======================================================================== 224 Received: from VM.CINECA.IT by IFEUNIV.UNIFE.IT (Mailer R2.08) with BSMTP id 1274; Sat, 16 Apr 94 12:00:47 ITA Received: from ICINECA (NJE origin @) by VM.CINECA.IT (LMail V1.2a/1.8a) with BSMTP id 9024; Sat, 16 Apr 1994 12:01:50 +0100 Received: from DUKEMC.MC.DUKE.EDU by ICINECA.CINECA.IT (IBM VM SMTP V2R2) with TCP; Sat, 16 Apr 94 12:01:45 SET Received: from mc.duke.edu by mc.duke.edu (PMDF V4.2-15 #5528) id <01HB8CL7LFMO003QOM@mc.duke.edu>; Sat, 16 Apr 1994 05:32:15 EDT Received: from raphael.acpub.duke.edu by mc.duke.edu (PMDF V4.2-15 #5528) id <01HB8CD35KXC0041FV@mc.duke.edu>; Sat, 16 Apr 1994 05:25:27 EDT Received: (from green011@localhost) by raphael.acpub.duke.edu (8.6.8.1/Duke-2.0) id FAA24611; Sat, 16 Apr 1994 05:21:16 -0400 Date: Sat, 16 Apr 1994 05:16:29 -0400 (EDT) From: "Gary N. Greenberg, MD" Subject: MMWR: Pedestrian MVA Mortality Resent-to: occ-env-med-l-expand@mc.duke.edu To: List OccEnvMed Errors-to: eoccmed@mc.duke.edu Reply-to: occ-env-med-l@mc.duke.edu Resent-message-id: <01HB8CL7NKSI003QOM@mc.duke.edu> Message-id: X-VMS-To: IN%"occ-env-med-l-forward@mc.duke.edu" "List OccEnvMed" MIME-version: 1.0 Content-type: TEXT/PLAIN; charset=US-ASCII Content-transfer-encoding: 7BIT Comments: Occupational & Environmental Medicine This is broadcast from the Occ-Env-Med-l Mail-list, which originates at Duke University Medical Center. Readership is intended to be clinicians and other health professionals interested in the medical and preventive aspects of occupational and environmental health. To subscribe, send a single line message to mailserv@mc.duke.edu Subscribe OCC-ENV-MED-L "your-name" Questions to Gary Greenberg: green011@mc.duke.edu To reply or post to the list, use occ-env-med-L@duke.mc.edu Effectiveness in Disease and Injury Prevention Motor-Vehicle-Related Deaths Involving Intoxicated Pedestrians -- United States, 1982-1992 Pedestrians account for 14% of all motor-vehicle-related deaths and (1). In 1992, a total of 5546 pedestrians were killed as a result of motor-vehicle crashes, and 96,000 suffered nonfatal injuries. Because of the effects of alcohol on attention, perception, vision, judgment, and motor control, intoxicated pedestrians are at increased risk for unintentional injury (2). Although alcohol consumption by pedestrians is an important contributing factor to motor-vehicle crashes in which pedestrians are injured, characteristics of intoxicated pedestrians who are killed as a result of such crashes have not been well defined. This report uses data from the National Highway Traffic Safety Administration's (NHTSA) Fatal Accident Reporting System for 1982-1992 to characterize intoxicated pedestrians aged greater than 14 years who were killed as a result of motor-vehicle-related crashes. NHTSA considers a fatal crash to be alcohol related if either the driver or a non-occupant (e.g., a pedestrian) had a blood alcohol concentration (BAC) greater than 0.01 g/dL in a police-reported motor-vehicle crash. In most states, a BAC greater than or equal to 0.10 g/dL is the statutory level of intoxication for drivers, although 10 states have established lower levels (e.g., greater than or equal to 0.08 g/dL). However, there is no statutory level of intoxication for pedestrians. In this report, the term "intoxicated pedestrian" refers to a pedestrian with a BAC greater than or equal to 0.10 g/dL. NHTSA uses statistical models, based on discriminant function analysis, to estimate BACs of drivers and pedestrians for whom alcohol levels were not available (3). Age groupings in this analysis are those used by NHTSA. From 1982 to 1992, the number of intoxicated pedestrians who were killed as a result of motor-vehicle crashes declined 28%, from 2395 to 1727; the percentage of all pedestrian deaths that involved intoxicated pedestrians declined by 8%, from 39.4% to 36.2%. The largest decline (29%) in the percentage of deaths involving intoxicated pedestrians occurred among persons aged 15-20 years, decreasing from 44% in 1982 to 31% in 1992 (Figure 1). The only increase in the percentage of pedestrian deaths involving intoxicated pedestrians occurred among persons aged 25-34 years, increasing from 53.3% in 1982 to 57.1% in 1992 (Figure 1). For all age groups, death rates for intoxicated pedestrians per 100,000 population declined in 1992 compared with 1982; the largest declines occurred among persons aged 15-20 years and 21-24 years (Figure 2). During both years, age-specific death rates for intoxicated pedestrians were lowest for persons aged greater than or equal to 65 years. For each year during 1982-1992, the number of deaths among intoxicated pedestrians was greater for males than females. However, the number decreased for both sexes from 1982 to 1992 (males: from 1923 to 1442; females: from 427 to 284). For males, the percentage of pedestrian deaths involving intoxicated pedestrians remained constant (44% versus 43% for 1982 and 1992, respectively); for females, the percentage declined steadily (27% versus 20% for 1982 and 1992, respectively). From 1982 to 1992, the number of deaths among intoxicated pedestrians declined in both rural and urban areas (rural: from 1014 to 577; urban: from 1368 to 1127). The percentage of pedestrian deaths involving intoxicated pedestrians declined in rural areas (49% versus 43% for 1982 and 1992, respectively) but remained constant in urban areas (35% versus 34% for 1982 and 1992, respectively). For both sexes, the percentage of pedestrian deaths involving intoxicated pedestrians in 1992 was higher in rural areas than in urban areas (males: 48% versus 41%, respectively; females: 26% versus 18%, respectively). In both rural and urban areas, the percentage was greatest among persons aged 21-24 years and 25-34 years combined (rural: 59%; urban: 54%). Data for 1992 were examined to characterize the relation between posted speed limit, type of roadway, and deaths among intoxicated pedestrians. Of the 560 deaths in rural areas where posted speed limit and land use were known, 381 (68%) occurred on roadways with a posted speed limit of 55 miles per hour (mph) or greater (Table 1). Most deaths in rural areas occurred either on major streets and highways (divided or undivided) (46%) or on local roadways (45%). Of the 1088 deaths in urban areas where posted speed limit and land use were known, 73% occurred on roadways with a posted speed limit of either 30-35 mph (431 [40%]) or 40-50 mph (357 [33%]). Most deaths in urban areas occurred either on major streets and highways (57%) or on interstates and freeways (25%). State Programs, Traffic Safety Programs, T Lindsey, National Center for Statistics and Analysis, Research and Development, National Highway Traffic Safety Administration. Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control, CDC. Editorial Note: The findings in this report indicate that among all pedestrian deaths, the proportion involving intoxicated pedestrians was higher in rural areas than in urban areas. In rural areas, these deaths occurred on roads with higher posted speed limits, suggesting that deaths among intoxicated pedestrians in rural areas may be associated with increased traffic speed or with the location of establishments that serve or sell alcohol along high-speed roadways where few barriers or sidewalks exist. In urban areas, deaths among intoxicated pedestrians may be associated with traffic volume or the location of establishments that serve or sell alcohol along densely populated commercial roadways with low posted speed limits. In 1992, approximately 12% of all pedestrian deaths involved an intoxicated driver, and 36% involved an intoxicated pedestrian (4). Although reasons for the higher proportion of deaths involving intoxicated pedestrians are unclear, 60% of fatally injured intoxicated pedestrians have BACs greater than or equal to 0.20 g/dL--twice the legal limit for drivers in most states (5) and many may be alcoholics (6). In addition, previous studies indicate that pedestrians with BACs greater than or equal to 0.08 g/dL are 3.6 times more likely to be struck by a motor vehicle than those who are not alcohol impaired (7) and that severity of injuries is directly associated with BAC. To characterize risk factors associated with motor-vehicle-related deaths among intoxicated pedestrians, NHTSA is sponsoring a study in Baltimore to assess selected variables (e.g., time and location of crash, purpose of the pedestrian trip, and number of roadway lanes); the findings may assist in developing community-based interventions to reduce motor-vehicle crashes involving intoxicated pedestrians. In addition, a working group established by the International Council on Alcohol, Drugs, and Traffic Safety is reviewing the effectiveness of programs and developing recommendations for reducing this problem worldwide (8). During 1982-1992, progress toward reducing the proportion of deaths among intoxicated drivers was greater than that among intoxicated pedestrians. Although no legal definition of intoxication exists for pedestrians, some of the prevention and intervention strategies designed to reduce alcohol-impaired driving may be adapted to reduce intoxication among pedestrians. Examples include statutory limitations on BAC; laws that control the availability of alcohol; early identification and treatment for persons with alcohol problems; and interventions targeting consumers, sellers, and servers of alcohol (9). Additional strategies include using environmental approaches that separate pedestrians from traffic (e.g., overpasses and pedestrian malls), which should assist in reducing deaths among all pedestrians (10); initiating publicawareness and public-education programs to inform drivers and pedestrians about the hazards associated with intoxicated pedestrians; devising different interventions for use on high-speed roads (in rural areas) and medium-speed roads (in urban areas); and developing ecologic approaches that focus on the interaction between the pedestrian, driver, vehicle design, community characteristics, and the physical and social environment. References 1. National Highway Traffic Safety Administration. Traffic safety facts, 1992: a compilation of motor vehicle crash data from the Fatal Accident Reporting System and the General Estimates System. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1993; report no. DOT-HS-808-022. 2. Cherpitel CJ. The epidemiology of alcohol-related trauma. Alcohol Health Res World 1992;16:191-6. 3. Klein TM. A method of estimating posterior BAC distributions for persons involved in fatal traffic accidents: final report. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1986; report no. DOT-HS-807-094. 4. CDC. Alcohol involvement in pedestrian fatalities--United States, 1982- 1992. MMWR 1993;42:716-9. 5. Fell JC, Hazzard G. The role of alcohol involvement in fatal pedestrian collisions. In: Proceedings of the 29th Annual Conference of the American Association for Automotive Medicine. Des Plains, Illinois: American Association for Automotive Medicine, 1985:105-25. 6. Blomberg RD, Fell JC, Anderson TE. A comparison of alcohol involvement in pedestrians and pedestrian casualties. In: Proceedings of the 23rd Annual Conference of the American Association for Automotive Medicine. Des Plains, Illinois: American Association for Automotive Medicine, 1979:1-17. 7. Irwin ST, Patterson CC, Rutherford WH. Association between alcohol consumption and adult pedestrians who sustain injuries in road traffic accidents. Br Med J 1983;286:522. 8. International Council on Alcohol, Drugs, and Traffic Safety. ICADTS establishes a working group to address the problem of alcohol involved pedestrians [Newsletter]. ICADTS Reporter 1993;4:2. 9. Sleet DA, Wagenaar AC, Waller PF. Introduction: drinking, driving, and health promotion. Health Educ 1989;16:329-33. 10. Zegeer CV, Stutts JC, Huang H, Zhou M, Rodgman E. Analysis of elderly pedestrian accidents and recommended countermeasures: transportation research record no. 1405 (Operations and safety). Washington, DC: National Academy of Sciences, National Research Council, 1993:56-63.