Increased Rates of Death From Unintentional Injury Among Non-Hispanic White, American Indian/Alaska Native, and Nonmetropolitan Communities


Unintentional injury is the third leading cause of death, with an age-adjusted death rate of 48.0 per 100,000 in 2018. This rate has increased over time, with metropolitan and nonmetropolitan areas experiencing increases in unintentional injury deaths, particularly those related to traffic accidents and drug overdoses, from 2014 to 2017. There are also known differences in the rate of death from unintentional injury related to race and ethnicity. To build targeted prevention programs, it is important to understand how race/ethnicity and urbanization impact unintentional injury rates.

The National Hospital Ambulatory Medical Care Survey public use datafile for 2018 was used to generate estimates of nonfatal unintentional injury rates. This dataset sampled 20,291 visit records occurring in 2018 and used a weighting procedure to generate estimates of the total number of emergency department (ED) visits made in the U.S.

Visits to the emergency department (ED) for unintentional injuries in 2018 were similar in metropolitan and nonmetropolitan areas. The rate of deaths from unintentional injuries in 2018 was higher in nonmetropolitan areas, compared to metropolitan areas, for all racial/ethnic groups except non-Hispanic Black. Living in a nonmetropolitan area was associated with the largest increase in deaths for those who are American Indian or Alaska Native. The effects of urbanization, race, and ethnicity appear to vary depending on the cause of death.

Residents of nonmetropolitan areas are more likely than those living in metropolitan areas to suffer a fatal unintentional injury, though there was no difference in the rates of nonfatal unintentional injury emergency department visits. The reason for the difference between fatal and nonfatal injury rates is unclear. Further work is needed to determine if the high rate of fatal unintentional injury in nonmetropolitan areas, particularly among American Indian and Alaska Native communities, would be ameliorated with increased access to trauma care.

Rural and Underserved Health Research Center
Lindsey Hammerslag, Jeffery Talbert, Tyrone Borders