Factors Associated with Pediatric Mortality from Motor Vehicle Crashes in the United States: A State-Based Analysis

Abstract

Objective To examine geographic variation in motor vehicle crash (MVC)-related pediatric mortality and identify state-level predictors of mortality. Study design Using the 2010–2014 Fatality Analysis Reporting System, we identified passengers <15y involved in fatal MVCs, defined as crashes on U.S. public roads with ≥1 death (adult or pediatric) within 30d. We assessed passenger, driver, vehicle, crash, and state policy characteristics as factors potentially associated with MVC-related pediatric mortality. Our outcomes were age-adjusted, MVC-related mortality rate per 100,000 children (AAMR) and percentage of children that died of those in fatal MVCs. Unit of analysis was U.S. state. We used multivariable linear regression to define state characteristics associated with higher levels of each outcome. Results Of 18,116 children in fatal MVCs, 15.9% died. AAMR varied from 0.25 in Massachusetts to 3.23 in Mississippi (mean national rate=0.94). Predictors of greater AAMR included greater percentage of children unrestrained/inappropriately restrained (p<0.001) and greater percentage of crashes on rural roads (p=0.016). Additionally, greater percentages of children died in states without red light camera legislation (p<0.001). For 10% absolute improvement in appropriate child restraint use nationally, our risk-adjusted model predicted >1,100 pediatric deaths averted over 5y. Conclusions MVC-related pediatric mortality varied by state and was associated with restraint nonuse/misuse, rural roads, vehicle type, and red light camera policy. Revising state regulations and improving enforcement around these factors may prevent substantial pediatric mortality.

Inter-Group Disparities in Fatal Road Traffic Accident in Texas

“…Children between the ages of 6 and 15, youths and young adult were found to be more vulnerable to fatal road accident compared with both older age groups and infants/pre-school age group (0-5). This finding corroborates the cohort study at the national level by Wolf et al (2017). The reason why children within the ages 6 to 15 were more involved in fatal can be partly related to driver license policy (Romano, Fell, & Voas, 2011).…”

“…Earlier studies found no significant difference among race/ethnicity for seat belt usage among Blacks, Whites and Hispanics drivers involved in fatal accident (Daniel, Bladikas, & Curley, 2007;Wells et al, 2002). Study on children (0-15 years) involvement in fatal road traffic accident found that difference in state policy on red-light camera and restraint use had significant influence on risk of fatality in the US (Wolf et al, 2017). There has not been a consistent result of safety measures among race/ethnicity in accident literature.…”

“…Previous studies have revealed that accident risk exposure and outcomes depend on many complex factors such as personal behavior (Sümer, 2003;Tao, Zhang, & Qu, 2017), safety compliance and policies (Han, Newmyer, & Qu, 2017;Wolf et al, 2017), socio-economic status (Braver, 2003), emergency response system and pre-existing health conditions (Lu & Davidson, 2017; Rupp et al, 2013). There is no consensus on factors contributing to risk disparity among diverse groups especially in the US with high cultural diversity.…”

“…At the national level, studies have been conducted to compared state level accident risk which conceal small level risk within a lower geography. Since aggregated studies are liable to ecological fallacy (Briggs et al, 2005(Briggs et al, , 2006; Factor, Williams, & Kawachi, 2013; Wolf et al, 2017), it is germane to examine the inter-group disparity in traffic-induced mortality at smaller geographic scale.…”

“…The teen death rate in Texas is 50.7 which is slightly lower than the US teen rate of 51.2 (www.worldlifeexpectancy.com/usa/texas-teen-death-rate). Yet, limited research exists on the contribution of road accident to children and teen mortality (Wolf et al 2017). Further, in Texas there is no outstanding research on the vulnerability of some ethnic minority groups involved in fatal road traffic accident.…”