Elsevier

The Journal of Pediatrics

Volume 187, August 2017, Pages 295-302.e3
The Journal of Pediatrics

Original Articles
Factors Associated with Pediatric Mortality from Motor Vehicle Crashes in the United States: A State-Based Analysis

https://doi.org/10.1016/j.jpeds.2017.04.044Get rights and content

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 <15 years of age involved in fatal MVCs, defined as crashes on US public roads with ≥1 death (adult or pediatric) within 30 days. 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 and percentage of children who died of those in fatal MVCs. Unit of analysis was US 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. The age-adjusted, MVC-related mortality rate per 100 000 children varied from 0.25 in Massachusetts to 3.23 in Mississippi (mean national rate of 0.94). Predictors of greater age-adjusted, MVC-related mortality rate per 100 000 children included greater percentage of children who were unrestrained or inappropriately restrained (P < .001) and greater percentage of crashes on rural roads (P = .016). Additionally, greater percentages of children died in states without red light camera legislation (P < .001). For 10% absolute improvement in appropriate child restraint use nationally, our risk-adjusted model predicted >1100 pediatric deaths averted over 5 years.

Conclusions

MVC-related pediatric mortality varied by state and was associated with restraint nonuse or misuse, rural roads, vehicle type, and red light camera policy. Revising state regulations and improving enforcement around these factors may prevent substantial pediatric mortality.

Section snippets

Methods

We performed a retrospective analysis of data to inform state-level policy. We compiled our analytic dataset from multiple sources. The primary source was the Fatality Analysis Reporting System (FARS), a nationwide census providing publicly available data on fatalities associated with MVCs. The FARS includes all fatal crashes in the US, defined as crashes that occur on a public road and result in ≥1 death (adult or pediatric) within 30 days. Data collection is supervised by the National Highway

Results

After applying the inclusion and exclusion criteria, we established a cohort of 18 116 children (Figure 1). This national cohort had a mean age of 6.9 years (SD 4.4) and was 51% male. The majority of children involved in a fatal crash lived in the South (52%), with 21% in the West, 19% in the Midwest, and 7.5% in the Northeast. Of the 18 116 children involved in a fatal crash, 2885 died (15.9%) within 30 days, of which 1424 died at the scene of the MVC. This corresponded with an overall AAMR

Discussion

We analyzed data from the National Highway Traffic Safety Administration's FARS to assess geographic variation of pediatric mortality from MVCs in the US and found substantial variation by state in AAMR as well as percentage of children who die of those involved in a fatal crash. Percentage of nonuse or misuse of restraints was a key predictor for both outcomes. Additional state-level characteristics that predicted increased risk of death included a greater percentage of crashes on rural roads

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    Supported by the American College of Surgeons Resident Research Scholarship (to L.W.) and the US National Institute of Health/National Institute of Arthritis and Musculoskeletal and Skin Diseases (K24AR057827-02 [to E.L.]). A.H. is the PI of a contract (AD-1306-03980) with the Patient-Centered Outcomes Research Institute entitled “Patient-Centered Approaches to Collect Sexual Orientation/Gender Identity in the ED” and a Harvard Surgery Affinity Research Collaborative (ARC) Program Grant entitled “Mitigating Disparities Through Enhancing Surgeons' Ability To Provide Culturally Relevant Care.” The other authors declare no conflicts of interest.

    Portions of this study were presented as an oral presentation at the American Academy of Pediatrics National Conference & Exhibition in San Francisco, California, October 21-25, 2016.

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