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ORIGINAL ARTICLE |
1 Maricopa County Department of Public Health, Phoenix, Arizona
2 Department of Academic Affairs, Maricopa Integrated Health System, Phoenix, Arizona
3 Division of Environmental Health Services, Indian Health Service, Rockville, Maryland
4 Research and Teaching Faculty, Department of Psychiatry and Psychiatry Residency Program, Maricopa Integrated Health System, Phoenix, Arizona
Correspondence and reprints requests to:
Dr Doug Campos-Outcalt, Maricopa County Department of Public Health, 1825 E. Roosevelt St., Phoenix, AZ 85006, USA;
dougcampos{at}mail.maricopa.gov
Objective: To compare rates of motor vehicle crash (MVC) fatalities among different race/ethnic groups in urban and rural Arizona.
Method: Using the Fatality Analysis Reporting System and the National Center for Health Statistics Multiple Cause of Death file, MVC fatalities in Arizona from 1990–96 inclusive were classified by gender, race/ethnicity, and urban or rural residence. Age adjusted rates of total, occupant, pedestrian, and alcohol related fatalities were calculated. The total MVC fatality rate for each race/ethnic group was then adjusted for proportion of rural residence.
Results: Compared with non-Hispanic whites (NHWs), American Indians had raised relative risks for MVC fatality in all gender and residence subgroups. Hispanic females and rural Hispanic males had lower relative risks, as did rural African-American men.
Raised relative risks for American Indian men and women included all subgroups: total, occupant, pedestrian, and alcohol related. Hispanic and African-American men both had raised relative risks of pedestrian related fatalities, and Hispanic men had a slightly higher relative risk while Hispanic women had a lower relative risks, for alcohol related fatality. Hispanic men and women and African-American men had lower occupant fatality rates. Close to half (45%) of the excess MVC fatality among American Indians can be attributed to residence in rural areas, where MVC fatality rates are higher. There were 1.85 occupants in crashes involving NHW deaths compared with 2.51 for Hispanics and 2.71 for American Indians (p<0.001). The proportion of occupants not using a seatbelt was higher in Hispanics and American Indians in both urban and rural areas.
Conclusion: The major disparity in MVC fatality in Arizona is among American Indians. The higher MVC fatality rates among American Indians occur in all age groups, in both urban and rural areas, and among occupants and pedestrians. Rural residence, lower rates of seatbelt use, higher rates of alcohol related crashes, a greater number of occupants, and higher rates of pedestrian deaths all contribute to the American Indian MVC fatality disparity.
High rates of pedestrian fatality occur in men in all three race/ethnic minorities in Arizona and among American Indian women. In contrast to other studies, African-Americans and Hispanics did not have raised total MVC fatality rates and compared to NHWs actually had lower rates in the rural areas of the state.
Keywords: motor vehicle crash; race/ethnicity
Abbreviations: BAC, blood alcohol concentration; FARS, Fatality Analysis Reporting System; MVC, motor vehicle crash; NCHS, National Center for Health Statistics; NHWs, non-Hispanic whites
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