Int. J. Environ. Res. Public Health 2012, 9 1. Introduction 773 We have previously investigated train-person collisions on the state-owned Swedish rail network at the national level as a basis for systems-oriented prevention [1–4]. Systems-oriented measures refer to both technical and environmental changes, as well as efforts targeting operation, planning, and management of the system. We found an annual national toll of about 80–100 people being killed from such incidents, of which about 75% are classified as suicide by the police. We also found that a majority of the suicide victims appeared to have been waiting on or nearby tracks for a period of time before the train arrived, potentially leaving time for early detection and prompt intervention. With regard to place, we found that most collisions occur in densely populated areas, however, often some distance away from stations and platforms at more hidden spots and usually in the vicinity of the victim’s residence. Incidents were concentrated to urban areas, especially the three major cities; Stockholm, Gothenburg and Malmoe. This result is also important from a preventive point of view, since it means that measures can be prioritized to limited geographical areas. When comparing suicidal and accidental cases, we found differences with regard to individual and temporal characteristics, but similarities in injury mechanisms and possible countermeasures. This lead to the conclusion that prevention of railway suicide can benefit from a spectrum of well-known accident preventative strategies and should therefore become an integral part of regular railway safety work. This view was broadly accepted by practitioners as well, when discussing our findings in focus groups. The international literature in this field is limited. Several studies describe the frequency and characteristics of railway suicide in different countries [5–13], but only few of them explore systems-oriented preventative possibilities in more detail [14,15], mostly with reference to underground systems [16,17]. Our findings on victims awaiting trains on site and the nearness between place of occurrence and place of residence are in line with findings from other studies [5]. A special branch of studies refer to “hot spots”, especially their nearness to psychiatric institutions [18,19]. From our national studies we have not been able to identify geographical clustering patterns in that respect, possibly as a result of a broad transition to non-institutional psychiatric care in the Swedish society. Instead we have chosen to look deeper into the urban patterning of train-person collisions against the background of earlier results. The aim of the current study is to analyze train-person collision fatalities on state-owned rail networks in the Stockholm region with regards to place as well as temporal, demographical, behavioral and technical patterns relevant for safety work. Special attention is paid to patterns deviating from the national picture, implying special conditions and needs in larger urban settings. 2. Materials and Methods This study is a total investigation (census; no sampling) of all train-person collisions on the dominating state-owned rail network in greater Stockholm (defined below) occurring during the years 2005–2008 and registered by the Swedish Transport Administration (STA). STA is the national agency responsible for the state-owned rail network in Sweden, including its infrastructural safety. Public rail transportation to a lesser extent also exists on private and municipal rail systems (underground, tram and a few commuter lines) within the same geographical area. This study was conducted in