Trends in walking and cycling safety: Recent evidence from high-income countries, with a focus on the United States and Germany

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.