Objective Pedestrians account for a third of the 1.2 million traffic fatalities annually worldwide, and men are overrepresented. We examined the factors that contribute to this male-female discrepancy: walking exposure (kilometres walked per person-year), vehicle-pedestrian collision risk (number of collisions per kilometres walked) and vehicle-pedestrian collision case fatality rate (number of deaths per collision).

Design The decomposition method quantifies the relative contributions (RCs) of individual factors to death rate ratios among groups. The male-female ratio of pedestrian death rates can be expressed as the product of three component ratios: walking exposure, collision risk and case fatality rate. Data sources included the 2008–2009 US Fatality Analysis Reporting System, General Estimates System, National Household Travel Survey and population estimates.

Setting USA.

Participants Pedestrians aged 5 years and older.

Main outcome measures Death rate per person-year, kilometres walked per person-year, collisions per kilometres walked and deaths per collision by sex.

Results The pedestrian death rate per person-year for men was 2.3 times that for women. This ratio of male to female rates can be expressed as the product of three component ratios: 0.995 for walking exposure, 1.191 for collision risk and 1.976 for case fatality rate. The RCs of these components were 1%, 20% and 79%, respectively.

Conclusions The majority of the male-female discrepancy in 2008–2009 pedestrian deaths in the US is attributed to a higher fatality per collision rate among male pedestrians.