ArticleAnnals of emergency medicine2013
Safety in numbers: are major cities the safest places in the United States?
Article in Annals of emergency medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 17 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
17 citing papers in PubMed.
- Shooting-Free Days as a New Metric of Success in Reducing Firearm Violence.JAMA health forum · 2026Article
- Measuring the Impact of Healthcare Provider Availability on Quality of Care and Disease Burden in Ohio: A Cross-Sectional Study.Journal of general internal medicine · 2025Observational
- Geography of the Underserved: The Contribution of Rural Non-trauma Hospitals to Trauma Care.Annals of surgery · 2025Article
- Urban and Rural Child Deaths from Motor Vehicle Crashes: United States, 2015-2019.The Journal of pediatrics · 2022Article
- County-Level Variation in Changes in Firearm Mortality Rates Across the US, 1989 to 1993 vs 2015 to 2019.JAMA network open · 2022Article
- Assessing the impact of a local community subsidised rideshare programme on road traffic injuries: an evaluation of the Evesham Saving Lives programme.Injury prevention : journal of the International Society for Child and Adolescent Injury Prevention · 2020Article
- The influence of behavioural and socioeconomic factors on the community injury rates of adolescents assessed by the south Korean emergency medical services: an ecological approach.BMC public health · 2019Article
- Injury-Related Deaths according to Environmental, Demographic, and Lifestyle Factors.Journal of environmental and public health · 2019Article
- Associations between Urban Sprawl and Life Expectancy in the United States.International journal of environmental research and public health · 2018Article
- Association of Drug and Alcohol Use With Adolescent Firearm Homicide at Individual, Family, and Neighborhood Levels.JAMA internal medicine · 2017Article
- Rural risk: Geographic disparities in trauma mortality.Surgery · 2016Article
- Undertriage of Trauma-Related Deaths in U.S. Emergency Departments.The western journal of emergency medicine · 2016Article
- Homicide in Greenland 1985-2010.Forensic science, medicine, and pathology · 2016Article
- Temporal variation in major trauma admissions.Annals of the Royal College of Surgeons of England · 2016Article
- Aboriginal community-level predictors of injury-related hospitalizations in British Columbia, Canada.Prevention science : the official journal of the Society for Prevention Research · 2015Article
- Appropriateness of disposition following telemedicine consultations in rural emergency departments.Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies · 2015Article
- Factors responsible for mortality variation in the United States: A latent variable analysis.Demographic research · 2014Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
7 authors.
Funding
Abstract
STUDY
objectivesMany US cities have experienced population reductions, often blamed on crime and interpersonal injury. Yet the overall injury risk in urban areas compared with suburban and rural areas has not been fully described. We begin to investigate this evidence gap by looking specifically at injury-related mortality risk, determining the risk of all injury death across the rural-urban continuum.
methodsA cross-sectional time-series analysis of US injury deaths from 1999 to 2006 in counties classified according to the rural-urban continuum was conducted. Negative binomial generalized estimating equations and tests for trend were completed. Total injury deaths were the primary comparator, whereas differences by mechanism and age were also explored.
resultsA total of 1,295,919 injury deaths in 3,141 US counties were analyzed. Injury mortality increased with increasing rurality. Urban counties demonstrated the lowest death rates, significantly less than rural counties (mean difference=24.0 per 100,000; 95% confidence interval 16.4 to 31.6 per 100,000). After adjustment, the risk of injury death was 1.22 times higher in the most rural counties compared with the most urban (95% confidence interval 1.07 to 1.39).
conclusionUsing total injury death rate as an overall safety metric, US urban counties were safer than their rural counterparts, and injury death risk increased steadily as counties became more rural. Greater emphasis on elevated injury-related mortality risk outside of large cities, attention to locality-specific injury prevention priorities, and an increased focus on matching emergency care needs to emergency care resources are in order.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.