Motor Vehicle--Related Death Rates --- United States, 1999--2005

In 2005, the most recent year for which data are available, 45,520 deaths in the United States were related to motor vehicles (1). A Healthy People 2010 objective calls for reducing the rate of deaths related to motor vehicles to 9.2 per 100,000 population from a baseline of 15.6 in 1998 (2). To assess progress toward the Healthy People objective and to examine characteristics of motor vehicle--related death rates, CDC analyzed data from the National Vital Statistics System (NVSS) for the period 1999--2005. This report summarizes the results of that analysis, which determined that, during 1999--2005, although annual age-adjusted motor vehicle--related death rates overall were nearly unchanged (range: 15.2--15.7 per 100,000 population), substantial differences were observed by state, U.S. Census region,* sex, race, and age group. Among states, the average annual death rate ranged from 7.9 per 100,000 population in Massachusetts to 31.9 in Mississippi. Among regions, the rate ranged from 9.8 per 100,000 population in the Northeast to 19.5 in the South. The rate for men (21.7 per 100,000 population) was more than double the rate for women (9.4); the rate for American Indians/Alaska Natives (27.2) was nearly twice the rate for whites (15.7) and blacks (15.2), and the rate for persons aged 15--24 years (26.8) was 74% higher than the average annual rate overall (15.4). Additional analysis and research to determine the causes of geographic and demographic variations in motor vehicle--related deaths might result in more effective targeted interventions among the states, regions, and populations at greatest risk.

NVSS data were obtained from CDC's Web-based Injury Statistics and Query System, an interactive surveillance system that provides customized reports of injury-related deaths based on death certificate records from state vital statistics offices (1). CDC analyzed data on motor vehicle--related deaths for the period 1999--2005, the most recent years for which data were available, using codes^† from the International Classification of Diseases, 10th Revision (ICD-10) (3). Because the mortality coding system in the United States changed significantly from ICD-9 to ICD-10 in 1999, analysis was limited to data for the period 1999--2005 to ensure appropriate comparisons of data from year to year (4). Bridged-race population estimates from the U.S. Census were used to calculate death rates. Rates were age adjusted to the 2000 standard U.S. population. Negative binomial regression was used to determine the statistical significance (p<0.05) of changes in rates from 1999 to 2005. Data were analyzed by state, census region, sex, race (regardless of Hispanic ethnicity), and age group.

During 1999--2005, a total of 311,356 motor vehicle--related deaths occurred in the United States. The overall average annual age-adjusted rate for this period was 15.4 deaths per 100,000 population (range: 15.2--15.7 per 100,000 population); the annual death rate decreased by 1% from 15.3 in 1999 to 15.2 in 2005 (Table 1).

Of the motor vehicle--related deaths in the United States during 1999--2005, a total of 141,780 (46%) occurred in the South census region. The average annual death rate was highest in the South (19.5 per 100,000 population), followed by the Midwest (14.7), West (14.2), and Northeast (9.8). By state, the average annual death rate was highest in Mississippi (31.9 per 100,000 population), followed by Wyoming (27.7), Arkansas (25.6), Montana (25.6), and Alabama (25.1). In four states and the District of Columbia (DC), the average annual death rate was below the Healthy People target of 9.2 per 100,000 population: Massachusetts (7.9), New York (8.4), Rhode Island (8.5), DC (8.4), and New Jersey (9.0) (Table 1).

During 1999--2005, the average annual death rate for males (21.7 deaths per 100,000 population) in the United States was more than twice the rate for females (9.4) (Table 2). By race, the average annual death rate was highest among American Indians/Alaska Natives (27.2 deaths per 100,000 population), followed by whites (15.7), blacks (15.2), and Asians/Pacific Islanders (8.2) (Table 2).

By age group, the average annual motor vehicle--related death rate was highest among persons aged 15--24 years (26.8 deaths per 100,000 population) and persons aged >75 years (25.9) and lowest among persons aged <14 years (4.0) (Table 3). From 1999 to 2005, the annual rate was flat (26.3 versus 25.9) among persons aged 15--24 years and increased by 8% among persons aged 45--64 years and by 4% among persons aged 25--44 years. The annual rate decreased by 18% among persons aged <14 years and by 15% among persons aged >75 years.

Reported by: N Adekoya, DrPH, National Center for Public Health Informatics; Motor Vehicle Injury Prevention Team, Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC.

Editorial Note:

During 1999--2005, approximately 300,000 deaths in the United States were related to motor vehicle crashes; however, the overall annual death rate did not change substantially (range: 15.2--15.7 per 100,000 population). During an earlier period, from 1969 to 1992, the overall annual rate of motor vehicle--related deaths in the United States decreased 43%, from 27.7 per 100,000 population^§ to 15.8 (1), a rate only slightly higher than the rate observed during 1999--2005. Motor vehicle--related deaths are preventable, and numerous factors have been credited for the decrease in the death rate during 1969--1992, including adoption of the 0.08 g/dL blood alcohol concentration limit for drivers; vehicle safety improvements, primary enforcement of seat belt and child restraint laws, an increased minimum legal drinking age, alcohol checkpoints, lower speed limits and increased enforcement, and increased availability of statewide trauma systems (5). Nonetheless, additional and vigorous measures are needed if the Healthy People 2010 national objective of 9.2 deaths per 100,000 population is to be met.

The findings in this report revealed substantial variation in motor vehicle--related death rates among states during 1999--2005. Some of this variation is explained by the extent of population exposure to the road environment, which was not part of this population-based analysis. Similar calculations using a denominator such as vehicle miles traveled can yield different variations among states. Motor vehicle--related death rates also can vary for other reasons, including the types of road users. In this analysis, rates might be higher in states with greater percentages of more vulnerable road users (e.g., pedestrians, bicyclists, and motorcyclists) than in states with more passenger vehicle occupants.

The South accounted for 46% of the deaths during the period studied but only 36% of the population. Reasons for this disproportion are unclear. In addition to variations in exposure to the road environment and type of road user, rates might be affected by the proportion of the population living in rural versus urban locations and greater distances traveled, differences in population demographics (e.g., income and education), and differences in safety behaviors such as safety belt use (6--8). However, regional differences also mask substantial state variability. For example, in the South, Alabama and Arkansas had rates approximately twice as high as Maryland and Virginia. The differences in death rates by sex, race, and age group observed in this analysis are consistent with other reports and again underscore the importance of identifying populations at greatest risk for targeted interventions (e.g., males, American Indian/Alaska Natives, and young adults) (9,10). Further studies should address reasons for the higher motor vehicle--related death rates in certain states to enable creation of strategies that directly address this concern.

The findings in this report are subject to at least two limitations. First, death certificates and population estimates might not accurately record race, resulting in overreporting or underreporting of deaths and rates for certain racial populations. Second, the Healthy People objective was based on unintentional deaths only. However, this study examined all motor vehicle--related deaths, including homicides and suicides, which accounted for 1,400 deaths, or approximately 0.45% of all motor vehicle--related deaths during the study period.

Motor vehicle crashes continue to be a leading cause of death and injury in every U.S. region and state. States should reexamine their unique demographic, geographic, and cultural risk factors to determine the extent to which they are contributing to motor vehicle crashes and injuries. In addition, state and local highway safety and public health officials should reconsider additional strategies that have demonstrated effectiveness in reducing the number of motor vehicle--related deaths and injuries. For example, when properly used, lap/shoulder safety belts reduce by 45% the risk for dying in a crash and by 50% the risk for moderate to serious injury (6). Currently, 49 states and DC have safety belt laws; however, 23 states have only implemented laws with secondary enforcement (i.e., allowing police to ticket motorists for not using safety belts only if they are stopped for another violation). Secondary laws are less effective at increasing safety belt use and decreasing fatalities than primary laws (10). States should reexamine their motor vehicle safety policies to ensure that they are implementing and enforcing measures with the greatest effectiveness. Information on the effectiveness of strategies to increase use of safety belts and child safety seats and reduce alcohol-impaired driving is available at http://www.thecommunityguide.org/mvoi/index.html.

References

1. CDC. WISQARS (Web-based Injury Statistics Query and Reporting System). Available at http://www.cdc.gov/ncipc/wisqars.
2. US Department of Health and Human Services. Injury and violence protection: objective 15-15. In: Healthy people 2010 (conference ed. in 2 vols). Washington, DC: US Department of Health and Human Services; 2000. Available at http://www.healthypeople.gov/document/pdf/volume2/15injury.pdf.
3. World Health Organization. International statistical classification of diseases and related health problems: 10th revision (ICD-10). 3 vols. Geneva, Switzerland: World Health Organization; 1992.
4. Anderson RN, Minino AM, Hoyert DL, Rosenberg HM. Comparability of cause of death between ICD--9 and ICD--10: preliminary estimates. Natl Vital Stat Rep 2001;49(2).
5. Dellinger AM, Sleet DA, Jones BH. Drivers, wheels, and roads: motor vehicle safety in the twentieth century [Chapter 16]. In: Ward JW, Warren C, eds. Silent victories: the history and practice of public health in twentieth-century America. New York, NY: Oxford; 2007:343--62.
6. National Highway Traffic Safety Administration. Traffic safety facts---2007 data. Occupant protection. Washington, DC: National Highway Traffic Safety Administration; 2008. DOT HS 810 991. Available at http://www-nrd.nhtsa.dot.gov/pubs/810991.pdf.
7. National Highway Traffic Safety Administration. Traffic safety facts, 2005. A compilation of motor vehicle crash data from the Fatality Analysis Reporting System and the General Estimates System. Washington, DC: National Highway Traffic Safety Administration; 2006. DOT HS 810 631.
8. O'Neill B, Kyrychenko SY. Use and misuse of motor-vehicle crash death rates in assessing highway-safety performance. Traffic Inj Prev 2006;7:307--18.
9. CDC. Injury mortality among American Indian and Alaska Native children and youth---United States, 1989--1998. MMWR 2003;52:697--701.
10. Shults RA, Nichols JL, Dinh-Zarr TB, Sleet DA, Elder RW. Effectiveness of primary enforcement safety belt laws and enhanced enforcement of safety belt laws: a summary of the Guide to Community Preventive Services systematic reviews. J Safety Res 2004;35:189--96.

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Date last reviewed: 2/25/2009