title: Death and injury from motor vehicle crashes: a tale of two countries.
abstract: OBJECTIVE
  To determine why road deaths dropped by 33.9% in the United Kingdom, compared to 6.5% in the United States, between 1990 and 1999.
  
  
  METHODS
  Deaths per billion vehicle kilometers traveled (D/BVKM), and case fatality rates (CFR) in the United States and the United Kingdom were tracked. Time trends in CFR can be used to track the direct effects of speed of impact. CFR is a crash-phase outcome that is independent of exposure, and varies approximately to the fourth power of the speed of crash impact. Joinpoint regression analysis was used to analyze changes in time trends of CFR.
  
  
  RESULTS
  In the 1990s, the decrease in deaths in the United Kingdom was attributable mostly to the 29.6% drop in the CFR. In the United States, the CFR dropped by only 6.6%. The United Kingdom introduced speed cameras and an array of speed-calming measures. By contrast, in the United States, use of speed cameras was extremely rare, and speed limits and speeds increased in 32 of the 50 states, mostly in 1995 and 1996, after which CFR actually rose (p<.0001). Intercountry differences in time trends in seat belt use, trauma care, vehicle kilometers traveled, congestion, and driving under the influence of alcohol (DUI), along with massive increase in use of higher-risk sports utility vehicles in the United States, did not account for the contrasting trends in deaths through the 1990s. But increases in DUI in the United States after 1997 may have contributed to increases in speed-related crashes.
  
  
  CONCLUSIONS
  The reductions in CFR, probably from small drops in speed of impact account for the disproportionately greater drop in death tolls in the United Kingdom compared to the United States. The temporal fit between drops in CFR and deaths following the introduction of speed cameras in the United Kingdom and increases in speed (speed creep), CFR, and deaths in the United States following raised speed limits suggests that diverging changes in speeds of impact accounted mainly for these changes. Use of D/BVKM to correct for exposure concealed the lack of progress after 1990 in the United States, since falling time trends in D/BVKM reflect increases in congestion. If the United States had implemented United Kingdom-type speed control policies and not raised speed limits, there would have been an estimated 6500 to 10,000 (approximately 16% to 25%) fewer road deaths per year during the period following speed-limit increases (1996 to 1999), including many DUI-related deaths. Reductions of up to 50% are now achievable based on newer population-wide strategies for speed control.
authors.affiliation: Hebrew University-Hadassah School of Community Medicine and Public Health, Injury Prevention Center, Jerusalem, Israel. elir@cc.huji.ac.il
authors.forename: Elihu D
authors.initials: ED
authors.lastname: Richter
authors.forename: Lee S
authors.initials: LS
authors.lastname: Friedman
authors.forename: Tamar
authors.initials: T
authors.lastname: Berman
authors.forename: Avraham
authors.initials: A
authors.lastname: Rivkind
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000639:trends; D006801:Humans; D008137:Longitudinal Studies; D006113:United Kingdom / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology*