title: Epidemiology of trauma: a population-based study of geographical risk factors for injury deaths in the working-age population of Norway.
abstract: BACKGROUND
  Trauma is a major global cause of morbidity and mortality. Population-based studies identifying high-risk populations and regions may facilitate primary prevention and the development of optimal trauma systems. This study describes the epidemiology of adult trauma deaths in Norway and identifies high-risk areas by assessing different geographical measures of rurality.
  
  
  METHODS
  All trauma-related deaths in Norway from 1998 to 2007 among individuals aged 16-66 years were identified by accessing national registries. Mortality data were analysed by linkage to population and geographical data at municipal, county and national levels. Three measures of rurality (centrality, population density and settlement density) were compared based on their association with trauma mortality rates.
  
  
  RESULTS
  The study included 8466 deaths, of which 78% were males. The national annual trauma mortality rate was 28.7 per 100,000. Population density was the best predictor of high-risk areas, and there was a consistent inverse relationship between mortality rates and population density. The most rural areas had 52% higher trauma mortality rates compared to the most urban areas. This difference was largely due to deaths following transport-related injury. Seventy-eight per cent of all deaths occurred in the prehospital phase. Rural areas and death following self-harm had higher proportion of prehospital deaths.
  
  
  CONCLUSIONS
  Rural areas, as defined by population density, are at a higher risk of deaths following traumatic injuries and have higher proportions of prehospital deaths and deaths following transport-related injuries. The heterogeneous characteristics of trauma populations with respect to geography and mode of injury should be recognised in the planning of preventive strategies and in the organisation of trauma care.
authors.affiliation: Department of Research and Development, The Norwegian Air Ambulance Foundation, PO Box 94, N-1441 Drøbak, Norway; University of Oslo, Faculty Division Oslo University Hospital, Kirkeveien 166, N-0450 Oslo, Norway; Diakonhjemmet Hospital, Department of Anaesthesiology, PO Box 23 Vinderen, N-0319 Oslo, Norway. Electronic address: thomas.kristiansen@norskluftambulanse.no.
authors.forename: Thomas
authors.initials: T
authors.lastname: Kristiansen
authors.forename: Hans Morten
authors.initials: HM
authors.lastname: Lossius
authors.forename: Marius
authors.initials: M
authors.lastname: Rehn
authors.forename: Petter
authors.initials: P
authors.lastname: Kristensen
authors.forename: Hans Magne
authors.initials: HM
authors.lastname: Gravseth
authors.forename: Jo
authors.initials: J
authors.lastname: Røislien
authors.forename: Kjetil
authors.initials: K
authors.lastname: Søreide
mesh_terms: D000059:Accidents / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D004632:Emergency Medical Services / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D011322:Primary Prevention; D012042:Registries; D012307:Risk Factors; D012424:Rural Population; D016728:Self-Injurious Behavior / Q000401:mortality*; D012737:Sex Factors; D013405:Suicide / Q000706:statistics & numerical data*; D014505:Urban Population; D014754:Violence / Q000706:statistics & numerical data*; D014947:Wounds and Injuries / Q000401:mortality* / Q000517:prevention & control
keywords: Epidemiology; Injury; Norway; Population-based; Rural health; Trauma