Proximity to hospital and mortality from motor vehicle traffic accidents.

Policy in England and Wales has encouraged the concentration of hospital accident and emergency facilities into large units with substantial catchment areas. This means that many rural areas are considerable distances from the nearest hospital providing such services. Analysis of data on mortality from motor vehicle traffic accidents for males aged 15 to 24 reveals that death rates are substantially higher in rural areas than in the cities. It is shown that geographical variations in mortality rate are related to differences in the dependence on private transport, to the social composition of the population and to proximity to hospital accident and emergency facilities. This latter result suggests that policy-makers need to pay more attention to the accessibility of accident and emergency services.