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The Relationship Between Remoteness and Trauma Deaths in Western Australia

Fatovich, Daniel M. MBBS, FACEM; Jacobs, Ian G. RN, PhD

The Journal of Trauma: Injury, Infection, and Critical Care: November 2009 - Volume 67 - Issue 5 - p 910-914
doi: 10.1097/TA.0b013e3181815a26
Original Article

Background: Mortality from trauma in rural areas is increased compared with the urban environment. We aimed to describe the relationship between trauma deaths and various categories of remoteness in rural areas, in Western Australia (WA).

Methods: We used Death Registry data from July 1, 1997 to June 30, 2006. Deaths were allocated to one of the five Remoteness Areas classified by the Accessibility/ Remoteness Index of Australia: Major Cities, Inner Regional, Outer Regional, Remote, and Very Remote. Population data were obtained from the Australian Bureau of Statistics 2001 census.

Results: There were 4,937 deaths (3,543, 71.8% men; mean age 43.4 years ± 24.3 years). The least number of deaths occurred in Remote WA, and the age at which death occurred decreased as remoteness increased. Falls occur predominantly in the elderly in the major city. Transport injuries are the leading cause of death (43.3%) outside the major city, where self harm is the leading cause of death (31.2%). The relative risk for death in very remote WA compared with the major city is 4.28 (95% CI 3.93–4.68). The standardized age-specific death rates ranged from 24.09 per 100,000 person-years in the major city, to 103.30 per 100,000 person-years in very remote WA.

Conclusions: We have quantified the direct relationship between remoteness and trauma deaths. In particular, the death rate in very remote areas is over four times the rate in major cities. Such data should be useful for the planning of trauma systems in these areas.

From the Department of Emergency Medicine, University of Western Australia, Royal Perth Hospital, Perth, Western Australia, Australia.

Submitted for publication April 10, 2008.

Accepted for publication May 28, 2008.

Address for reprints: Daniel M. Fatovich, Department of Emergency Medicine, Royal Perth Hospital, Box X2213 GPO, Perth, WA 6847, Australia; email:

© 2009 Lippincott Williams & Wilkins, Inc.