A comparison of traumatic injury characteristics in rural and urban adults living in Wisconsin

Purpose

Rural compared to urban populations have higher age-adjusted injury mortality rates. We sought to describe differences in traumatic injury mechanisms, severity, and mortality in Wisconsin adults in rural and urban areas.

Methods

State trauma registry data were analyzed for adult patients injured in 2021–2022. The Wisconsin Health Innovation Program's rural and urban classification scheme, consisting of urban advantaged, urban, urban underserved, rural advantaged, rural, and rural underserved groups, was used. Multivariable logistic regression models for in-hospital injury mortality and prolonged length of stay (LOS) were developed.

Findings

Overall, 47,460 patients were included; 14.3% in rural, 9.5% in rural advantaged, 4.1% in rural underserved areas, 35.4% in urban, 22.0% in urban advantaged, and 14.8% in urban underserved areas. Firearm and pedestrian injuries were more common in urban areas, and motor vehicle/transportation injuries were common in rural areas. Lower odds of prolonged LOS were observed in those residing in rural advantaged (OR = 0.70, 95%CI: 0.55–0.90; p = 0.004), rural (OR = 0.66, 95%CI: 0.53–0.82; p < 0.001), and rural underserved (OR = 0.64, 95%CI: 0.50–0.82; p < 0.001) compared to urban advantaged areas. Those in rural underserved areas had higher odds of in-hospital mortality (OR = 1.48, 95%CI: 1.15–1.91; p = 0.003) compared to urban advantaged areas.

Conclusions

Patients in rural Wisconsin experienced different injury mechanisms than in urban areas. Those in urban areas were more likely to have a prolonged hospital LOS, but those in rural underserved areas had higher in-hospital mortality. Rural populations may benefit from injury prevention specific to the mechanisms of injury in that area and resource allocation to enhance trauma services.