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INTRODUCTION

General Orientation to the Problem

Roadway use and health are closely linked. Road traffic injuries are a leading cause of death worldwide and the number one cause of death among people 5–29 years of age.1 Approximately 1.35 million people die each year on the world’s roads, and 20–50 million sustain nonfatal injuries.1,2 Risk of death and injury show large disparities across the globe; low- and middle-income countries (LMICs) contain 60% of the world’s vehicles but account for 93% of road traffic deaths. Low-income countries alone contain only 1% of the world’s vehicles but account for 13% of road traffic deaths.1 In addition to the public health burden of lives lost, LMICs lose approximately 3–5% of GDP to the consequences of these crashes.2

High-income countries have death rates that are about half those seen in LMICs, but within this group there are also important differences.1,2 For example, a 2016 CDC report compared the United States with 19 other high-income countries and determined that the United States had the highest number of motor vehicle crash deaths per 100,000 population (a typical public health measure), and per 10,000 registered vehicles (a typical traffic safety measure).3 Moreover, recent trends do not show evidence of significant improvements. In 2018, a total of 36,560 people were killed in car crashes in the United States; a 2.4% decrease from the 37,473 people killed in 2018.4

Approximately 100 people die and thousands more are injured in motor vehicle crashes every day in the United States.4,5 As a leading cause of death, road traffic injuries represent a critical public health problem (Table 170-1), but what makes this issue even more compelling is the variety of highly effective strategies to reduce this burden.

TABLE 170-1LEADING CAUSES OF DEATH IN THE UNITED STATES, 2018

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