In which city or country are you more likely to have a car accident?

All things being equal, you are more likely to suffer a fatal accident in a rural area than in an urban area. However, all things are never equal, so we can’t go full TLDR on this one. We wrote “fatal accident,” and that’s how the National Highway Transportation Safety Agency (NHTSA) looks at car accidents. In other words, they don’t study car accidents as much as car accidents that end in death, such as hit-and-run accidents.

But a fatal car accident is still a car accident. And there’s also good news for car accidents that end in death. Yes, we wrote those words. First, according to an Insurance Institute for Highway Safety (IIHS) analysis of the NHTSA system, the proportion of urban deaths continues to fall compared to rural ones.

This matters, because until recently, the numbers have been dire. More than 83,000 people died on rural roads from 2017 to 2021, according to Federal Highway Administration data. This is despite only 20% of the US population living outside cities. And only one in three car trips made by Americans during that period traversed these sparsely populated roads.

But as we said, according to the IIHS, the rural death rate is falling, and the urban versus rural death count is coming down. In 2000, 61% of people who died in car accidents in the country were driving. By 2024 it will reduce to 41%. However, take 100 million miles of car travel in the US and drivers and passengers in the country still have a 1.56% chance of being killed on the road. In urban areas it is only 1.01%. Then again, on paper, driving in what snobs call “flyover country” is still deadly. But this is not the whole story.

There is some evidence that risky behavior may be responsible for driving deaths in rural areas, as well as poor sight lines and road conditions, as well as fewer policemen and other traffic enforcement and even inconsistently painted lanes on roadways.

Weak enforcement may be the reason that when speeds are posted at 50 mph or less, speeding deaths occur at a higher rate for rural drivers (72%) than for urban drivers (61%). This matches some studies about attitudes toward risky driving behavior, and that people who live in more remote locations not only have to drive longer distances, but are also more able to do so and not buckle up. Earlier data showed that rural drivers were more likely to drink and drive, but DUI-related deaths are fortunately occurring among all Americans.

Naturally, there is another serious reason why deaths may be higher in ex-urban areas and beyond: longer times to reach hospitals and help. A 2017 Journal of the American Medical Association study found that rural accident victims wait an average of 14 minutes for EMS to arrive, whereas if you’re in a car accident in a city you wait only seven minutes. The longer the wait, the more likely it is that you won’t get critical care.

We know that urban smart people think that because they don’t drive, they’re somehow safe. Sadly, they are not, even if they practice “defensive walking.” Positively, the Governors Highway Safety Association (GHSA) says that in the first half of 2025, car crashes with pedestrians will finally approach 2019 levels. Thankfully, this is much lower than the 2022 rate, which reached a 40-year high.

But as you might guess, there are people on foot and on bikes in cities. So in 2024, more than 80% of deaths among bikers and pedestrians occurred in densely populated areas. Plus, sadly, you’re more likely to die in a city if you ride a motorcycle than down a beautiful country lane.

Get grainy, however, and the picture will be blurry. Several more rural states saw double-digit increases in pedestrian deaths during the first half of 2025, with Michigan (26%), Missouri (23%) and Utah (54%) all increasing. Increases were also seen in Idaho, Wyoming, North Dakota and Montana. Not to downplay the deaths, but you have to take those statistics with a handful of salt. Utah’s worrying jump is from 13 deaths to 20 deaths. It’s terrible, but it’s an increase of seven, which suddenly doesn’t seem so bad. Especially when California had 154 fewer deaths in the first half of 2025 than the same period last year. This is a decline of 27%.

What does it all mean? Well, the death rate for urban commuters by car is high, though thankfully not as often as it used to be. And pedestrian deaths are approaching more “normal” levels, but they are still 2.5% higher than before the pandemic. But hey, we don’t want to leave you feeling ruined. So if you live in California you live in a safe state for pedestrians and bikers, as the Golden State’s recent decline comes after the last two years where they led the nation in improved pedestrian safety.