Abstract
PURPOSE: Although myriad health disparities exist in Appalachia, limited research has examined traffic fatalities in the region. This study compared traffic fatality rates in Appalachia and the non-Appalachian United States. METHODS: Fatality Analysis Reporting System and Census data from 2008 through 2010 were used to calculate traffic fatality rates. Poisson models were used to estimate unadjusted (rate ratio [RR]) and adjusted rate ratios, controlling for age, gender, and county-specific population density levels. RESULTS: The Appalachian traffic fatality rate was 45% (95% confidence interval [CI], 1.42-1.47) higher than the non-Appalachian rate. Although only 29% of fatalities occur in rural counties in non-Appalachia versus 48% in Appalachia, rates in rural counties were similar (RR, 0.97; 95% CI, 0.95-1.00). However, the rate for urban, Appalachian counties was 42% (95% CI, 1.38-1.45) higher than among urban, non-Appalachian counties. Appalachian rates were higher for passenger vehicle drivers, motorcyclists, and all terrain vehicle riders, regardless of rurality, as well as for passenger vehicle passengers overall and for urban counties. Conversely, Appalachia experienced lower rates among pedestrians and bicyclists, regardless of rurality. CONCLUSIONS: Disparities in traffic fatality rates exist in Appalachia. Although elevated rates are partially explained by the proportion of residents living in rural settings, overall rates in urban Appalachia were consistently higher than in urban non-Appalachia.