By Julie A. Ward,  Javier A. Cepeda, Dylan B. Jackson, Cassandra K. Crifasi

Much research on shootings by police has focused on urban jurisdictions, but most U.S. law enforcement agencies are not located in cities. Prior research suggests that rates of fatal shootings by police are comparable between urban and non-urban areas. Yet, shooting characteris tics across the urban−rural continuum are unknown. This study describes and compares fatal and nonfatal injurious shootings by officers in U.S. urban, suburban, and rural areas from 2015 to 2020. Methods: Characteristics of fatal and nonfatal injurious shootings by police were abstracted from Gun Violence Archive. In 2023−2024, using ZIP-code and county-based rurality designations, the national distribution, incidence, and characteristics of injurious shootings by police were compared across urban, suburban, and rural areas of the U.S. Results: Rates of injurious shootings in rural areas approached or exceeded those of urban rates. As rurality increased, proportionately more injurious shootings involved single responders, sheriffs, or multiple agency types. Across the urban−rural continuum, characteristics of precipitating incidents were similar. Injurious shootings were most frequently preceded by domestic violence incidents, traffic stops, or shots-fired reports; co-occurring behavioral health needs were common. After accounting for local demographic differences, Black, indigenous, and Hispanic residents were injured at higher rates than White residents in all examined areas. Conclusions: Shootings by police represent an overlooked and inequitable source of injury in rural areas. Broadly similar incident characteristics suggest potential for wide-reaching reforms. To prevent injuries, crisis prevention, dispatch, and response systems must assure proportionate rural area coverage. In addition, legislative prevention and accountability measures should include sheriffs' offices for optimal rural-area impact. 

AmJPrev Med 2024;000(000):1−9. © 2024