Geographic Variation in Preventable Deaths from Motor Vehicle Crashes

Abstract

In Michigan, drivers in rural motor vehicle crashes (MVCs) are twice as likely to die as nonrural drivers: this could be due to variation in the quality of acute trauma care. This study tests the hypothesis that the preventable death rate (PDR) is higher and that anatomic injury severity is lower for rural compared to nonrural MVC fatalities. Retrospective cohort study. Autopsy results from MVC victims of three rural counties and one nonrural county were reviewed. The time period was 1986-1991. Using the Abbreviated Injury Scale, 1985 version (AIS-85), Injury Severity Scores (ISSs) and Anatomical Profile G scores were calculated. Preventability was determined based on ISSs (< 59) and AIS scores in the head region (< 5). Student's t test and the chi-squared test were used for analysis; a p value of < 0.05 was considered statistically significant. 143 rural and 306 nonrural fatalities were analyzed. The rural PDR was 37.1% and nonrural 48.0% (p < 0.05). ISSs and also G scores were significantly different between rural (54.8; -2.1) and nonrural (50.2; -1.2) areas. This study suggests that regional variation in the quality of acute trauma care is not a significant factor in regional variation in MVC mortality.