Abstract
Introduction: A rural gradient in trauma mortality disfavoring remote inhabitants is well known. Previous studies have shown higher risk of traumatic deaths in rural areas in Norway, combined with a paradoxically decreased prevalence of non-fatal injuries. We investigated the risk of fatal and severe non-fatal injuries among all adults in Norway during 2002–2016.Methods: All traumatic injuries and deaths among persons with a residential address in Norway from 2002–2016 were included. Data were collected from the Norwegian National Cause of Death Registry and the Norwegian Patient Registry. All cases were stratified into six groups of centrality based on Statistics Norway's classification system, from most urban (group one) to least urban/most rural (group six). Mortality and injury rates were calculated per 100,000 inhabitants per year.Results: The mortality rate differed significantly among the centrality groups (p<0.05). The rate was 64.2 per 100,000 inhabitants/year in the most urban group and 78.6 per 100,000 inhabitants/year in the most rural group. The lowest mortality rate was found in centrality group 2 (57.9 per 100,000 inhabitants/year). For centrality group 6 versus group 2, the risk of death was increased (relative risk, 1.36; 95%CI: 1.11–1.66; p<0.01). The most common causes of death were transport injury, self-harm, falls, and other external causes. The steepest urban–rural gradient was seen for transport injuries, with a relative risk of 3.32 (95%CI: 1.81-6.10; p<0.001) for group 6 compared with group 1. There was a significantly increasing risk for severe non-fatal injuries from urban to rural areas. Group 2 had the lowest risk for non-fatal injuries (1531 per 100,000 inhabitants/year) and group 6 the highest (1803 per 100,000 inhabitants/year). The risk for non-fatal injuries increased with increasing rurality, with a relative risk of 1.07 (95%CI: 1.02–1.11; p<0.01) for group 6 versus group 1.Conclusions: Fatal and non-fatal injury risks increased in parallel with increasing rurality. The lowest risk was in the second most urban region, followed by the most urban (capital) region, yielding a J-shaped risk curve. Transport injuries had the steepest urban–rural gradient.
Highlights
A rural gradient in trauma mortality disfavoring remote inhabitants is well known
Traffic injuries are ninth among causes of the global burden of disease, and road traffic deaths continue their climb, topping 1.35 million deaths worldwide in 2016 [1,2]
The lowest mortality rate was found in centrality group 2 (57.9 per 100,000 inhabitants/year), which we used as a reference in addition to group 1
Summary
Previous studies have shown higher risk of traumatic deaths in rural areas in Norway, combined with a paradoxically decreased prevalence of non-fatal injuries. We investigated the risk of fatal and severe non-fatal injuries among all adults in Norway during 2002–2016. Traumatic injury is a leading cause of death and disability worldwide, accounting for 10% of the global burden of disease [1]. The main causes are road traffic injuries, suicide, falls, and violence. Traffic injuries are ninth among causes of the global burden of disease, and road traffic deaths continue their climb, topping 1.35 million deaths worldwide in 2016 [1,2]. Most rural deaths (85%) in northern Norway occur in the prehospital setting within the first hour after an injury [15]. It has been suggested that this discrepancy is the result of increased trauma severity or reduced trauma care [3], but firm evidence for such assumptions is lacking [16]
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