"There probably is some component to access to care, but when we tried to adjust it in the way that we could with the data we had and look at—'do you have a trauma center in your county or surrounding county and how many do you have?'—to give an overall sense of 'do you have access to care?' and put that back into our analysis, it didn't seem to change the overall, even though there was a mild attenuation," Myers says. "But the same overall difference between rural and urban areas was still there. So it seems like there is more to it than just that."
Injury death risk fell in rural areas with larger populations of African-Americans, and Myers says she can only guess as to why. "Suicides have been found to be higher in rural areas than in urban areas and the black populations tend to be somewhat protected from suicides. That may be part of it," she says.
The opposite was true for rural counties with large Latino populations, which had significantly higher risk of injury death than rural counties with small Latino populations. And perhaps most surprisingly, the study found that risk of injury death increased in rural areas with higher income and education levels. Explaining the causes for this and other findings, Myers says, "was not our focus, but it was more hypothesis-generating. Let's have further studies that look into this and try to see some of the underlying reasons."
Myers says she hopes the study will prompt people to reexamine assumptions about healthcare needs in rural and urban America.