Americans’ vision of the rural U.S. is often the idyllic Mayberry setting of The Andy Griffith Show. However, a new study has now shown that the rural U.S. can actually be more dangerous than U.S. cities.

The study, to be published this week in the journal Annals of Emergency Medicine, shows that the risk of death from injuries is lower on average in urban counties than in suburban and rural counties. Overall, the risk of death from injuries was found to be approximately 20% lower in urban areas than in the rural U.S.

“Perceptions have long existed that cities were innately more dangerous than areas outside of cities, but our study shows this is not the case” said Dr. Sage Myers, lead author of the study and a professor of pediatrics at the University of Pennsylvania’s Perelman School of Medicine. “These findings may lead people who are considering leaving cities for non-urban areas due to safety concerns to re-examine their motivations for moving. And we hope the findings could also lead us to re-evaluate our rural health care system and more appropriately equip it to both prevent and treat the health threats that actually exist.”

The study looked at over 1.2 million injury deaths from 1999 to 2006. Car accidents, firearms, and poisoning were found to be the top causes of injury-related death for the U.S. population. Deaths from car crashes were found to be twice as high in rural areas than in urban ones. Firearm-related deaths were higher for children and those over 45 in rural areas, but higher in urban areas for Americans age 20 to 44. Overall homicide rates are higher in urban areas, though suicide rates for those under 19 were higher in rural areas.

“Cars, guns and drugs are the unholy trinity causing the majority of injury deaths in the U.S.,” said Myers. “Although the risk of homicide is higher in big cities, the risk of unintentional injury death is 40 percent higher in the most rural areas than in the most urban. And overall, the rate of unintentional injury dwarfs the risk of homicide, with the rate of unintentional injury more than 15 times that of homicide among the entire population. This has important implications about staffing of emergency departments and trauma care systems in rural areas, which tend to be underserved as it is.”