Highway transportation incidents are the leading cause of occupational fatalities in the United States, with the highest fatality rates occurring among workers aged >65 years. To characterize older workers at highest risk, CDC analyzed data from the Census of Fatal Occupational Injuries (CFOI) for the period 2003-2010 and compared occupational highway transportation deaths among workers aged 55-64 years and >65 years with those among workers aged 18-54 years. This report describes the results of that analysis, which indicated that workers aged >65 years had the highest overall fatality rate (3.1 highway transportation deaths per 100,000 full-time-equivalent [FTE] workers per year), more than three times that of workers aged 18-54 years (0.9 per 100,000 FTE workers). This pattern held across demographic and occupational categories. These results demonstrate the need to further implement interventions that consider road safety risks specific to older workers. The U.S. Department of Labor Bureau of Labor Statistics (BLS) collects CFOI data from multiple sources. To be included in CFOI, the decedent must have been working, serving as a volunteer in a manner similar to a paid employee, or present at a site as a job requirement. As defined in this report, an occupational highway transportation death involved a motorized or nonmotorized vehicle and a worker aged =18 years, with the incident occurring on a public road, where the victim was the operator, passenger, or a pedestrian struck in or on the side of the road. Deaths while traveling between work locations are included in CFOI, whereas those during commuting to and from work are not. Fatality rates were calculated using estimates of the employed labor force from the Current Population Survey for FTE workers aged =18 years as denominators. Poisson regression methods were used to estimate fatality rates and 95% confidence intervals (CIs). During 2003-2010, a total of 11,587 workers aged =18 years in the United States died in occupational highway transportation incidents, of whom 3,113 (26.9%) were aged =55 years. Overall, fatality rates were highest among workers aged =65 years (3.1 deaths per 100,000 FTE workers), followed by those aged 55-64 years (1.4 deaths per 100,000 FTE workers). Over time, fatality rates remained relatively stable for workers aged 18-54 and 55-64 years. For workers aged >65 years, a sharp decrease in risk was observed in 2008, but by the end of the study period, their risk for a transportation death remained more than three times the risk among those aged 18-54 years. Risk for an occupational highway transportation death among American Indian/Alaska Native workers aged =65 years was more than four times the risk among those aged 18-54 years. A similar pattern, although of lower magnitude, was observed among white and black workers. For Hispanic workers, the risk for an occupational highway transportation death among workers aged >65 years was more than twice the risk among workers aged 18-54 years; for non-Hispanic workers, the risk among workers aged =65 years was more than three times the risk among workers aged 18-54 years. By primary industry, workers in transportation and warehousing accounted for a third of all deaths and had the highest rates across all age groups: 6.5, 10.6, and 21.2 for ages 18-54, 55-64, and >65 years, respectively. By primary occupation, rates were highest in transportation and material moving occupations for all age groups: 7.4, 12.9, and 22.9 for ages 18-54, 55-64, and >65 years, respectively, and these occupations accounted for one half of all deaths. The distribution of events leading to highway transportation deaths was similar across all age groups, with collisions between vehicles accounting for the largest proportion of deaths in each age group: 43%, 43%, and 48% for ages 18-54, 55-64, and >65 years, respectively. Across all age groups, driving a vehicle was the most common work activity being performed by the decedent. Proportions of pedestrian deaths were small: 12%-13% in all age groups. Among workers aged >65 years, the type of vehicle most often involved was an automobile (23%), semi-tractor trailer truck (22%), or pickup truck (15%), and a greater proportion of deaths involved off-road and industrial vehicles (9%, compared with 2% for the other age groups). Higher proportions of deaths involving semi-tractor trailer trucks were observed for workers aged 18-54 years and 55-64 years (31% and 37%, respectively).