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.