People who most believe in a culture of honor -- who agree that "A real man doesn't let other people push him around" or that aggression is a reasonable response to being insulted -- told the researchers they were quite willing to engage in risky behaviors, such as bungee jumping or gambling away a week's wages. This willingness to take risks might well translate into an early death[.] . . .
Honor cultures are more powerful in rural areas, where the influence of personal reputation is higher than it is in cities. Although honor states had a 14% higher accidental death rate in the cities, they had a 19% higher rate of accidental death in more rural areas, compared to non-honor states. More than 7,000 deaths a year can be attributed to risk-taking associated with the culture of honor in the USA.
FWIW, it could also have something to do with the fact that "cultures of honor" also have disproportionate shares of blue collar workers whose jobs are more dangerous. But, the urban-rural comparison casts some doubt on that economic as opposed to cultural interpretation.