Factors related to the risk of pedestrian fatality after a crash in Spain, 1993-2013

Introduction: The aim of this study was to quantify the magnitude of association between pedestrian fatalities during the first 24 h after a crash and pedestrian-, driver-, vehicle-and environment- related characteristics in Spain from 1993 to 2013. Methods: Data were analyzed for all 203,622 traffic crashes involving a pedestrian and a motor vehicle recorded in the Spanish Registry of Road Crashes with Victims. After multiple imputation for missing values, crude (CMRR) and adjusted mortality rate ratios (AMRR) were obtained for each variable with Poisson regression models. Results: Pedestrian risk of death after a crash increased nearly exponentially with pedestrian age. Male sex, committing an infraction and having a physical defect were also associated with a higher risk of death (AMRR 1.27, 95% CI 1.17-1.37 for physical defect). Regarding driver-related factors associated with pedestrian fatalities, visual defects (AMRR 1.21, 95% CI 1.08-1.37) and the commission of a speed infraction (AMRR 2.59, 95% CI 2.43-2.76) increased the risk. Heavy vehicles (trucks, vans, buses) and the presence of passengers were also associated with a higher risk of pedestrian death. The risk of pedestrian death was lower for crashes that occurred between 12:00 and 14:00, in good light conditions, at intersections, and when the pedestrian was on a sidewalk. Risk was higher in crashes in rural areas with fewer than 5000 inhabitants. Conclusions: We identified several factors strongly associated with the risk of pedestrian fatality; some of these factors are analyzed here for the first time. This knowledge is potentially useful in the design and prioritization of measures intended to increase pedestrian safety.