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This article was downloaded by: On: 30 August 2010 Access details: Access Details: Free Access Publisher Taylor & Francis Informa Ltd Registered in England and Wales Registered Number: 1072954 Registered office: Mortimer House, 37- 41 Mortimer Street, London W1T 3JH, UK Traffic Injury Prevention Publication details, including instructions for authors and subscription information: http://www.informaworld.com/smpp/title~content=t713456148 Incidence and Total Lifetime Costs of Motor Vehicle-Related Fatal and Nonfatal Injury by Road User Type, United States, 2005 Rebecca B. Naumanna; Ann M. Dellingera; Eduard Zaloshnjab; Bruce A. Lawrenceb; Ted R. Millerb a Motor Vehicle Injury Prevention Team, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia b Pacific Institute for Research & Evaluation, Calverton, Maryland Online publication date: 20 August 2010 To cite this Article Naumann, Rebecca B. , Dellinger, Ann M. , Zaloshnja, Eduard , Lawrence, Bruce A. and Miller, Ted R.(2010) 'Incidence and Total Lifetime Costs of Motor Vehicle-Related Fatal and Nonfatal Injury by Road User Type, United States, 2005', Traffic Injury Prevention, 11: 4, 353 — 360 To link to this Article: DOI: 10.1080/15389588.2010.486429 URL: http://dx.doi.org/10.1080/15389588.2010.486429 PLEASE SCROLL DOWN FOR ARTICLE Full terms and conditions of use: http://www.informaworld.com/terms-and-conditions-of-access.pdf This article may be used for research, teaching and private study purposes. Any substantial or systematic reproduction, re-distribution, re-selling, loan or sub-licensing, systematic supply or distribution in any form to anyone is expressly forbidden. The publisher does not give any warranty express or implied or make any representation that the contents will be complete or accurate or up to date. The accuracy of any instructions, formulae and drug doses should be independently verified with primary sources. The publisher shall not be liable for any loss, actions, claims, proceedings, demand or costs or damages whatsoever or howsoever caused arising directly or indirectly in connection with or arising out of the use of this material. Trafﬁc Injury Prevention, 11:353–360, 2010 Copyright C 2010 Taylor & Francis Group, LLC ISSN: 1538-9588 print / 1538-957X online DOI: 10.1080/15389588.2010.486429 Incidence and Total Lifetime Costs of Motor Vehicle – Related Fatal and Nonfatal Injury by Road User Type, United States, 2005 REBECCA B. NAUMANN,1 ANN M. DELLINGER,1 EDUARD ZALOSHNJA,2 BRUCE A. LAWRENCE,2 and TED R. MILLER2 1 Motor Vehicle Injury Prevention Team, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia 2 Paciﬁc Institute for Research & Evaluation, Calverton, Maryland Objectives: To estimate the costs of motor vehicle–related fatal and nonfatal injuries in the United States in terms of medical care and lost productivity by road user type. Methods: Incidence and cost data for 2005 were derived from several data sources. Unit costs were calculated for medical spending and productivity losses for fatal and nonfatal injuries, and unit costs were multiplied by incidence to yield total costs. Injury incidence and costs are presented by age, sex, and road user type. Downloaded At: 17:23 30 August 2010 Results: Motor vehicle–related fatal and nonfatal injury costs exceeded $99 billion. Costs associated with motor vehicle occupant fatal and nonfatal injuries accounted for 71 percent ($70 billion) of all motor vehicle–related costs, followed by costs associated with motorcyclists ($12 billion), pedestrians ($10 billion), and pedalcyclists ($5 billion). Conclusions: The substantial economic and societal costs associated with these injuries and deaths reinforce the need to implement evidence-based, cost-effective strategies. Evidence-based strategies that target increasing seat belt use, increasing child safety seat use, increasing motorcyclist and pedalcyclist helmet use, and decreasing alcohol-impaired driving are available. Keywords Crash; Cost; Injury prevention; Road users; Motor vehicle INTRODUCTION trafﬁc death rates to the United States in the early 1980s, have since made considerable progress in reducing the number of Road trafﬁc injuries are the ninth leading cause of death lives lost on their roads. Death rates in many of these nations worldwide and by 2030 they are expected to become the 5th have been reduced more than 60 percent (from 23–25 to 7–9 leading cause of death, outranking diabetes, HIV/AIDS, and deaths per 100,000 persons) since the early 1980s (WHO 2009). hypertensive heart disease (World Health Organization [WHO] In contrast, the United States continues to experience death rates 2009). In June 2009, the World Health Organization released a of 15–16 deaths per 100,000 population, for a reduction of 35 report examining this global epidemic (WHO 2009). The report percent (Centers for Disease Control and Prevention [CDC] provides estimates of road trafﬁc injuries and assessments of 2010; WHO 2009). road safety in 178 countries. Assessments reveal that the United Many factors contribute to changes in road trafﬁc death rates States has fallen far behind the trafﬁc safety gains of many other over time, including highway safety policies and interventions, countries. Comparable member countries in the Organization for demographics, miles driven, road user type distribution, urban Economic Co-operation and Development (OECD), including vs. rural mileage distribution, and vehicle mix on roadways. France, Canada, and Australia, which exhibited similar road Though such factors make comparisons over time and between countries difﬁcult, the United States probably should not lag so far behind the trafﬁc safety gains of many OECD countries Received 5 February 2010; accepted 14 April 2010. Disclaimer: The ﬁndings and conclusions in this report are those of the (Hedlund 2007). These countries have stronger road trafﬁc poli- authors and do not necessarily represent the ofﬁcial position of the Centers for cies than the United States and a higher use of strategies shown to Disease Control and Prevention. be effective at reducing motor vehicle–related crashes, injuries Address correspondence to: Rebecca B. Naumann, Motor Vehicle Injury and deaths (National Highway Trafﬁc Safety Administration Prevention Team, National Center for Injury Prevention and Control, Centers [NHTSA] 2000; WHO 2009). For example, unlike most states for Disease Control and Prevention, 4770 Buford Hwy NE, Atlanta, GA 30341. E-mail: RNaumann@cdc.gov in the United States, nearly all European countries have seat belt 353 354 NAUMANN ET AL. laws that cover all seating positions, 0.05 blood alcohol content Road user categories included motor vehicle occupants, mo- (BAC) laws, and motorcycle helmet laws that cover all riders torcyclists, pedalcyclists, pedestrians, and an unspeciﬁed road (WHO 2009). user category. A motor vehicle occupant was deﬁned as a driver Additionally, research on the costs of road trafﬁc crashes or passenger of a motor vehicle who was killed or injured as as a proportion of gross national product (GNP) has found a result of a collision, rollover, crash, or other event involving that U.S. crash costs equal approximately 2.0–2.3 percent of another vehicle, object, or pedestrian. Motor vehicle occupants the GNP (Blincoe et al. 2002; Elvik 2000). Road trafﬁc crash included occupants of cars, pickup trucks, vans, heavy trans- costs in Great Britain and Sweden are estimated at 0.5 and port vehicles, buses, and SUVs. A motorcyclist was deﬁned as 0.9 percent of their GNPs, respectively (Elvik 2000). As the a driver or passenger of a motorcycle who was killed or in- United States and global community face new economic and jured as a result of a collision, loss of control, crash, or some health care challenges, emphasizing and refocusing on preven- other event involving a vehicle, object, or pedestrian. Motor- tive measures is critical. Many underutilized evidence-based cyclists included riders of motorcycle sidecars, mopeds, and motor vehicle–related interventions offer large life-saving and motor-powered scooters. Pedalcyclists included riders of unicy- cost-saving potential. Recognizing this immediate need to im- cles, bicycles, tricycles, and mountain bikes who were killed or plement such prevention efforts, the WHO’s global road safety injured as a result of a collision, loss of control, crash, or some report speciﬁcally calls for economic studies as a tool to justify other event involving a moving vehicle or pedestrian. Pedestri- prevention efforts and show the full range of consequences that ans included persons involved in a collision who were not at the road trafﬁc crashes place on societies (WHO 2009). time of the injury riding in or on a motor vehicle, railway train, This study estimates the burden of motor vehicle–related fa- motorcycle, bicycle, airplane, streetcar, animal-drawn vehicle, tal and nonfatal injuries in the United States in terms of medical or other vehicle. Unspeciﬁed road users included persons who care, treatment, rehabilitation services, and productive life-years sustained a motor vehicle–related injury, fatal or nonfatal, but lost due to premature death or long-term disability. Two prior whose road user type was unknown. Downloaded At: 17:23 30 August 2010 studies, using year-2000 data, have presented estimates of the economic and societal costs of crashes in the United States Injury Incidence Data (Blincoe et al. 2002; Finkelstein et al. 2006). Our study up- Fatality incidence data were censuses obtained from the 2005 dates these estimates and goes further to examine these costs National Vital Statistics System (NVSS) for off-road crashes by road user type. These estimates are useful for understanding and from the 2005 Fatality Analysis Reporting System (FARS) the maximum amount of resources that may be saved through for crashes on public roads (National Center for Health Statistics injury prevention efforts. Examining costs by road user type [NCHS] 2007; NHTSA 2005). The 2005 Healthcare Cost and can provide a rationale for focusing on speciﬁc high-yield in- Utilization Project–National Inpatient Sample (HCUP-NIS) was terventions for speciﬁc road user groups or segments of the the source of incidence data for hospitalizations with a live population. discharge, and the 2005 NEISS-AIP was the source of incidence data for ED-treated injuries (Agency for Healthcare Research METHODS and Quality [AHRQ] 2005b; Schroeder and Ault 2000). HCUP- Injury Categories NIS and NEISS-AIP each include weights that allow for the Injuries are presented in three mutually exclusive categories: (1) generation of nationally representative estimates (AHRQ 2005b; injuries resulting in a death, including deaths occurring within Schroeder and Ault 2000). and outside a health care setting; (2) injuries resulting in hospi- talization with survival to discharge; and (3) injuries resulting Injury Cost Data in emergency department (ED) treatment and release without Unit costs were calculated for medical spending and productiv- hospitalization. Motor vehicle injuries not receiving medical ity losses for nonfatal and fatal injuries. Unit costs were mul- treatment or not treated in one of the above settings are ex- tiplied by the corresponding incidence to yield total costs. All cluded from this analysis. A societal perspective was used to costs are presented in year-2005 U.S. dollars, and all future report the injury incidence and total lifetime costs, and injuries costs were converted to present value using a 3 percent discount were stratiﬁed by age, sex, and road user type. rate. Costs per capita were calculated by dividing total costs by population estimates from the U.S. Census Bureau for the year Road User Deﬁnitions 2005 (U.S. Census Bureau 2005b). International Classiﬁcation of Diseases (ICD), 10th Revision Medical costs were calculated using charge data from HCUP- codes (V01-V06 [.0, .1, .9], V09 [.0, .1, .2, .3, .9], V10-V-79, NIS and ED discharge data, cost-to-charge ratios from the and V87-89), ICD, 9th Revision, Clinical Modiﬁcation, exter- Agency for Healthcare Research and Quality, Medstat’s Mar- nal cause of injury codes (E800-807 [.2, .3], E810-825 [.0–.9, ketscan, Medical Expenditure Panel Survey (MEPS), and De- except .4, .5, .8], E826 [.0, .1, .9], and E827-829 [.0, .1]), and tailed Claim Information from longitudinal workers’ compensa- National Electronic Injury Surveillance System–All Injury Pro- tion claims (AHRQ 2005a, 2005c; MEDSTAT 2005; Rice et al. gram (NEISS-AIP) codes (01–04) were used to deﬁne motor 1989). Depending on place of death, medical costs of fatal in- vehicle–related fatal and nonfatal injuries. juries may have included coroner/medical examiner, medical INCIDENCE AND TOTAL LIFETIME COSTS OF INJURIES BY ROAD USER TYPE 355 Table I Incidence and total lifetime costs of motor vehicle–related fatal and nonfatal injuries by road user type and sex, United States, 2005 Fatal injuries Nonfatal hospitalized injuries Nonfatal ED-treated and released injuriesa Total fatal and nonfatal injuries Total Total Total Total Incidence costs in Incidence costs in Incidence costs in Incidence costs in (%)b millions $ (%) (%) millions $ (%) (%) millions $ (%) (%) millions $ (%) MV occupant 33,230 74 42,255 73 173,807 65 17,801 63 2,616,759 77 10,027 74 2,823,796 76 70,083 71 Men 21,937 32,350 96,247 11,652 1,149,140 5,031 1,267,324 49,033 Women 11,293 9,905 77,560 6,149 1,467,619 4,996 1,556,472 21,050 Motorcyclist 4,550 10 6,908 12 31,195 12 3,992 14 206,493 6 1,046 8 242,238 6 11,946 12 Men 4,102 6,460 27,405 3,636 173,911 935 205,418 11,031 Women 448 448 3,790 356 32,582 111 36,820 915 Pedalcyclist 1,006 2 1,324 2 22,904 9 2,125 8 451,451 13 2,039 15 475,361 13 5,488 6 Men 882 1,207 18,179 1,799 328,508 1,590 347,569 4,596 Women 124 117 4,725 326 122,943 449 127,792 892 Pedestrian 6,057 13 6,830 12 27,157 10 3,000 11 139,870 4 480 4 173,084 5 10,310 10 Men 4271 5,472 16,933 2,102 78,076 299 99,280 7,873 Women 1,786 1,358 10,224 898 61,794 181 73,804 2,437 Unspeciﬁed 187 0.4 214 0.4 13,104 5 1,278 5 N/Ac N/A N/A N/A 13,291 0.4 1,492 2% Men 124 156 6,977 830 7,101 986 Women 63 58 6,127 448 6,190 506 Total 45,030 57,530 268,168 28,194 3,414,574 13,591 3,727,770 99,319 Men 31,316 45,645 165,741 20,019 1,729,635 7,855 1,926,692 73,519 Women 13,714 11,886 102,426 8,177 1,684,938 5,737 1,801,078 25,800 Downloaded At: 17:23 30 August 2010 Note. Columns may not sum to totals due to rounding. a Incidence counts for nonfatal ED-treated and released injuries include injuries of both intentional and unintentional intent with known age and sex. b All percentages are column percentages. c No unspeciﬁed MV-related ED injuries because NEISS-AIP had no cases for which this information was missing. transport, ED, and inpatient hospital costs. For hospitalized in- RESULTS juries, costs included inpatient facility charges, nonfacility fees In 2005, total medical and lost productivity costs of motor incurred during an inpatient stay, costs of hospital readmis- sion, costs for rehabilitation, short- to medium-term costs for vehicle–related fatal and nonfatal injuries totaled $99 billion, of which $58 billion was attributable to fatalities (Table I). Costs follow-up care of injury, long-term medical costs, and costs for associated with nonfatal hospitalized injuries totaled $28 billion, transport to the hospital. For ED-treated and released injuries, medical costs included an estimate for treatment in the ED and and $14 billion was associated with injured persons that were treated in the ED and released. postdischarge, as well as costs for medical transport to the ED when transported. Table I displays fatal and nonfatal injury incidence and costs Productivity loss includes both temporary and permanent by road user type and sex. Costs associated with motor vehicle occupant fatal and nonfatal injuries ($70 billion) constituted the work loss. Temporary work loss was calculated by multiplying the probability of an injury resulting in work days lost by the largest proportion of all motor vehicle–related costs, followed average number of work days lost (Lawrence et al. 2000). To by costs associated with motorcyclists ($12 billion), pedestri- ans ($10 billion), and pedalcyclists ($5 billion). Motor vehicle assign a monetary value, average daily wage and fringe beneﬁt costs were taken from the Current Population Survey, stratiﬁed occupant fatal and nonfatal injuries comprised 76 percent of all by age and sex (U.S. Census Bureau 2005a). A monetary value motor vehicle–related injuries and 71 percent of the costs. Mo- torcyclists and pedestrians bore disproportionately higher costs for household work days lost was also added. It was calculated as the average amount of housework performed by age and sex with respect to their injury incidence. Motorcyclists comprised 6 percent of fatal and nonfatal injuries but 12 percent of the costs. categories multiplied by costs for these services obtained from Pedestrians comprised 5 percent of fatal and nonfatal injuries the Bureau of Labor Statistics. Permanent total disability pro- ductivity loss, including death, was calculated by multiplying yet 10 percent of the costs. In contrast, pedalcyclists comprised 13 percent of fatal and nonfatal injuries but 6 percent of the lifetime earnings and household production loss by the probabil- costs. ity of permanent disability for each type of injury. For permanent partial disability productivity loss, lifetime earnings estimates Men accounted for 52 percent of motor vehicle–related fatal and nonfatal injuries yet 74 percent ($74 billion) of the associ- were multiplied by the probability of permanent partial disabil- ity times the percentage of disability resulting from the speciﬁc ated costs (Table I). Comparisons by injury disposition (i.e., fa- type of injury. Finkelstein et al. (2006) described the methods tal, nonfatal hospitalized, and nonfatal ED-treated and released) show that men had a much higher proportion of fatal motor in further detail. 356 NAUMANN ET AL. Table II Incidence and total lifetime costs of motor vehicle–related fatal and nonfatal injuries by road user type and age group, United States, 2005 Fatal injuries Nonfatal hospitalized injuries Nonfatal ED-treated and released injuriesa Total fatal and nonfatal injuries Total costs Total costs Total costs Total costs Incidence (%)b in millions $ (%) Incidence (%) in millions $ (%) Incidence (%) in millions $ (%) Incidence (%) in millions $ (%) MV occupant 33,230 42,255 173,807 17,801 2,616,759 10,027 2,823,796 70,083 Children (0–14) 1,420 4 1,948 5 11,340 7 1,178 7 190,249 7 511 5 203,009 7 3, 637 5 Teens (15–19) 4,271 13 7,366 17 22,402 13 2,740 15 399,248 15 1,137 11 425,921 15 11,243 16 Young adults (20–24) 4,758 14 8,909 21 22,221 13 2,802 16 402,202 15 1,694 17 429,181 15 13,405 19 Adults (25–64) 17,122 52 23,116 55 91,356 53 9,924 56 1,481,069 57 6,293 63 1,589,547 56 39,333 56 Older adults (65+) 5,659 17 916 2 26,487 15 1,157 6 143,991 6 393 4 176,137 6 2,466 4 Motorcyclist 4,550 6,908 31,195 3,992 206,493 1,046 242,238 11,946 Children (0–14) 41 1 67 1 916 3 95 2 26,814 13 122 12 27,771 11 284 2 Teens (15–19) 226 5 427 6 1,995 6 244 6 32,392 16 138 13 34,613 14 809 7 Young adults (20–24) 640 14 1,290 19 3,625 12 505 13 35,392 17 172 16 39,657 16 1,967 16 Adults (25–64) 3,446 76 5,072 73 23,746 76 3,103 78 109,536 53 604 58 136,728 56 8,779 73 Older adults (65+) 197 4 51 1 913 3 44 1 2,360 1 9 1 3,470 1 104 1 Pedalcyclist 1,006 1,324 22,904 2,125 451,451 2,039 475,361 5,488 Children (0–14) 141 14 227 17 7,966 35 722 34 241,965 54 1,065 52 250,072 53 2,014 37 Teens (15–19) 65 6 122 9 2,011 9 212 10 50,287 11 188 9 52,363 11 522 10 Young adults (20–24) 61 6 122 9 1,035 5 136 6 27,562 6 141 7 28,658 6 399 7 Adults (25–64) 613 61 828 63 10,045 44 973 46 122,446 27 622 31 133,104 28 2,423 44 Older adults (65+) 125 12 25 2 1,847 8 82 4 9,191 2 23 1 11,163 2 130 2 Pedestrian 6,057 6,830 27,157 3,000 139,870 480 173,084 10,310 Children (0–14) 516 9 711 10 5,559 20 566 19 28,024 20 86 18 34,099 20 1,363 13 Teens (15–19) 325 5 568 8 1,981 7 248 8 18,379 13 51 11 20,685 12 867 8 Young adults (20–24) 420 7 803 12 2,071 8 274 9 16,934 12 63 13 19,425 11 1,140 11 Adults (25–64) 3,509 58 4,543 67 13,327 49 1,681 56 69,563 50 262 55 86,399 50 6,486 63 Downloaded At: 17:23 30 August 2010 Older adults (65+) 1,287 21 205 3 4,221 16 231 8 6,970 5 17 4 12,478 7 453 4 Unspeciﬁed 187 214 13,104 1,278 N/Ac N/A 13,291 1,492 Children (0–14) 30 16 43 20 141 1 10 1 171 1 53 4 Teens (15–19) 17 9 30 14 1,312 10 156 12 1,329 10 186 12 Young adults (20–24) 16 9 29 14 1,506 11 201 16 1,522 11 230 15 Adults (25–64) 84 45 105 49 7,891 60 820 64 7,975 60 925 62 Older adults (65+) 41 22 7 3 2,254 17 90 7 2,295 17 97 7 Total 45,030 57,530 268,168 28,194 3,414,574 13,591 3,727,770 99,319 Children (0–14) 2,148 5 2,996 5 25,922 10 2,571 9 487,052 14 1,784 13 515,122 14 7,351 7 Teens (15–19) 4,904 11 8,513 15 29,701 11 3,600 13 500,306 15 1,514 11 534,911 14 13,627 14 Young adults (20–24) 5,895 13 11,153 19 30,458 11 3,918 14 482,090 14 2,070 15 518,443 14 17,141 17 Adults (25–64) 24,774 55 33,664 59 146,365 55 16,501 59 1,782,614 52 7,781 57 1,953,753 52 57,946 58 Older adults (65+) 7,309 16 1, 204 2 35,722 13 1,604 6 162,512 5 442 3 205,543 6 3,250 3 Note. Columns may not sum to totals due to rounding. a Incidence counts for nonfatal ED-treated and released injuries include injuries of both intentional and unintentional intent with known age and sex. b All percentages are column percentages within each road user type category. c No unspeciﬁed MV-related ED injuries because NEISS-AIP had no cases for which this information was missing. vehicle–related injuries (70%) and an even higher proportion a lower incidence of fatal and nonfatal injuries and costs per of the costs associated with these fatal injuries (79%). Nonfatal population. hospitalized injuries showed a similar pattern with men con- Within age groups, we found that most children’s motor stituting 62 percent of the injured and 71 percent of the costs. vehicle–related injuries were sustained as motor vehicle oc- Injured persons who were treated in an ED then released were cupants or pedalcyclists (Table II). Children constituted more more evenly distributed, with men constituting 51 percent of the than half of all pedalcyclist injuries (53%). The majority of these injured and 58 percent of the costs. Men accounted for a higher children (96%) were treated in an ED and released; however, proportion of both injuries and costs in every road user type and these injuries still accounted for more than $2 billion in medical injury disposition category with the exception of motor vehicle care and lost productivity costs. occupants who were treated in an ED then released. Women Like in overall injuries, teens and young adults were overrep- accounted for 56 percent of those injured but 50 percent of the resented in motor vehicle occupant injuries, deaths, and costs costs. (Table II). They constituted a combined 30 percent of all fatal Table II displays injury incidence and associated costs by and nonfatal motor vehicle occupant injuries and 35 percent road user type and age group. Teens and young adults be- of the costs or $25 billion in medical care and lost produc- tween the ages of 15–24 constituted 28 percent of all motor tivity costs. Older adults were also overrepresented in motor vehicle–related fatal and nonfatal injuries and 31 percent of the vehicle occupant injuries, representing 17 percent of the motor costs yet only 14 percent of the U.S. population; these pro- vehicle occupant deaths, 15 percent of the nonfatal hospitalized portions were similar for men and women. In contrast, chil- injuries, but only 12 percent of the U.S. population. However, dren (0- to 14-year-olds) and older adults (65+ years old) bore older adults were not overrepresented in terms of injuries treated INCIDENCE AND TOTAL LIFETIME COSTS OF INJURIES BY ROAD USER TYPE 357 Table III Total lifetime costs and costs per capita of motor vehicle–related fatal and nonfatal injuries by sex and age group, United States, 2005 Fatal injuries Nonfatal hospitalized injuries Nonfatal ED-treated and released injuries Total fatal and nonfatal injuries Total costs Costs per Total costs Costs per Total costs Costs per Total costs Costs per in millions $ capita $ in millions $ capita $ in millions $ capita $ in millions $ capita $ Total 57, 530 195 28, 194 95 13, 591 46 99, 319 336 Men 45, 645 314 20, 019 138 7, 855 54 73, 519 505 Children (0–14) 1, 991 64 1, 754 57 1, 219 39 4, 965 160 Teens (15–19) 6, 350 590 2, 468 229 883 82 9, 701 901 Young adults (20–24) 9, 337 868 2, 932 272 1, 174 109 13, 443 1, 249 Adults (25–64) 27, 228 351 12, 004 155 4, 362 56 43, 596 562 Older adults (65+) 739 48 861 56 213 14 1, 814 118 Women 11, 886 79 8, 177 54 5, 737 38 25, 800 172 Children (0–14) 1, 004 34 818 28 564 19 2, 387 81 Teens (15–19) 2, 163 211 1, 133 111 631 62 3, 927 384 Young adults (20–24) 1, 817 179 986 97 895 88 3698 365 Adults (25–64) 6, 436 82 4, 497 57 3, 418 43 14, 351 182 Older adults (65+) 466 22 743 35 229 11 1, 438 67 Note. Columns may not sum to totals due to rounding. in an ED then released or in terms of the costs associated with is consistent with the small decrease (5.7%) in the incidence of crash injuries. motor vehicle–related injuries and deaths between these years. Most motorcyclist injury and associated costs were concen- The National Highway Trafﬁc Safety Administration (Blincoe Downloaded At: 17:23 30 August 2010 trated among adults between the ages of 25 and 64 (Table II). et al. 2002) also released a cost analysis examining the eco- Young adults (20- to 24-year-olds) also were overrepresented. nomic burden of motor vehicle crashes on public roads in 2000. Pedestrians sustained the second highest number of deaths, NHTSA’s analysis took into account medical costs, lost produc- with 6,000 pedestrians killed in 2005 alone (Table II). Among tivity, property damage, and travel delays. The report concluded pedestrian deaths, older adults were overrepresented (21%); that crashes cost the United States’ economy $230.6 billion in however, they were not overrepresented in terms of costs (3%). 2000. Moreover, nearly 75 percent of these costs were not paid Finally, we examined total lifetime injury costs per capita by by those directly involved in the crashes but by society as a sex and age group (Table III). Cost per capita of motor vehicle– whole through insurance premiums, taxes, and travel delays. related fatal and nonfatal injuries was $336. Cost per capita for Our study provides a narrower estimate of the economic cost men was three times higher than women ($505 vs. $172). Young of crashes than NHTSA’s because it focuses strictly on injury adults and teens had the highest costs per capita. Men between costs. Costs related to medical care and earnings loss are espe- the ages of 20 and 24 years had costs per capita of $1,249, and cially relevant to public policy because the government pays for men between the ages of 15 and 19 years had costs per capita of some of these losses. $901. Young adult and teen women had costs per capita of $365 Our study went further than previous analyses by examining and $384, respectively. Older adults (ages 65+) had the lowest the burden of injury incidence and associated costs within spe- costs per capita ($118 for men and $67 for women). ciﬁc sex, age, and road user groups. We found that men made up a greater proportion of motor vehicle–related deaths (70%) and injuries (52%) than women (NHTSA 2008b). Additionally, DISCUSSION men accounted for a disproportionately higher proportion of In 2005, motor vehicle crashes led to more than 3.7 mil- costs (74%), primarily driven by increased productivity losses, lion deaths or injuries resulting in medical care on U.S. roads. because men historically have higher average wages and life- The medical costs and productivity losses associated with these time earnings potential than women (Finkelstein et al. 2006). crashes totaled nearly $100 billion. Motor vehicle occupant in- Examining costs per capita, we found that in 2005 every man juries and deaths comprised three quarters of the fatal and non- in the United States would have had to pay more than $500 to fatal injury incidence and 71 percent of the associated costs. cover the motor vehicle–related costs attributed to men, whereas Males, teens, and young adults bore a greater share of injury in- each woman would have had to pay about $172. cidence and associated costs, and motorcyclists and pedestrians Examining costs by age and road user type provides insight bore a disproportionately higher share of costs relative to their into potential lives saved and the upper limit of costs that spe- injury incidence. ciﬁc intervention strategies can save. For example, children’s A similar cost analysis by Finkelstein et al. (2006) conducted (0–14 years) fatal and nonfatal injuries were associated with $7 with year-2000 data found that total motor vehicle–related med- billion in medical care and productivity loss costs or $121 per ical and lost productivity costs totaled $83.6 billion in 2000 dol- child. The majority of their injury incidence and costs were as- lars or $103 billion inﬂated to 2005 dollars. The small decrease sociated with pedalcyclist and motor vehicle occupant injuries. in costs ($103 billion to $99 billion) between 2000 and 2005 Many of the injuries children sustain as pedalcyclists might be 358 NAUMANN ET AL. prevented with helmet use. Prior research has estimated that crashes, respectively, among 16-year-old drivers (Baker et al. head injuries account for more than 62 percent of pedalcyclist 2007). Additionally, risk-taking behaviors, including speeding, deaths, more than 67 percent of their hospital admissions, and alcohol-impaired driving, and not using restraints, have avail- about 33 percent of their ED visits (CDC 1995). Additionally, able cost-effective policy and enforcement solutions, including helmets have been shown to reduce the risk of sustaining a blood alcohol content (BAC) laws, sobriety checkpoints, en- head injury by about 60 percent in the event of a crash and hanced enforcement, and primary seat belt laws, among others to reduce the risk of brain injury by 58 percent (Attewell et (T. R. Miller et al. 2006; Zaza et al. 2005). If suggested policy al. 2001). However, national estimates report that only 48 per- changes and targeted programs were applied to these high-risk cent of child pedalcyclists always wear a helmet (Dellinger and behaviors, as they have been in other nations, much of this injury Kresnow 2010). These estimates suggest an excellent opportu- incidence and a portion of the $24.6 billion spent on teen and nity for injury and cost reduction. Helmet use laws successfully young adult occupant injuries would be saved (NHTSA 2000). increase the likelihood that a pedalcyclist will wear a helmet In terms of costs per capita, interventions could help reduce the and decrease associated head injuries (Karkhaneh et al. 2006; $1250 spent per young adult male, $900 spent per male teen, MacPherson and Spinks 2008). If even a quarter of childhood and more than $350 spent per young adult and teen female annu- pedalcyclist injuries and deaths could be prevented by increased ally. Additionally, evidence-based strategies aimed at reducing use of effective policy and evidence-based programs, more than the prevalence of these high-risk behaviors in all adult motor $500 million in medical costs and lost productivity could be vehicle occupants could reduce some of the $39 billion spent on saved. adult (ages 25–64) occupant injuries annually across the United Motor vehicle occupant injuries accounted for a large propor- States. tion of childhood motor vehicle–related injury incidence. Child Another high-risk road user group, motorcyclists, comprised safety seats, booster seats, and seat belts are known to reduce a disproportionate share of injury and death costs, making up the risk of injury to their respective age groups; however, prior 6 percent of all fatalities and injuries but 12 percent of the Downloaded At: 17:23 30 August 2010 research shows that the likelihood of a child being in the proper costs. Motorcyclists frequently incur more severe injuries, and restraint decreases with increasing age (NHTSA 2008c). Policy many of their nonfatal injuries result in long-term disability changes coupled with enforcement are an effective mechanism and the need for rehabilitative services (T. Miller et al. 2006). for increasing compliance (Zaza et al. 2005). Though all states Between the years 2000 and 2005, the incidence of injury and have belt use laws in place for children under the age of 16, death decreased for all road user types, except for motorcyclists most laws do not specify the appropriate type of restraint that (Finkelstein et al. 2006). Motorcyclists experienced a 59 percent a child must be in (e.g., child safety seat, booster seat, seatbelt; increase in deaths, 24 percent increase in injuries, and 39 percent Insurance Institute for Highway Safety [IIHS] 2009a). Addi- increase in costs, after adjusting for inﬂation. Motorcycle helmet tionally, 20 states lack comprehensive primary seat belt laws, laws, which have met resistance in some states, are known to which allow police ofﬁcers to stop motor vehicles for restraint be cost-effective at reducing motorcyclist injury and death and use violations alone (IIHS 2009b). In evaluating new restraint the associated costs (T. R. Miller et al. 2006; NHTSA 2008a). use policies, states should be made aware of the economic ad- These laws merit support for their life-saving potential and as a vantages. Comprehensive child restraint use laws and primary way to reverse the increasing trend of death, injury, and cost. seat belt laws could reduce the $3.6 billion annual bill for child Finally, older adults were disproportionately injured as pedes- occupant injuries and the $64 billion bill for teen and adult oc- trians. Pedestrians, as unprotected road users, often sustain se- cupant injuries. Further, the out-of-pocket savings from these vere injuries, which can translate to higher costs. More than interventions exceed their costs (T. R. Miller et al. 2006). $10 billion was spent on pedestrian injuries in 2005. Interven- Our study also found that 2 of the most at-risk groups on U.S. tions acting on the built environment to create and maintain safe roads, young drivers and motorcyclists, represent more than walking environments, including well-designed sidewalks, curb a third of the economic costs associated with motor vehicle– cuts, and increased crossing signal time at intersections, may related injury and death. Young drivers and motorcyclists are help reduce the number of injuries and deaths to not only older overrepresented in deaths, injuries, and costs in terms of their adults but pedestrians of all ages (Retting et al. 2003). population proportion and road user proportion, respectively. Policy changes focused on protecting new drivers through grad- Limitations uated drivers licensing programs (GDL) hold the potential to This analysis was subject to limitations. First, the data come decrease the incidence and associated costs of motor vehicle from many different sources, with each source presenting the injury and death cost-effectively (Lin 2003; T. R. Miller et al. possibility of measurement error and reporting bias. Addition- 2006). It has long been known that the risk of motor vehicle crash ally, long-term medical costs were derived from longitudinal is higher among teens than any other age group and that teens 1979 to 1988 Detailed Claim Information (DCI) data on 463,174 and young adults are more likely to engage in risk-taking behav- workers’ compensation claims (Rice et al. 1989). Though a iors (NHTSA 2006). Comprehensive GDL programs have been more recent data source would have been preferred, the data are estimated to be about 38 percent effective at reducing fatal in- unique and nothing similar has become available. The methods jury crashes and 40 percent effective at reducing nonfatal injury assume that though the cost of treatment has varied over time, INCIDENCE AND TOTAL LIFETIME COSTS OF INJURIES BY ROAD USER TYPE 359 the ratio of 18 month costs to total lifetime costs has remained holders behind life-saving and cost-saving prevention programs similar. Comparisons between the workers’ compensation claim and policies. data for the ﬁrst 18 months as a fraction of the costs of the initial acute care visit were similar to the comparable fraction from REFERENCES the MEPS data for that time period. These comparisons suggest that the workers’ compensation claim data are reasonably ap- Agency for Healthcare Research and Quality. Cost-to-Charge Ratio propriate. Finkelstein et al. 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