Geographical risk of fatal and non-fatal injuries among adults in Norway

Vegard Andersen; Vilde Ravnsborg Gurigard; June Alette Holter; Torben Wisborg

doi:10.1016/j.injury.2021.08.012

Geographical risk of fatal and non-fatal injuries among adults in Norway

Injury. 2021 Oct;52(10):2855-2862. doi: 10.1016/j.injury.2021.08.012. Epub 2021 Aug 12.

Authors

Vegard Andersen¹, Vilde Ravnsborg Gurigard¹, June Alette Holter¹, Torben Wisborg²

Affiliations

¹ Interprofessional Rural Research team, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, N-9600 Hammerfest, Norway.
² Interprofessional Rural Research team, Faculty of Health Sciences, University of Tromsø, The Arctic University of Norway, N-9600 Hammerfest, Norway; Department of Anaesthesia and Intensive Care, Hammerfest Hospital, Finnmark Health Trust, N-9613 Hammerfest, Norway; Norwegian National Advisory Unit on Trauma, Division of Emergencies and Critical Care, Oslo University Hospital, N-0424 Oslo, Norway. Electronic address: torben.wisborg@uit.no.

PMID: 34425992
DOI: 10.1016/j.injury.2021.08.012

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.

Keywords: Fatal injury; epidemiology; fatality risk; geography; non-fatal injury; rural areas.

MeSH terms

Adult
Geography
Humans
Norway / epidemiology
Registries
Rural Population*
Self-Injurious Behavior*