The rates of motor-vehicle crash mortality are highest among American Indians and Alaska Natives, compared to other ethnic groups. The aim of this study was to compare risk factors for motor-vehicle crashes and occupant injuries between rural and urban American-Indian (AI) drivers, and between rural AI and non-AI rural drivers. A statewide traffic-accident database was linked to the Indian Health Service patient-registration database to identify crashes that involved American-Indian drivers. Using a cross-sectional design, crashes occurring in a two-county region during 1989 and 1990 were studied. A total of 9329 motor-vehicle crashes involving 16,234 drivers and 6431 passengers were studied. Two percent of drivers were American Indian. Compared to American-Indian drivers in urban crashes, rural crashes involving American-Indian drivers were more likely to result in injury or death (38% vs 64% p < 0.001). The difference in risk for crashes between urban and rural non-AI drivers was not as high (42% vs 33%). Only 44 percent of rural American-Indian motor-vehicle occupants reported wearing seat belts, compared to 70 percent of urban American-Indian occupants (p < 0.05). Rates of driver alcohol impairment, as assessed by the police, were much higher among AI drivers and highest among rural AI drivers. We conclude that, compared to non-American-Indian drivers, AI drivers are less likely to be restrained and more likely to be alcohol-impaired at the time of the crash. These risks are higher among rural AI drivers than urban AI drivers.
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