title: Alcohol-related motor vehicle accident fatality: Wisconsin rural-urban trends and observations.
abstract: BACKGROUND
  Wisconsin leads the nation in binge-drinking and alcohol consumption rates, creating substantial costs for taxpayers and contributing to countless alcohol-related comorbidities and numerous fatalities each year. This study was designed to assess the nature and extent of the alcohol problem in Wisconsin and compare alcohol- and non-alcohol-related motor vehicle accident (MVA) fatality rates between the subcultures of rural and urban counties and assess access to alcohol by examining Wisconsin liquor licensing.
  
  
  METHODS
  County-level alcohol- and non-alcohol-related MVA fatality data from 1999 to 2006 were obtained from the Wisconsin Department of Transportation and the Wisconsin Interactive Statistics on Health (WISH) database; urban and rural counties were compared. Liquor license per capita rates were determined; rural and urban counties were compared. Additionally, trends in alcohol-related fatalities between 1999 and 2002 and between 2003 and 2006 were computed for all Wisconsin counties.
  
  
  RESULTS
  Alcohol-related MVA fatalities were significantly higher in rural counties than non-alcohol-related MVA fatalities as compared to those in urban counties, with an Odds Ratio (OR) of 2.17 (95% Confidence Interval [CI], 2.00-2.35) and 1.68 (95% CI, 1.58-1.79), respectively. More importantly, significant interaction was found to be present between the 2 odds ratios (P < 0.001). When comparing these fatalities using county-level vehicle miles of travel (VMT) as a denominator, similar results were found; rural counties are still at significantly increased risk of MVA fatality in both alcohol- and non-alcohol-related MVAs compared to urban, with an OR of 1.76 (95% CI, 1.62-1.91) 1.37 (95% CI, 1.28-1.45), respectively.
  
  
  CONCLUSIONS
  Evidence characterizing the rural alcohol subculture in Wisconsin's notorious consumption predicament is partially elucidated here, indicating the potential for rural counties to be a cost-effective target of intervention and policy.
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, WI, USA. zjbaeseman@wisc.edu
authors.forename: Zachary J
authors.initials: ZJ
authors.lastname: Baeseman
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000428:Alcohol Drinking / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D012424:Rural Population; D014505:Urban Population; D014922:Wisconsin / Q000453:epidemiology