Road & Traffic Safety
CDC Yellow Book 2024
Travel by Air, Land & SeaAround the world, thousands of people are killed every day in motor vehicle crashes involving bicycles, buses, cars, motorcycles, trucks, and pedestrians.
Motor Vehicle Crashes: By The Numbers
Annually, ≈1.35 million people are killed (≈3,740 people every day) and an additional 20–50 million are injured in motor vehicle crashes. Road traffic injuries have become the leading cause of death for children and young adults aged 5–29 years. Although only 60% of the world’s vehicles are in low- and middle-income countries, 93% of the world’s crash deaths occur in these countries. More than half of people who die on the world’s roads each year are cyclists, motorcyclists, and pedestrians, also called vulnerable road users.
According to US Department of State data, motor vehicle crashes are the leading cause of nonnatural death among US citizens who die in a foreign country (see Sec. 4, Ch. 12, Injury & Trauma). In 2017 and 2018, 431 US citizens living or traveling internationally died following motor vehicle crashes; 62% of crash deaths occurred among drivers and passengers of passenger vehicles (cars, sport utility vehicles, trucks). Other traffic-related fatalities involved motorcycle drivers and passengers (21%) and pedestrians (8.8%).
Table 8-01 shows the top 30 countries visited by US citizens (2016–2017) based on the Survey of International Air Travelers from the US Department of Commerce. For each country, the table lists the estimated motor vehicle crash death rate per 100,000 population as an indicator for the risk of motor vehicle crash death and the number of US citizens who died in each country because of a crash death from 2017 through 2018.
Table 8-01 Thirty most visited destinations for US citizens traveling abroad, 2016–2017 (US Department of Commerce), World Health Organization (WHO) estimated motor vehicle crash death rate (per 100,000 population) & number of US citizen crash deaths per country, 2017–20181
COUNTRY | 2016–2017 COUNTRY VISITATION RANK2 | WHO ESTIMATED CRASH DEATH RATE (PER 100,000 POPULATION)3 | NUMBER OF US CITIZEN CRASH DEATHS4,5 |
---|---|---|---|
Mexico6,7 |
1 |
13.1 |
126 |
Canada6 |
2 |
5.8 |
8 |
United Kingdom6 |
3 |
3.1 |
NA |
Dominikanische Republik |
4 |
34.6 |
12 |
Frankreich |
5 |
5.5 |
3 |
Italy6 |
6 |
5.6 |
5 |
Deutschland |
7 |
4.1 |
8 |
Spanien |
8 |
4.1 |
NA |
Jamaika |
9 |
13.6 |
9 |
China6 |
10 |
18.2 |
6 |
Japan |
11 |
4.1 |
3 |
Irland |
11 |
4.1 |
7 |
Indien |
13 |
22.6 |
10 |
Netherlands6 |
13 |
3.8 |
NA |
Costa Rica6 |
15 |
16.7 |
11 |
Bahamas |
16 |
NA |
1 |
Philippines6 |
17 |
12.3 |
14 |
Kolumbien |
17 |
18.5 |
2 |
Aruba |
19 |
NA |
NA |
Schweiz |
20 |
2.7 |
NA |
Israel |
21 |
4.2 |
NA |
Österreich |
22 |
5.2 |
NA |
Peru |
23 |
13.5 |
2 |
Hongkong |
23 |
NA |
1 |
Thailand |
23 |
32.7 |
29 |
Griechenland |
26 |
9.2 |
5 |
Korea, South |
26 |
9.8 |
3 |
Taiwan |
26 |
NA |
5 |
Australien |
26 |
5.6 |
3 |
Island |
30 |
6.6 |
NA |
Abbreviation: NA, data not available.
1Most recent available complete data.
2US Department of Commerce, National Travel & Tourism Office. Top destinations of U.S. residents traveling abroad, 2016–2017. December 2018. Available from: https://travel.trade.gov/outreachpages/outbound.general_information.outbound_overview.asp
3World Health Organization. WHO global status report on road safety 2018. Geneva: World Health Organization; 2018.Available from: www.who.int/publications/i/item/9789241565684.
4US Department of State. Deaths of US citizens abroad by nonnatural causes, 2018. Available from: https://travel.state.gov/content/travel/en/international-travel/while-abroad/death-abroad1/death-statistics.html.
5A total of 158 crash deaths occurred in countries not included in the list of top-visited countries, including Vietnam (17 deaths) and Honduras (8 deaths). All other countries not listed reported ≤5 deaths in 2017–2018.
62016 data not available for reported number of road travel deaths based on WHO global status report on road safety, 2018.
7Number of drivers and passengers combined for road user death percentage based on WHO global status report on road safety, 2018.
Motor Vehicle Crashes: Risk Factors
Motor vehicle crashes are common among US citizens traveling abroad for many reasons. In many low- and middle-income countries, unsafe vehicles and an inadequate transportation environment contribute to the crash injury problem. According to the World Health Organization (WHO), vehicles sold in 80% of all countries worldwide fail to meet basic safety standards promoted by the United Nations World Forum for Harmonization of Vehicle Regulations. In addition, motor vehicles share the road with vulnerable road users, and the mix of traffic, including animals, buses, cars, rickshaws, taxis, and large trucks, increases the risk for crashes and injuries.
Speed is another risk factor for vehicular crashes, injuries, and deaths. According to the WHO, speed contributes to about a third of road fatalities in high-income countries and to nearly half in low- and middle-income countries, including fatalities among vulnerable road users. Other factors that contribute to the risk for motor vehicle crashes among travelers include lack of familiarity with the roads, driving on the opposite side of the road, the influence of alcohol, poorly made or inadequately maintained vehicles, travel fatigue, poor road surfaces without shoulders, unprotected curves and cliffs, and absent lighting creating conditions of poor visibility.
Use of protective equipment significantly decreases the risk for injury and death during a vehicle crash. Seat belts, correctly installed children’s booster and car seats, and helmets for bicycle and motorcycle riders reduce crash-related injury and death, but this equipment can be scarce in some countries. In addition, timely and effective emergency and hospital care might be unavailable in some locations. Trauma centers capable of providing optimal care for serious injuries are uncommon outside urban areas in many international destinations.
Motor Vehicle Crashes: Risk Reduction Strategies
Strategies travelers can use to reduce the risks for motor vehicle crash injuries include remaining alert and avoiding distractions when cycling, driving, or walking; choosing transportation carefully (e.g., avoiding overcrowded buses); abstaining from alcohol before driving; and not accepting rides from an impaired driver (see Table 8-02 for more strategies). Travelers should always use seat belts and child safety seats and should rent vehicles with seat belts. Whenever possible, travelers should only ride in taxis with seat belts, and opt for the rear seat. Travelers also should bring car seats or booster seats for their children from home, unless they can be assured of their availability and quality at the destination.
Discourage travelers from driving or riding on motorcycles or motorbikes, including motorcycle and motorbike taxis. For travelers who cannot be dissuaded, strongly recommend that they wear a helmet that meets US safety standards. A good-quality helmet can reduce the risk for death by 40% and for severe injury by 70%.
The Department of State has useful safety information for international travelers, including road safety and security alerts, international driving permits, and travel insurance, along with the Smart Traveler Enrollment Program. In addition, the Association for International Road Travel has useful safety information for international travelers, including road safety checklists and country-specific driving risks.
Table 8-02 Risk factors & recommended strategies to reduce risk for road traffic crashes and injuries while abroad
RISK FACTORS FOR CRASHES | RECOMMENDED RISK REDUCTION STRATEGIES |
---|---|
Alcohol-impaired driving |
Alcohol increases the risk for all causes of injury. Do not drive after consuming alcohol or other drugs. Do not accept rides from drivers who have been drinking. Penalties for impaired driving (alcohol, drugs) can be severe overseas, and laws vary widely by country. |
Bus travel |
Avoid riding in overcrowded, overweight, or top-heavy buses or minivans, and avoid riding in mountainous terrain. Always avoid riding with an impaired (alcohol, drugs) or distracted driver. |
Mobile telephones |
Do not use a mobile or cellular telephone or text while driving. Distracted driving increases crash risk. Many countries have enacted laws banning cellular telephone use while driving and some countries have made using any kind of telephone, including hands-free, illegal while driving. |
Country-specific driving hazards |
Check the US Department of State Driving and Road Safety Abroad website to learn more about driving in another country, and check the Association for Safe International Road Travel website for driving hazards or risks by country. |
General driving hazards |
Avoid driving at night in low- and middle-income countries because adequate lighting is limited in many places. Always pay close attention to the correct side of the road when driving in countries that drive on the left. Speed is a major risk factor for crashes, injury, and death. Note speed limits and consider the driving conditions (road quality, infrastructure, weather). |
Pedestrian hazards |
Be alert when crossing streets, especially in countries where motorists drive on the left side of the road. Walk with a companion or someone from the host country. Use crosswalks and follow pedestrian signals when available. Pay full attention when crossing streets (i.e., don’t walk distracted). |
Taxis or hired drivers |
Ride only in marked taxis, preferably those with working seat belts. If no seat belt is available or the vehicle is in disrepair, refuse the ride and wait for another taxi. Hire drivers familiar with the area and that have official status or credentials as taxis. Ask the US embassy or consulate for taxi company recommendations. |
The following authors contributed to the previous version of this chapter: Erin K. Sauber-Schatz, Erin M. Parker, David A. Sleet, Michael F. Ballesteros