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How exposure information can enhance our understanding of child traffic “death leagues”
  1. Nicola Christie1,
  2. Sally Cairns2,
  3. Elizabeth Towner3,
  4. Heather Ward4
  1. 1Postgraduate Medical School, University of Surrey, Guildford, UK
  2. 2Transport Studies, University College London, London, UK
  3. 3University of the West of England, Centre for Child and Adolescent Health, Bristol, UK
  4. 4Centre for Transport Studies, University College London, London, UK
  1. Correspondence to:
 Dr N Christie
 Postgraduate Medical School, Daphne Jackson Road, Manor Park, University of Surrey, Guildford GU2 7WG, UK; n.christie{at}


Objectives: To explore whether population-based fatality rates and measures of traffic exposure can be combined to provide a more comprehensive measure of safety. To illustrate how this could be achieved using surveys from a range of Organisation for Economic Cooperation and Development (OECD) countries. To discuss why exposure is important.

Design and setting: Fatality data were obtained from the International Road Traffic and Accident Database and travel data from surveys among government transport administrations in each country.

Methods: Comparable exposure data were obtained for children aged 10–14 years from the UK, the USA, Germany, The Netherlands, Norway, Sweden, Switzerland and New Zealand. Fatality rates for children travelling as pedestrians, cyclists and car occupants were calculated based on (1) per head of population and (2) a combination of rate per head population and per kilometre travelled.

Results: In this study, exposure-based fatality rates suggest a more polarized distribution rather than a graduated league. The USA and the UK were at the lower end of the table for child pedestrian safety; Germany for car-occupant safety, Sweden and New Zealand performed less well. For cycling, the inclusion of exposure data considerably changes positions within the table. Countries with higher cycling levels like The Netherlands perform better than those with low levels like the UK and New Zealand.

Conclusions: Exposure-based fatality rates can help us to understand whether policies reduce exposure or whether they increase safety, given a similar level of exposure. Data need to be harmonized across OECD countries for a better understanding of the risks and links between health and sustainable travel.

  • IRTAD, International Road Traffic and Accident Database
  • OECD, Organisation for Economic Cooperation and Development

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  • Competing interests: None.