Comparison of US metropolitan region pedestrian and bicyclist fatality rates.

Annual US pedestrian and bicyclist fatalities involving motor vehicles have each increased by 30% in just six years, reaching their highest levels in two decades. To provide information to reverse this trend, we quantified pedestrian and bicyclist fatality rates in 46 of the largest US metropolitan statistical areas (MSAs) during two five-year time periods: 1999-2003 and 2007-2011. We divided the annual average number of pedestrian and bicyclist fatalities during 1999-2003 from the Fatality Analysis Reporting System by the annual estimates of pedestrian and bicycle trips, kilometers traveled, and minutes traveled from the 2001 National Household Travel Survey (NHTS) and the annual average number of fatalities from 2007 to 2011 by similar estimates from the 2009 NHTS. The five most dangerous regions for walking during 2007-2011 averaged 262 pedestrian fatalities per billion trips while the five safest averaged 49 pedestrian fatalities per billion trips. The five most dangerous regions for bicycling averaged 458 bicyclist fatalities per billion trips while the five safest averaged 75 bicyclist fatalities per billion trips. Random-effects meta-analysis identified eight metropolitan regions as outliers with low pedestrian fatality rates, six with high pedestrian fatality rates, one with a low bicyclist fatality rate, and five with high bicyclist fatality rates. MSAs with low pedestrian and bicycle fatality rates tended to have central cities recognized as Walk Friendly Communities and Bicycle Friendly Communities for investing in pedestrian and bicycle projects and programs. Random-effects meta-regression showed that certain socioeconomic characteristics and high pedestrian and bicyclist mode shares were associated with lower MSA fatality rates. Results suggest that pedestrian and bicycle infrastructure and safety programs should be complemented with strategies to increase walking and bicycling. In particular, safety initiatives should be honed to reduce pedestrian and bicyclist fatality risk in immigrant communities and to make pedestrian travel safer for the growing senior-age population.