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                             Traffic Injury Prevention
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                             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




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                                      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.
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                                                     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.
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                                      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
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                                      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
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                                        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
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                                      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
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                                      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
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