Reducing Motor Vehicle Injuries in Rural Communities: A Social Determinants of Health Framework

Purpose: Motor vehicle accidents (MVAs) remain a leading cause of injury and death in California's San Joaquin Valley (SJV), especially for minority, low-income citizens of rural communities. Public health experts from six counties collaborated to identify the underlying social and environmental determinants behind the disparities in rural/urban MVAs.

Methods: Fatality Analysis Reporting System (FARS) data from 2001 to 2005 for six SJV counties were used to examine rural/urban differences in demographic, behavioral, and environmental features of MVA deaths. We also analyze data from the emergency medical services in the region, comparing accident severity and response times for rural and urban non-fatal/injury accident.

Findings: A strong majority of fatal and non-fatal/injury accidents in the six counties from 2001 to 2005 occurred on rural roads; Hispanics accounted for almost half of all fatalities. Rural MVAs were found to differ from urban for both environmental conditions and driver characteristics. Significant variables associated with rural accidents included two-way roads without dividers, unlit roads, non-junctions, higher speed limits, absence of functional vehicle air bags, weekend and rush hour driving, invalid license status, and vehicle age. Rural accidents were also associated with more severe injuries, higher rates of transport to hospital, and longer response times.

Conclusion: There is a clear need to identify and address disparities in the prevalence, severity, and underlying causes of rural and urban MVAs. Both environmental and social influences play a role in MVA disparities and should be considered in the development and evaluation of programs and community planning.