Pedestrian Fatalities -- Cobb, DeKalb, Fulton, and Gwinnett Counties, Georgia, 1994-1998

In 1997, a total of 5307 pedestrian fatalities occurred in the United States, accounting for 13% of motor-vehicle-related deaths (1). The Atlanta metropolitan statistical area (MSA) is reported to be the third most dangerous large metropolitan area for walking, behind Fort Lauderdale and Miami, Florida (2). This report summarizes an investigation of pedestrian fatalities in four central metropolitan Atlanta counties; the findings indicate that the annual pedestrian fatality rate* for these counties combined has been consistently higher than the national rate, and from 1994 to 1998 the four-county area pedestrian fatality rate increased 13%.

A pedestrian fatality was defined as a death of a person on foot within 30 days after being struck on a public roadway by a motor vehicle during 1994-1998 in the Georgia counties of Cobb, DeKalb, Fulton, and Gwinnett. The four counties constitute 65% of the 20-county Atlanta MSA population. These are the only counties in the Atlanta MSA with medical examiners (MEs), and MEs were the only source identified with a complete record of pedestrian deaths through the end of 1998. Cases identified in ME databases were confirmed using police crash reports from the Georgia Department of Public Safety. Both ME data and police crash report data were used in the analysis. MEs assigned each person who died a race/ethnicity in the mutually exclusive categories of black, white, and Hispanic. The corresponding census groups used in calculating the rates were non-Hispanic black, non-Hispanic white, and Hispanic, respectively. Other races/ethnicities were not included in the analysis. Population estimates from the Bureau of the Census were used to calculate rates. However, because estimates of the 1998 population by age, race, and sex were not available for the counties, the 1996 population was used to calculate average annual rates for these variables. Pedestrian fatality rates for the United States were obtained from the National Highway Traffic Safety Administration, Fatality Analysis Reporting System.

A total of 309 pedestrian fatalities occurred in the four-county area during 1994-1998. The pedestrian fatality rate (per 100,000 population) increased from 2.53 in 1994 to 2.85 in 1998 (Figure 1). In comparison, the U.S. pedestrian fatality rate decreased from 2.19 in 1993 to 1.98 in 1997.

The pedestrian fatality rates for the two most central counties in the Atlanta MSA (DeKalb and Fulton) were higher than the rates for the other two counties studied (Cobb and Gwinnett) (Table 1). The pedestrian fatality rate for males was three times that for females. Rates for non-Hispanic blacks and Hispanics were two and six times greater, respectively, than for non-Hispanic whites. All rates for pedestrians aged greater than or equal to 20 years were higher than for those aged less than 20 years; the highest rate was for pedestrians aged 45-54 years. Of the 266 pedestrians aged greater than or equal to 15 years who died, alcohol test results were available for 219 (82%). Of these, 74 (34%) had a blood alcohol concentration (BAC) of greater than or equal to 0.10 g/dL.

Sixty-seven (22%) pedestrians died after being struck on interstate highways, 96 (31%) on state highways, 62 (20%) on county roads, and 84 (27%) on city streets. Thirty-three (11%) pedestrian deaths occurred after a person exited a privately owned vehicle in traffic; of these, 24 (73%) were on interstate highways. One hundred ninety-three (63%) pedestrians involved in fatal collisions were attempting to cross a street at the time they were struck; 28 (9%) were at crosswalks.

The monthly number of pedestrian deaths varied considerably (mean: 5.1 deaths per month; range: 0-12). More pedestrian fatalities occurred on Saturday (64 [21%]) than any other day of the week. The number of fatal pedestrian incidents peaked from 6 p.m. through midnight, when 138 (45%) of the incidents occurred. According to police crash reports, 87 (44%) of 198 pedestrians struck after dark were on unlighted roads. Street surface conditions were wet at the time 64 (21%) pedestrians were struck.

Multiple motor vehicles were involved in 38 (12%) of pedestrian fatalities. Of the 363 drivers involved in the 309 pedestrian fatalities, information was available on 312 (86%); 217 (70%) were men; median age was 33 years (range: 17-90 years). Fifteen (5%) drivers were cited for driving under the influence of alcohol. Forty-eight (16%) pedestrian fatalities involved a driver who fled or attempted to flee the scene.

Reported by: R Hanzlick, MD, D McGowan, Fulton County Medical Examiner's Office, Atlanta; J Havlak, DeKalb County Medical Examiner's Office, Decatur; M Bishop, H Bennett, Cobb County Medical Examiner's Office, Marietta; R Rawlins, Gwinnett County Medical Examiner's Office, Lawrenceville; B Raines, Georgia Dept of Public Safety; K DeBowles, Georgia Dept of Administrative Svcs; D Graves, T Leet, D Crites, Georgia Dept of Transportation; S Davidson, MEd, M Schmertmann, MPH, K Powell, MD, Div of Public Health, Georgia Dept of Human Resources. Medical Examiner/Coroner Information Sharing Program, Surveillance Br, Div of Environmental Hazards and Health Effects, National Center for Environmental Health; Div of Unintentional Injury Prevention, National Center for Injury Prevention and Control; State Br, Div of Applied Public Health Training, Epidemiology Program Office; and EIS officers, CDC.

Editorial Note:

The findings in this report document that the pedestrian fatality rate of the four most populous Atlanta MSA counties combined has remained higher than the national rate since at least 1994. Moreover, the rate in these four counties has increased while the overall U.S. rate has declined. Characteristics of pedestrian fatalities in the four counties were similar to those of pedestrian fatalities nationwide (1,3,4). For example, higher pedestrian fatality rates have been reported for certain minority populations (5,6). Rate differences by race/ethnicity probably result, in part, from differences in walking patterns; the 1995 Nationwide Personal Transportation Survey showed that blacks walk 82% more than whites, and Hispanics walk 58% more than non-Hispanics (7). In other reports, one third of fatally injured pedestrians aged greater than or equal to 15 years had BACs of greater than or equal to 0.10 g/dL (4). In the United States during 1982-1992, the proportion of fatally injured pedestrians with BACs of greater than or equal to 0.10 g/dL declined from 39% to 36%, compared with a decrease from 20% to 12% among drivers in such collisions (4). Also, the finding that pedestrian death rates were higher in the two most central counties is consistent with previous reports of higher rates in more urban areas of the United States (3).

Half of all pedestrian fatalities in the four counties occurred on state or county roads. Generally, these roads have posted speed limits of 30-45 miles per hour (mph) and often do not provide physical separation between pedestrians and traffic. The risk for pedestrians dying from collisions increases rapidly as speeds exceed 25 mph (8).

Fatalities typically represent only a small proportion of pedestrian injuries (1). Data from police crash reports show that pedestrian injuries also have increased in the four-county area. During 1994-1997, the rate of pedestrian injuries (fatal and nonfatal) increased 21% from 50.6 to 61.2 per 100,000 population in these counties (Georgia Department of Public Safety, unpublished data, 1999).

The findings in this report have at least five limitations. First, limited information was available about pedestrian characteristics (e.g., color of clothing), driver behavior, environmental factors (e.g., availability of crosswalks and crossing signals), and pedestrian exposure information (e.g., prevalence of walking). Second, only pedestrian fatalities were studied, and nonfatal incidents may have different modifiable risk factors. Third, if census estimates underestimated the four-county area's rapidly growing populations, pedestrian fatality rates reported here would be inflated. Fourth, BAC reports were not obtained for drivers; therefore, the reported proportion of drivers cited for "driving under the influence" probably underestimates the true prevalence of alcohol use. Finally, race/ethnicity misclassifications may have occurred.

The findings described in this and other reports suggest potential engineering, education, and enforcement measures to protect pedestrians (9). Engineering interventions should include methods to separate pedestrians from traffic (e.g., sidewalks); "traffic-calming" measures (e.g., speed bumps and lower posted speed limits) (10); safer ways to cross streets (9); and improved street lighting.

On the basis of the data in this report, three educational interventions were identified. First, drivers and passengers need to know about the dangers of exiting a vehicle in traffic. In 1995, the Georgia Department of Transportation instituted the Highway Emergency Response Operators (HERO) program to assist stranded motorists, primarily on Atlanta's interstate highways. During 1994-1998, 25 pedestrians died after exiting a vehicle on roads now covered by the HERO program. Increased awareness of the availability of this service has the potential to prevent pedestrian deaths and injuries. Second, messages to increase awareness of the risk for injury to pedestrians who have been drinking alcohol should be developed for both the public and establishments that serve alcohol (4). Third, pedestrians should be made aware of the dangers of being struck even while crossing at crosswalks. Stricter enforcement of driving laws (e.g., speeding, running a red light, and yielding to pedestrians) and pedestrian regulations (e.g., jaywalking) also may help protect pedestrians. The success of public health measures will require involvement of local community groups, evaluation to identify effective interventions, and ongoing surveillance.

References

1. US Department of Transportation, National Highway Traffic Safety Administration. Traffic safety facts 1997. Washington, DC: US Department of Transportation, National Highway Traffic Safety Administration, 1998.
2. Cohen BA, Wiles R, Campbell C, Chen D, Kruse J, Corless J. Mean streets: pedestrian safety and reform of the nation's transportation law. Washington, DC: Environmental Working Group/The Tides Center, April 1997. Available at http://www.ewg.org. Accessed December 15, 1998.
3. Baker SP, O'Neill B, Ginsburg MJ, Li G. Injury fact book. 2nd ed. New York, New York: Oxford University Press, 1992.
4. CDC. Alcohol involvement in pedestrian fatalities--United States, 1982-1992. MMWR 1993;42:716-9.
5. Harruff RC, Avery A, Alter-Pandya AS. Analysis of circumstances and injuries in 217 pedestrian traffic fatalities. Accid Anal Prev 1998;30:11-20.
6. CDC. Pedestrian fatalities--New Mexico, 1958-1987. MMWR 1991;40:312-4.
7. US Department of Transportation, Federal Highway Administration, Office of Highway Policy Information. Our nation's travel: 1995 NPTS Early Results Report, 1997. Washington, DC: US Department of Transportation, Federal Highway Administration, 1997; report no. FHWA-PL-97-028. Available at http://www-cta.ornl.gov/npts. Accessed April 1999.
8. Anderson RW, McLean AJ, Farmer MJB, Lee BH, Brooks CG. Vehicle travel speeds and the incidence of fatal pedestrian crashes. Accid Anal Prev 1997;29:667-74.
9. Zegeer CV. Synthesis of safety research--pedestrians. Washington, DC: US Department of Transportation, Federal Highway Administration, 1991; publication no. FHWA-SA-91-034.
10. Engel U, Thomasen LK. Safety effects of speed reducing measures in Danish residential areas. Accid Anal Prev 1992;24:17-28.

* Dividing the number of pedestrian deaths from collisions in a county by the population of the county is not a rate because some of those who died may not have been county residents. For simplicity and consistency with reporting of national crash data, the term "rate" instead of "ratio" was used.

TABLE 1. Distribution and rate* of pedestrian fatalities, by selected characteristics+ --
Cobb, DeKalb, Fulton, and Gwinnett counties, Georgia, 1994-1998&
================================================================================================
                          Deaths
                         ---------
Characteristic           No.   (%)    Rate
------------------------------------------
Year
  1994                    56   (18)   2.53
  1995                    52   (17)   2.29
  1996                    63   (20)   2.72
  1997                    69   (22)   2.92
  1998                    69   (22)   2.85

County
  Cobb                    34   (11)   1.26
  DeKalb                 104   (34)   3.55
  Fulton                 140   (45)   3.92
  Gwinnett                31   (10)   1.30

Sex
  Female                  81   (26)   1.36
  Male                   228   (74)   4.04

Age group (yrs)@
   0- 4                   16   ( 5)   1.84
   5- 9                   13   ( 4)   1.59
  10-14                   12   ( 4)   1.58
  15-19                   12   ( 4)   1.58
  20-24                   28   ( 9)   3.32
  25-34                   56   (18)   2.53
  35-44                   58   (19)   2.61
  45-54                   55   (18)   3.78
  55-64                   28   ( 9)   3.71
  65-74                   15   ( 5)   2.96
   >=75                   14   ( 5)   3.74

Race/Ethnicity**
  Black, non-Hispanic    140   (45)   3.85
  White, non-Hispanic    117   (38)   1.64
  Hispanic                40   (13)   9.74
------------------------------------------
 * Per 100,000 population.
 + Age-, race/ethnicity-, and sex-specific average annual rates were calculated using the 1996
   population as the denominator.
 & n=309.
 @ Age was unknown for two pedestrians.
** Ten persons were of "other" races/ethnicities, and race/ethnicity was unknown for two.
================================================================================================

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