Road Traffic Accidents and Disparities in Child Mortality

Pediatrics. 2020 Nov;146(5):e20193009. doi: 10.1542/peds.2019-3009. Epub 2020 Oct 20.


Background and objectives: Road traffic accidents are a leading cause of child deaths in the United States. Although this has been examined at the national and state levels, there is more value in acquiring information at the county level to guide local policies. We aimed to estimate county-specific child mortality from road traffic accidents in the United States.

Methods: We queried the Fatality Analysis Reporting System database, 2010-2017, for road traffic accidents that resulted in a death within 30 days of the auto crash. We included all children <15 years old who were fatally injured. We estimated county-specific age- and sex-standardized mortality. We evaluated the impact of the availability of trauma centers and urban-rural classification of counties on mortality.

Results: We included 9271 child deaths. Among those, 45% died at the scene. The median age was 7 years. The overall mortality was 1.87 deaths per 100 000 children. County-specific mortality ranged between 0.25 and 21.91 deaths per 100 000 children. The availability of a trauma center in a county was associated with decreased mortality (adult trauma center [odds ratio (OR): 0.59; 95% credibility interval (CI), 0.52-0.66]; pediatric trauma center [OR: 0.56; 95% CI, 0.46-0.67]). Less urbanized counties were associated with higher mortality, compared with large central metropolitan counties (noncore counties [OR: 2.33; 95% CI, 1.85-2.91]).

Conclusions: There are marked differences in child mortality from road traffic accidents among US counties. Our findings can guide targeted public health interventions in high-risk counties with excessive child mortality and limited access to trauma care.

MeSH terms

  • Accidents, Traffic / mortality*
  • Adolescent
  • Bayes Theorem
  • Child
  • Child Mortality*
  • Child, Preschool
  • Databases, Factual / statistics & numerical data
  • Educational Status
  • Female
  • Humans
  • Income
  • Local Government
  • Male
  • Odds Ratio
  • Poisson Distribution
  • Rural Population / statistics & numerical data
  • Sex Distribution
  • Small-Area Analysis
  • Trauma Centers / classification
  • Trauma Centers / supply & distribution*
  • United States / epidemiology
  • Urban Population / statistics & numerical data