Mortality risk associated with leaving home: recognizing the relevance of the built environment.

OBJECTIVES I analyzed traffic fatalities and homicides related to leaving home for routine activities, and considered connections between these fatalities and the built environment. METHODS I analyzed city, county, state, and federal data for traffic fatalities and homicides by strangers for 15 metropolitan areas, and classified deaths as occurring in the central city, in inner suburbs, or in outer suburbs (exurbs). RESULTS Traffic fatality rates were highest in exurban areas. Combined traffic fatality and homicide-by-stranger rates were higher in some or all outer counties than in central cities or inner suburbs in all of the metropolitan areas studied. CONCLUSIONS Traffic fatalities are largely unrecognized as a danger to be factored into residential location decisions. Land use controls that deter sprawl along narrow exurban roads can reduce the mortality risks associated with leaving home.