title: The relationship between remoteness and trauma deaths in Western Australia.
abstract: BACKGROUND
  Mortality from trauma in rural areas is increased compared with the urban environment. We aimed to describe the relationship between trauma deaths and various categories of remoteness in rural areas, in Western Australia (WA).
  
  
  METHODS
  We used Death Registry data from July 1, 1997 to June 30, 2006. Deaths were allocated to one of the five Remoteness Areas classified by the Accessibility/ Remoteness Index of Australia: Major Cities, Inner Regional, Outer Regional, Remote, and Very Remote. Population data were obtained from the Australian Bureau of Statistics 2001 census.
  
  
  RESULTS
  There were 4,937 deaths (3,543, 71.8% men; mean age 43.4 years +/- 24.3 years). The least number of deaths occurred in Remote WA, and the age at which death occurred decreased as remoteness increased. Falls occur predominantly in the elderly in the major city. Transport injuries are the leading cause of death (43.3%) outside the major city, where self harm is the leading cause of death (31.2%). The relative risk for death in very remote WA compared with the major city is 4.28 (95% CI 3.93-4.68). The standardized age-specific death rates ranged from 24.09 per 100,000 person-years in the major city, to 103.30 per 100,000 person-years in very remote WA.
  
  
  CONCLUSIONS
  We have quantified the direct relationship between remoteness and trauma deaths. In particular, the death rate in very remote areas is over four times the rate in major cities. Such data should be useful for the planning of trauma systems in these areas.
authors.affiliation: Department of Emergency Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia. daniel.fatovich@health.wa.gov.au
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Fatovich
authors.forename: Ian G
authors.initials: IG
authors.lastname: Jacobs
mesh_terms: D000328:Adult; D002423:Cause of Death; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D038801:International Classification of Diseases; D008297:Male; D008875:Middle Aged; D012424:Rural Population / Q000706:statistics & numerical data*; D016019:Survival Analysis; D013997:Time Factors; D014195:Travel; D014904:Western Australia / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality*; D055815:Young Adult