Topics in Minority Health Pedestrian Fatalities -- New Mexico, 1958 - 1987

Pedestrian fatalities constitute approximately one seventh of all traffic-related deaths in the United States (1). In addition to the disproportionate numbers of pedestrian fatalities that occur among children and the elderly, minority populations are at increased risk for pedestrian deaths (2--4). In New Mexico, approximately half the population are minority persons---primarily Hispanics and American Indians. Injury fatality rates for these groups are substantially higher than national rates, especially for the state's American Indians (4,5). This report summarizes an analysis by the University of New Mexico School of Medicine of pedestrian fatalities among New Mexico's American Indians, Hispanics, and non-Hispanic whites.

Vital records data on pedestrian fatalities for 1958--1987 were analyzed by major ethnic population, by gender, and by 5-year period. Pedestrian deaths included cases that met the International Classification of Diseases definitions (6--8) for motor vehicle traffic-related*, motor vehicle nontraffic-related, train-related, and other road vehicle-related pedestrian deaths. Ethnic classification was determined by the state's Bureau of Vital Statistics based on information from death certificates. Denominators for rate calculations were obtained from U.S. census data from 1960, 1970, and 1980; age-adjusted rates were standardized to the 1970 U.S. population.

During the 30-year period, substantial ethnic and gender differences in pedestrian fatality rates occurred among New Mexico's three predominant ethnic populations (Table 1). For all periods, overall rates were higher for males than for females and higher for American Indians than for other ethnic groups. Most (87.4%) of the pedestrian fatalities were attributed to motor vehicle traffic; 7.7% were motor vehicle nontraffic-related; 4.6% were train-related; and 0.3% were related to other road vehicles, such as horse-drawn wagons. Age-specific data for 1983--1987 indicate these pedestrian fatality rates were highest for American Indian men aged 35--44 years and, for each age group, greater for American Indian males than for other males (Figure 1). Reported by: C Peek, CL Wiggins, TM Becker, MD, Univ of New Mexico School of Medicine, Albuquerque; A Ortiz, Bur of Vital Statistics, New Mexico Health Dept. Div of Injury Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: In New Mexico and nationwide, the injury burden is dispropor tionately greater for racial/ethnic minority groups (2--5). In New Mexico, for most American Indians and for a substantial percentage of Hispanics, the pedestrian fatality rates are higher because of rural residence (9), limited immediate access to emergency transportation, and exposure to roadways without designated pedestrian areas (10). In addition, pedestrians who are injured in rural locations are often struck at higher impact speeds, increasing the likelihood of death (2).

The vital statistics sources used for this assessment did not permit an examination of the role of alcohol-related injuries in New Mexico. However, for the United States in 1989, 32.7% of fatal pedestrian crashes involved pedestrians who were classified as legally intoxicated (blood alcohol concentration greater than or equal to 0.1 g/dL) (1).

Other potential limitations in this assessment include: 1) ethnic misclassification (although this source of bias appears to be minimal in New Mexico (11)); 2) errors in assignment of pedestrian-associated deaths to other causes (i.e., late medical complications that could occur in the hospital as sequelae to the initial injury event); and 3) lack of information on road conditions, time of day of the incident, and other specific data that might indicate additional risks for pedestrians.

The findings in this analysis underscore the need for education and public health prevention strategies in New Mexico and other states to focus on minority populations. In addition, to plan effective interventions, reliable race/ethnicity data are needed to elucidate the role of risk factors, such as alcohol use, for motor vehicle-related injuries among minority populations. Because the injury burden in the United States disproportionately affects persons of lower socioeconomic status and because persons of lower socioeconomic status are disproportionately represented in minority groups, data systems used for injury surveillance and for targeting prevention efforts should include elements for race/ethnicity.

References

1. National Highway Traffic Safety Administration. Fatal

Accident Reporting System, 1989: a review of information on fatal traffic crashes in the United States in 1989. Washington, DC: US Dept of Transportation, National Highway Traffic Safety Administration, 1991; DOT publication no. HS-807-693.

2. Baker SP, O'Neil B, Karpf RS. The injury fact book. Lexington, Massachusetts: Lexington Books, 1984.

3. Waller JA. Injury control. Lexington, Massachusetts: Lexington Books, 1985.

4. Sewell MC, Becker TM, Wiggins CL, et al. Injury mortality in New Mexico's American Indians, Hispanics, and non-Hispanic whites, 1958-1982. West J Med 1989;150:708--13.

5. Olson L, Becker TM, Wiggins CL, et al. Childhood injury mortality in New Mexico's American Indian, Hispanic, and non-Hispanic whites, 1958--1982. Soc Sci Med 1990;30:479--86.

6. World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death. Seventh revision. Geneva: World Health Organization, 1955.

7. World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death. Eighth revision. Geneva: World Health Organization, 1967.

8. World Health Organization. Manual of the international statistical classification of diseases, injuries, and causes of death. Ninth revision. Geneva: World Health Organization, 1975.

9. Williams J. New Mexico in maps. Albuquerque: University of New Mexico Press, 1981. 10. Simpson SG. Injuries among Hopi Indians: a population-based survey. JAMA 1983;249: 1873--6. 11. Becker TM, Wiggins C, Key CR, et al. Ischemic heart disease mortality in Hispanics, American Indians, and non-Hispanic whites in New Mexico, 1958--82. Circulation 1988;78:302--9.

*A traffic-related injury was defined as an injury occurring on a roadway customarily open to the public.

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