI: 2.2-3.5) and 1.2 (95% CI: 0.8-1.7), respectively.


CONCLUSIONS
Urban and rural drivers may have distinct risk factors for MVC fatality in rural areas. Interventions to reduce the risk of fatality in rural areas should evaluate the needs of both urban and rural drivers.
Donaldson
Amy E
AE
Department of Pediatrics, Intermountain Injury Control Research Center, University of Utah School of Medicine, 295 Chipeta Way, PO Box 581289, Salt Lake City, 84158-0289, USA. amy.donaldson@hsc.utah.edu
Cook
Lawrence J
LJ
Hutchings
Caroline B
CB
Dean
J Michael
JM
D000063:Accidents, Traffic / Q000401:mortality* / Q000706:statistics & numerical data*; D000328:Adult; D000368:Aged; D015986:Confounding Factors, Epidemiologic; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data; D016019:Survival Analysis; D014505:Urban Population / Q000706:statistics & numerical data