Background: Since the 1990s, West Virginia (WV) has led the United States in per capita death rate from all-terrain vehicle (ATV) incidents, with rates eight times higher than the national average. Safety legislation enacted in 2005 attempted to curtail this trend by prohibiting ATV operation on selected paved roads and by requiring helmets for ATV riders aged <18 years. This study describes the epidemiology of ATV fatalities in WV during the previous 8 years.

Methods: WV death certificates for 1999–2006 with International Classification of Deaths (10^th Rev.) (ICD-10) codes correlating to ATV unintentional injuries were identified. Descriptive analyses were performed to identify temporal trends and demographic variations.

Results: During 1999–2006, a total of 278 ATV fatalities occurred in WV. The greatest annual total occurred in 2006, with 60 ATV fatalities, approximately twice the annual average during the preceding 7 years of 31 (range: 14–43). Males accounted for 231 (81%) of fatalities. The average annual death rate for WV residents attributable to ATV incidents was 1.5/100,000, with adolescents aged 10–19 years exhibiting the highest rate (2.8/100,000) among all age groups. During the 8-year period, fatalities averaged a 20%/year increase. Half (139) of all ATV fatalities resulted from incidents occurring on public highways, rather than off-road incidents, with no significant difference in this trend before and after 2005.

Conclusions: Since 1999, ATV fatalities in WV have continued to increase, with little change observed since 2005 safety legislation. We recommend targeted community education efforts and improved ATV safety regulations.