U.S. Pedestrian Deaths Rose 50% as Other High-Income Countries' Fell, 2013–2022

This page summarizes a CDC report in MMWR comparing road deaths in the United States and 27 other high-income countries, 2013–2022.

Road crashes kill more than 40,000 people a year in the United States, and pedestrian deaths have risen fast: in 2022 they reached 7,522, the most in 41 years. CDC compared U.S. trends with those of 27 other high-income countries using the International Road Traffic and Accident Database, which draws U.S. figures from the Fatality Analysis Reporting System, a census of crashes on public roads that kill someone within 30 days.

The United States moved the wrong way

Pedestrian death rates in the United States and 27 other high-income countries, 2013–2022. Figure: CDC.

• By 2022 every one of the other 27 countries had a lower pedestrian death rate than the United States, whose rate was about three times their median (0.73).
• The United States had 2,857 more pedestrian deaths in 2022 than in 2013; the other 27 countries together had 3,071 fewer.
• The U.S. pedestrian rate rose about twice as much as the overall rate.
• Early U.S. Department of Transportation projections for 2023 suggested small declines, about 2% for pedestrian deaths and 4% overall.

By age

In 2018–2022, most countries had their highest pedestrian death rates among adults 65 and older, with South Korea highest. The United States had the highest rates of any country among people aged 15–24 and 25–64, and the second highest among children 0–14.

Five-year average pedestrian death rates by age group, 2018–2022. Figure: CDC.

Possible reasons

• Bigger vehicles. Taller, heavier vehicles with poor visibility, such as SUVs and pickups, make up a growing share of the fleet and have themselves grown, with heavier weights and higher bumpers. SUVs, vans and pickups were 79% of new U.S. sales and leases in 2022, while smaller vehicles such as sedans fell from 50% of new vehicles in 2012 to 21%. SUVs and pickups are more likely to hit pedestrians in some maneuvers, such as turning, and pedestrians hit by them are 50%–100% more likely to die.
• Dangerous road design. High-speed, complex multilane roads, especially arterials that try to both serve stores and restaurants and move traffic fast, are tied to more pedestrian deaths. Other countries often design roads around land use and safe walking, cycling and transit.
• Poverty in the suburbs. More people living below the poverty line in suburbs with fewer transportation options and less safe pedestrian infrastructure could add to the toll.
• Older pedestrians face risks from slower walking, poorer vision and distance judgment; longer crossing signals, shorter crossings and good lighting can help them and everyone else.

South Korea shows that progress is possible: although it had the highest older-adult pedestrian death rate, that rate fell 61% during 2013–2022, from 15.79 to 6.19.

The Safe System approach

The Safe System approach layers evidence-based protections so that no crash ends in death or serious injury, with a particular focus on limiting speeds and impact forces, which matters most for pedestrians. It aims at safer roads and vehicles, safer speeds, safer road users and better post-crash care. Examples include:

• road designs that encourage safe speeds, such as lane narrowing;
• separating road users, such as protected walkways and safe crossings;
• consistent street lighting and speed management policies;
• supporting safe behavior, such as ignition interlocks that keep impaired drivers from starting a vehicle.

Several countries have cut road deaths with this approach. The United States adopted it in its 2022 National Roadway Safety Strategy, and the international community has called for wider use during the second Decade of Action for Road Safety (2021–2030). Public health practitioners can help by using health data to set priorities, building coalitions, designing interventions with communities and evaluating them quickly.

Limitations

• Rates use population, not exposure such as distance traveled, which is not available for pedestrians in all countries; population-based rates do capture the effect of sprawl, which has been linked to rising U.S. road deaths.
• Rates are not age-adjusted, which could affect rankings, though not the finding that the U.S. pedestrian rate grew disproportionately.

Sources

• Naumann RB, West BA, Barry V, Matthews S, Lee R. "Pedestrian and Overall Road Traffic Crash Deaths — United States and 27 Other High-Income Countries, 2013–2022." MMWR 74(8). https://www.cdc.gov/mmwr/volumes/74/wr/mm7408a2.htm
• International Road Traffic and Accident Database: https://www.itf-oecd.org/irtad-road-safety-database · U.S. National Roadway Safety Strategy: https://www.transportation.gov/NRSS