Trends in Pedestrian-related mortality in the United States; 1999-2020, A CDC-WONDER analysis

Objective Pedestrian mortality in the United States has increased seven times faster than the population growth from 2019 to 2023, according to a Governors Highway Safety Association report. This alarming trend highlights the need to study pedestrian mortality patterns, stratified by gender, race/ethnicity, age group, and state-specific characteristics, along with an exploration of contributing factors driving this surge.

The Centers for Disease Control and Prevention Wide-Ranging Online Data for Epidemiologic Research (CDC-WONDER) database was used to extract pedestrian mortality data from 1999 to 2020. Age-Adjusted Mortality Rates (AAMRs) per 100,000 population and Annual Percentage Changes (APCs) with 95% confidence intervals (CIs) were calculated. Joinpoint regression analysis was employed to assess the trends across various demographic and regional subgroups.

A total of 140,280 pedestrian deaths occurred in the US between 1999 and 2020. The overall AAMR increased from 2.21 in 1999 to 2.32 in 2020. A steep rise in the APC (3.11) was observed from 2009 to 2020. Men consistently had higher AAMRs than women, while non-Hispanic (NH) American Indians or Alaska Natives had the highest AAMR among races. Individuals aged 35–44 years exhibited the highest APC (6.92) between 2011 and 2020. States in the 90th percentile (Arizona, Florida, New Mexico) had triple AAMRs compared to those in the 10th percentile. Rural areas had the highest APC (3.23) from 2011-2020.

Pedestrian mortality rates in the United States have been rising for over a decade. Enhanced public safety interventions and efforts to address disparities based on race, age, gender, and geographic location are essential to curb the growing burden of pedestrian deaths. Competing Interest Statement The authors have declared no competing interest. Funding Statement The study did not receive any funding Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Ethics committee/IRB approval was waived off because it uses de-identified government-issued public use data set and follows the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) guidelines for reporting. CDC-WONDER is a public service developed and operated by the Centers for Disease Control and Prevention, an agency of United States federal government. The public web site at http://wonder.cdc.gov is in the public domain, and only provides access to public use data and information. You may access the information freely, and use, copy, distribute or publish this information without additional or explicit permission. All necessary patient/participant consent has been obtained. any patient/participant/sample identifiers cannot be used to identify individuals I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes Email: anoud.17451{at}zu.edu.pk, Email: aryan.17546{at}zu.edu.pk, Email: muntahairfan24{at}gmail.com, Email: aroobasheikh4{at}gmail.com, Email: ushna.smd{at}gmail.com, Email: ayeshaimran11644{at}gmail.com, Email: amina.mujahid{at}students.mbru.ac.ae Data Availability All data produced in the present work are contained in the manuscript and in the supplemental files.