Abstract
Urban and rural child deaths from motor vehicle crashes: United States, 2015-2019
APHA 2022 Annual Meeting and Expo
Background: The U.S. motor vehicle crash (MVC) death rate on rural roads is twice that of urban roads. Lack of restraint use is known to contribute to higher rural death rates. Understanding differences in restraint use is important as MVCs are a leading cause of death among children. Proper child restraint use reduces the risk of injury by up to 80% when compared to seat belt use alone. The aims of this study are to examine child deaths in motor vehicle crashes by race/ethnicity, rurality, restraint use, and state child passenger restraint laws.
Methods: Fatality Analysis Reporting System data for 2015–2019 were analyzed to determine number and rates of deaths for occupants aged <18 years by county urban/rural level, age, race/ethnicity, optimal restraint use, and state child passenger restraint law. Optimal restraint use was defined using child’s age and restraint type according to best practice. Counties were categorized by state laws. State laws were grouped as either requiring children ≤6 years versus up to age 7 or 8 years to be in a car seat/booster seat.
Results: MVC death rates among American Indian or Alaska Native children (AIAN) overall were 1.4–4.7 times higher than other racial/ethnic groups. Deaths rates overall increased with increasing rurality—with over a 5-fold increase from most rural to most urban counties. Not optimally restrained children had deaths rates nearly twice that of optimally restrained children. States only requiring car seat/booster seat use for passengers ≤6 years had 1.5 times higher death rates and a 40% higher proportion of unrestrained deaths than states requiring car seat/booster seat use for passengers age ≤7 or ≤8.
Conclusions: Racial and geographic disparities in crash deaths exist among AIAN children and children in rural areas. Proper restraint use and extending the ages covered by child passenger restraint laws reduce the risk for child crash deaths. To address this disparity in child crash deaths, CDC developed the Booster Seat Planning Guide to assist States, Tribes, Localities, and Territories with assessing, planning, and implementing improved booster seat laws to reduce crash injuries and deaths among children. Additionally, the Booster Seat Planning Guide has a focus on equity and includes information on working with Tribal communities. Decision makers can consider extending the ages covered by child passenger restraint laws until at least age 9 to increase proper child restraint use and reduce crash injuries and deaths.