Using a Safe System Framework to Examine the Roadway Mortality Increase Pre-COVID-19 and in the COVID-19 Era in New York State.

Roadway mortality increased during COVID-19, reversing a multi-decade downward trend. The Fatality Analysis Reporting System (FARS) was used to examine contributing factors pre-COVID-19 and in the COVID-19 era using the five pillars of the Safe System framework: (1) road users; (2) vehicles; (3) roadways; (4) speed; and (5) post-crash care. Two study time periods were matched to control for seasonality differences pre-COVID-19 ( = 1725, 1 April 2018-31 December 2019) and in the COVID-19 era ( = 2010, 1 April 2020-31 December 2021) with a three-month buffer period between the two time frames excluded. Four of the five pillars of the safe system had road safety indicators that worsened during the pandemic. Mortality was 19.7% higher for motor vehicle occupants and 45.1% higher for riders of motorized two-wheeled vehicles. In adjusted analyses, failure to use safety equipment (safety belts/helmets) was associated with 44% higher mortality. Two road user groups, non-motorized bicyclists and pedestrians, did not contribute significantly to higher mortality. Urban roadway crashes were higher compared to rural crashes. Additional scientific inquiry into factors associated with COVID-19-era mortality using the Safe System framework yielded important scientific insights to inform prevention efforts. Motorized two-wheeled vehicles contribute disproportionately to pandemic-era higher mortality and constitute an emerging road safety issue that deserves further attention.