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Non-fatal injuries among urban and rural residents: The National Health Interview Survey, 1997–2001
  1. Hope Tiesman,
  2. Craig Zwerling,
  3. Corinne Peek-Asa,
  4. Nancy Sprince,
  5. Joseph E Cavanaugh
  1. The University of Iowa Injury Prevention Research Center, Iowa City, Iowa, USA
  1. Correspondence to:
 Professor C Zwerling
 The University of Iowa Injury Prevention Research Center, 100 Oakdale Campus, #126 IREH, Iowa City, IA 52242-5000, USA; craig-zwerling{at}


Objective: Although death rates from injuries are higher in rural areas compared with large metropolitan areas, little is known about how non-fatal injury rates vary by rurality. Data from the 1997–2001 US National Health Interview Surveys were used to explore associations between rurality and non-fatal injury.

Design: A nationally representative survey.

Methods: The annual injury rates per 1000 adults and 95% CIs were computed for medically attended injuries. Counties of residence were coded according to urban influence codes into four categories: large urban, small urban, suburban and rural. A linear-by-linear trend test was used to determine whether injury rates increase monotonically with county rurality. Logistic regression was used to control potential confounders.

Results: Compared with large urban counties, small urban counties experienced 8% higher injury odds (95% CI 1% to 15%); suburban counties 20% higher injury odds (95% CI 10% to 31%); and rural counties 30% higher injury odds (95% CI 17% to 43%) after adjusting for age, gender, marital status, education and health insurance.

Conclusions: Rural residents had higher non-fatal injury rates than urban and suburban residents. Exploring this discrepancy can further contribute to new hypotheses regarding rural injury risk and ultimately lead to better suited interventions for rural residents.

  • NCHS, National Center for Health Statistics
  • NHIS, National Health Interview Survey
  • UIC, Urban Influence Code

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  • Competing interests: None declared.