摘要：Objectives. To examine changes in pedestrian and cyclist fatalities per capita (1990–2014) and per kilometer (2000–2010) in selected high-income countries, and in fatalities and serious injuries per kilometer by age in the United States and Germany (2001–2009). Methods. We used Organisation for Economic Cooperation and Development data to estimate 5-year annual averages of per-capita fatalities relative to the 1990–1994 average. To control for exposure, we divided fatalities and serious injuries by kilometers of walking or cycling per year for countries with comparable data from national household travel surveys. Results. Most countries have reduced pedestrian and cyclist fatality rates per capita and per kilometer. The serious injuries data show smaller declines or even increases in rates per kilometer. There are large differences by age group in fatality and serious injury rates per kilometer, with seniors having the highest rates. The United States has much higher fatality and serious injury rates per kilometer than the other countries examined, and has made the least progress in reducing per-capita fatality rates. Conclusions. The United States must greatly improve walking and cycling conditions. All countries should focus safety programs on seniors and children. Improved traffic safety for pedestrians and cyclists is an important goal of public health policies in countries throughout the world. 1–3 The World Health Organization (WHO) has identified traffic injuries and fatalities as among the world’s 5 most important causes of unnatural death, with predictions that they will become the leading cause by 2030. 2 As of 2015, they were already the leading cause of unnatural death among persons in the group aged 15 to 29 years. Reducing pedestrian and cyclist deaths and injuries is obviously a benefit in itself. In addition, however, safer walking and cycling conditions have been shown to increase levels of walking and cycling, especially among vulnerable or risk-averse groups such as children, seniors, and women. 4–9 Increasing walking and cycling rates would help raise the low physical activity levels in most developed countries, thus contributing to improved public health. 3,5,10 The Organisation for Economic Cooperation and Development (OECD) issues annual reports with international comparisons of traffic safety over recent decades. 1 The OECD reports falling rates of total traffic fatalities per capita in most developed countries, including the United States, where traffic fatalities per capita fell by 46% from 1990 to 2014. 1 There are large differences among countries, however, and the United States has suffered for many years from a much higher traffic fatality rate per capita than most other OECD countries. In 2014, for example, the per-capita fatality rate in the United States was 2 to 3 times higher than that in most Western European countries. 1 The OECD’s published reports do not include separate fatality rates for walking and cycling over time. Nor do they control for exposure rates such as the number of trips, distance, or hours walked and cycled, which are crucial in measuring the safety of these 2 nonmotorized modes. 1 Yet another gap in the OECD reports is the variation in walking and cycling safety by age group. Several studies suggest that children and seniors are especially vulnerable to walking and cycling injuries and fatalities. 4,11 We first show trends in pedestrian and cyclist fatalities per capita from 1990 to 2014 for 11 major OECD countries on 4 continents to provide a broader context for the narrower analysis of the United States and Germany that follows. Most of the article is devoted to a detailed analysis of changes between 2001–2002 and 2008–2009 in pedestrian and cyclist fatalities and serious injuries per kilometer in the United States and Germany, disaggregated by the same 4 age groups used in both countries’ national travel surveys: 5 to 14, 15 to 24, 25 to 64, and 65 years and older. We focused on the United States and Germany because their 2 most recent national travel surveys are almost identical in methodology and timing, and because their data on fatalities and serious injuries are comparably defined. 12 The 2 countries are similar in other respects as well: high per-capita incomes, high rates of car ownership, nearly identical rates of driver licensing, extensive high-quality road networks, and similarly advanced systems of emergency medical care, both at the crash site and in hospitals. 12–14 As noted in the Discussion section, however, there are large differences in government policies toward walking and cycling, thus highlighting the importance of public policies in improving pedestrian and cyclist safety.
