title: Evaluating adverse rural crash outcomes using the NHTSA State Data System.
abstract: BACKGROUND
  The population-based rate of motor vehicle crash mortality is consistently higher in rural locations, but it is unclear how much of this disparity might be due to geographic barriers or deficiencies in emergency medical services (EMS). We sought to analyze separately factors associated with the occurrence of a severe injury and those associated with death after injury had occurred.
  
  
  METHODS
  Data from all police-reported crashes in 11 states from 2005-2007 were obtained through the National Highway Traffic Safety Administration (NHTSA) State Data System (SDS). Logistic regression was used to estimate factors associated with (1) death; (2) severe (incapacitating or fatal) injury; and (3) death given severe injury. Models included covariates related to the person, vehicle, and event; county location was specified using Rural-Urban Continuum Codes (RUCC).
  
  
  RESULTS
  Older age, not wearing a belt, ejection, alcohol involvement, high speed, and early morning times were associated with increased risk of both severe injury and death. Controlling for these factors, and restricting analysis to persons who had suffered a severe injury, the adjusted odds ratio (aOR) associated with death was higher for counties classified rural (RUCC 6-7, aOR 1.23, 95% CI 1.16-1.31) or very rural (RUCC 8-9, aOR 1.31, 95% CI 1.18-1.46).
  
  
  CONCLUSIONS
  Persons severely injured in crashes are more likely to die if they are in rural locations, possibly due to EMS constraints. As NHTSA-SDS data become more available and more uniform, they may be useful to explore specific factors contributing to this increased risk.
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA. Electronic address: peurac@mmc.org.
authors.forename: Christine
authors.initials: C
authors.lastname: Peura
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA. Electronic address: Joseph.Kilch@med.uvm.edu.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Kilch
authors.affiliation: Center for Outcomes Research and Evaluation, Maine Medical Center, Portland, ME, USA; Department of Surgery, Maine Medical Center, Portland, ME, USA. Electronic address: clarkd@mmc.org.
authors.forename: David E
authors.initials: DE
authors.lastname: Clark
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000706:statistics & numerical data*; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D012424:Rural Population; D017751:Safety Management; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Crash; Injury; Mortality; NHTSA; Rural; State Data System