Department of Public Health Sciences, University of North Carolina at Charlotte, Charlotte, North Carolina, USA.
Ronald O Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY, 10016, USA.
J Rural Health. 2022 Sep;38(4):999-1010. doi: 10.1111/jrh.12627. Epub 2021 Oct 19.
This study aimed to estimate the crash response times in rural and urban counties in the United States, their association with county-level crash fatalities, and identify spatial clusters of crash fatalities across the United States.
We analyzed data from the Fatality Analysis Reporting System (2010-2019). Data were aggregated at the county level across the contiguous United States. The selected counties (n = 3,108) were categorized as rural, micropolitan-urban, or metropolitan-urban using the 2013 rural-urban commuting area codes. The predictor variable was crash response time, and the outcome variable was county-level crash fatalities. Crash and county characteristics were used as potential confounders. We performed a spatial negative binomial regression analysis and reported the rate ratios of crash fatalities. We estimated the crude and adjusted fatality rates across all counties and identified clusters of crash fatalities across the United States.
As one migrates from urban to rural areas, crash response times became significantly increasingly longer. The Emergency Medical Service (EMS) notification to scene arrival time was most predictive of crash fatalities. A minute increase in the EMS notification to scene arrival time was associated with a 1%, 2%, and 5% increased fatality rate ratio in rural, micropolitan-urban, and metropolitan-urban counties, respectively. Although crash fatalities were lower in rural counties, the crash fatality rate was 3-fold higher in rural counties compared to metropolitan-urban counties. Significant clusters of crash fatality rates were heterogeneously distributed across the United States.
Reducing crash response time may contribute to reducing crash fatalities across the United States.
本研究旨在估计美国农村和城市县的碰撞反应时间，研究其与县级碰撞死亡率的关系，并确定美国全国范围内碰撞死亡率的空间聚类。
我们分析了来自 Fatality Analysis Reporting System（2010-2019 年）的数据。数据在美国大陆各县汇总。所选县（n=3108）根据 2013 年农村-城市通勤区代码分为农村、微城市或大都市-城市。预测变量是碰撞反应时间，结果变量是县级碰撞死亡率。碰撞和县级特征被用作潜在混杂因素。我们进行了空间负二项回归分析，并报告了碰撞死亡率的比率比。我们估计了所有县的粗死亡率和调整死亡率，并确定了美国全国范围内碰撞死亡率的聚类。
随着人们从城市向农村地区迁移，碰撞反应时间显著变长。紧急医疗服务（EMS）通知到现场到达时间是最能预测碰撞死亡率的因素。EMS 通知到现场到达时间增加一分钟，农村、微城市和大都市城市县的死亡率分别增加 1%、2%和 5%。尽管农村县的碰撞死亡率较低，但与大都市城市县相比，农村县的碰撞死亡率高 3 倍。碰撞死亡率的显著聚类在全美国不均匀分布。
减少碰撞反应时间可能有助于减少美国全国的碰撞死亡率。
