Background In crashes between a car and a light truck or van (LTV), car occupants are more likely to be killed than LTV occupants. The extent this is due to the greater harm imposed by LTVs on cars or the greater protection they offer their own occupants is not known.

Methods We conducted a case-control study of collisions between two passenger vehicles in the USA during 1990–2008. Cases were all decedents in fatal crashes (N=157 684); one control was selected from each crash in a national probability sample of crashes (N=379 458).

Results Adjusted for the type of vehicle they were riding in and other confounders, occupants of vehicles colliding with any type of LTVs (categorised as compact sport utility vehicles (SUV), full-size SUVs, minivans, full-size vans, compact pickups and full-size pickups) were at higher risk of death compared with occupants colliding with cars. Adjusted for the type of vehicle they crashed with and other confounders, occupants of LTVs in a collision with any vehicle were at lower risk of death compared with car occupants. Compared with a crash between two cars, the overall RR of death in a crash between any of the other 27 different combinations of vehicle types was 1.0 or greater, except for crashes between two full-size pickups, where the RR of death was 0.9.

Conclusions Although LTVs protect their own occupants better than cars do, LTVs are associated with an excess total risk of death in crashes with cars or other LTVs.