Abstract

One potential impact of COVID19 may be the accelerated movement of families from denser environments into less populated areas. We asked whether urban or rural environments are associated with child safety in car accidents. More driving age adults (>15 years old) were seriously injured or killed in urban accidents compared to rural, yet kids were more likely to be injured or killed in rural accidents. Notably, while only slightly more rural children were killed, considerably more were injured. We suggest that parents moving to or living in less populated areas think about ways to increase their child’s car safety. Further, we urge lawmakers to make child car safety a priority during transportation planning, and to work with community organizations and relevant private sector actors to address the disparity in child car safety in rural areas.

1 Introduction

Anecdotal observations emerging from the COVID19 crisis suggest young city families are moving out to suburbs, as well as the relocation of established families into more rural areas [1]. Car accidents are one of the leading causes of death and disfigurement among children [2]. Analyzing 135k fatal accidents involving 337k people from 2015-2018, we found an age/geography disparity among who suffered serious or fatal injuries, with slightly more adults in urban vs rural accidents (52%/48%), but more children in rural ones (43%/57%). We asked where the most children were maimed or killed. The ten states that saw the most children involved were (in order): Texas, California, Florida, Indiana, Georgia, North Carolina, Alabama, Illinois, Arizona, Ohio. While most of these top 10 states saw a similar split of rural/urban cases, several states stood out for having significantly more rural ones. We highlight these states to inform lawmakers, community organizations and relevant private sector actors, and to keep relocating parents aware and vigilant.

2 Methodology

‘PERSON’ and ‘ACCIDENT’ datafiles for 2015-2018 were retrieved from the FARS ftp site [3]. Files were joined on ‘ST_CASE’ number and aggregated to form full datasets. Each occupant was bucketed into one of three age buckets: ‘young child’ (0-5 years), ‘school age child’ (6-15), or ‘driving age’ (16+). Rural or urban was determined according to the FARS specification R UR_URB, first recorded in 2015 [4], with ‘unknown’ rows being discarded from granular analysis. Urban areas are defined by the Census Bureau [5], briefly summarized as “densely developed territory, and encompass residential, commercial, and other non-residential urban land uses...[and] must encompass at least 2,500 people, at least 1,500 of whom reside outside institutional group quarters.” Injury severity was assessed according to the FARS specification INJ_SEV scale [4] . Serious injury here being defined by NHTSA [6], briefly summarized as ‘severe lacerations, broken or distorted extremity, crush injuries, suspected skull/chest/abdominal injury more severe than bruising/simple laceration, unconsciousness, significant burns, or paralysis’. The preliminary analysis here does not correct for vehicle miles traveled (VMT) by state, or proportion of children in different age brackets per state from 2015-2018.

3 Urban/Rural Divide for Top 10 States

4 Preliminary Conclusions

We analyzed 135,500 fatal accidents involving 337,560 people nationwide from 2015-2018. Discarding unlabeled data, we found 185,061 (55%) people involved in urban accidents, while 150,109 (45%) were involved in rural ones. Of the 337,560 people involved in fatal accidents, 180,105 (53%) suffered serious or fatal injuries. Of those seriously injured or killed, 91,127 (51%) were in urban environments, while 88,978 (49%) were in rural ones.

4.1 Age/Geography Disparity

We divided people involved into three age brackets: 0-5yo (‘young children’), 6-15 (‘school-age children’), or 16yo+ (‘driving age’) and analyzed their serious injuries/fatalities and environment. There were two striking findings. First, an age/geography disparity: while slightly more adults were injured or killed in urban environments (87,097 urban vs 83,594 rural; 52% to 48%), more children were injured or killed in rural accidents (4,030 urban vs 5,384 rural: 43% to 57%). Second, degree of child injury severity differed along road geography: while slightly less children were killed in urban environments (47% urban to 53% rural), nearly 2/3rds of the children severely injured across the nation between 2015-2018 were in rural areas (37% urban to 63% rural).

4.2 Large States and Urban/Rural Divides In Child Safety

We asked if the 57% bias in child injury in rural areas held in large states. The 10 states with the most injured or killed children were large states popular with families: Texas, California, Florida, Indiana, Georgia, North Carolina, Alabama, Illinois, Arizona, and Ohio. Among those, we compared state splits to the national (43%/57%) urban/rural split in child safety. Texas, California, North Carolina, Illinois and Ohio were all +/- 10% of the nationwide average. In contrast Florida (59%/41%), Georgia (59%/41%), and Arizona (55%/45%) were comparatively more safe for rural children, while Alabama (24%/76%) and Indiana (27%/73%) were less safe.

4.3 No Preliminary Evidence of Age Discrepancy

We expected to see age discrepancies between young children and schoolchildren, but found no significant difference in distribution between the two age groups along injury severity or geographical distribution. Injury/death was evenly distributed among young children (0-5; 2,245 kids involved, 33% of age bracket, 32.2% of children involved) and schoolchildren (6-15; 6,382 kids, 67% of age bracket, 68% of children involved). Urban/rural injury/fatality splits were also similar to broader trends above, regardless of child age bracket. We note that in the course of this short study we did not correct for age demographic across timespan or location; further analysis here may uncover differences.

These findings suggest children are more at risk during car accidents in rural areas. We speculate that road factors (road upkeep, visibility, faster vehicle speeds with reduced traffic, longer distances traveled) and demographic factors (larger families, more children per car) may play a role. Differences between states suggest state-centric analysis may reveal causal factors. As the COVID19 pandemic has changed driving habits, we will be revisiting these data for further research as they become available.

Recommendations

Based on the preliminary findings that children are more at risk during car accidents in rural areas, we agree with expert recommendations to increase child passenger safety. Recommendations from experts including the NHTSA, National Safety Council, and American Academy of Pediatrics have been summarized below.

Age- and size-appropriate child safety seats should be universally accessible to all families.
Properly installed child safety seats are proven to save lives when used correctly and can reduce fatal injury by 71% for infants and 54% for toddlers [7].
Car seat safety education should be universally accessible to all families.
Comprehensive education efforts may increase the rate that child passengers are properly restrained in the car safety seat appropriate to their age, weight and height according to NHTSA recommendations [8].
Car safety seat checks should be universally accessible to all families to reduce car safety seat misuse.
A 2011 NHTSA study found that 46% of children observed in more than 4,000 vehicles were riding in child safety seats that were being misused in a manner likely to reduce protection in a crash [9]. More accessible, frequent car seat checks may reduce injuries and fatalities from car accidents.
Existing child passenger safety laws should be updated to meet NHTSA recommendations.
Child passenger restraint laws that increase the age for car seat or booster seat use result in more children being restrained [10]. Currently, requirements for how infants and children should be restrained in child safety seats and fines for noncompliance vary by state [11].

While these findings do not suggest that rural drivers are most at risk, since accidents may be attributed to cross-travel between states and between rural and urban areas, further analysis may provide more information about where car seat safety outreach should be targeted.

Exhibits A & B

Exhibit A - Urban/Rural Transition Outside Edinburg, Texas

Exhibit B - Top 10 States, Counts of Children Injured or Seriously Injured, 2015-18

References

[1] https://www.usatoday.com/story/money/2020/05/01/coronavirus-americans-flee-cities-suburbs/3045025001/
[2] https://www.cdc.gov/motorvehiclesafety/child_passenger_safety/cps-factsheet.html publication date: Sept 13, 2019.
[3] https://www.nhtsa.gov/research-data/fatality-analysis-reporting-system-fars
[4] https://data.nber.org/fars/ftp.nhtsa.dot.gov/fars/FARS-DOC/Analytical%20User%20Guide/USERGUIDE-2015.pdf Aug 2016. [5] https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812607
[6] https://www.transportation.gov/sites/dot.gov/files/docs/resources/government/traffic-records/274866/sifactsheetfinal.pdf [7] https://injuryfacts.nsc.org/motor-vehicle/occupant-protection/child-restraint/
[8] https://www.nhtsa.gov/equipment/car-seats-and-booster-seats#age-size-rec
[9] https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812157
[10] https://www.cdc.gov/vitalsigns/childpassengersafety/infographic.html
[11] https://www.ghsa.org/state-laws/issues/child%20passenger%20safety

Child Safety on US Highways, 2014-2018