(Reuters Health) - Although motor vehicle crashes remain a leading cause of death for U.S. children, rates of crash fatalities involving kids on bikes or on foot continue to decline each year, researchers say.

Based on 2000-2014 data from 26 states, crashes declined by 40% for child pedestrians and 53% for child cyclists, they found.

Noting that the decreases varied from state to state, the authors report in Injury Prevention that steady decline was seen in every state. They give some of the credit to federal and local programs such as Safe Routes to School.

“Pedestrian deaths and injuries can be prevented in a number of ways, namely through policy, built environment interventions, enforcement of traffic safety laws, and education,” said study leader Katie Wheeler-Martin of the New York University Langone School of Medicine in New York City.

Crash fatality rates have declined in the past 30 years, but pedestrian deaths have increased during the past five years, according to the National Highway Traffic Safety Administration.

“As more and more states provide crash data for research, we can complete the national picture and learn more about local trends,” Wheeler-Martin told Reuters Health by email.

She and her colleagues analyzed crash data from the National Highway Traffic Safety Administration and found that school-age children accounted for about a third of pedestrians and half of cyclists involved in crashes during the study period. Among the nearly 485,000 injuries reported, about 6,000 were fatal.

Examining geographic trends, they found an average rate of 43 school-age pedestrian crashes per 100,000 people annually, ranging from a low of 25 per 100,000 in Arkansas to a high of 100 in New York. Similarly, about 35 school-age bicyclist crashes occurred per 100,000 children annually, ranging from 20 in Arkansas to 50 in California.

The geographic variability likely relates to factors like population density, traffic density, traffic speed, socioeconomic factors and built environment design, the study authors note. States with the most crashes per capita tended to have large metropolitan areas, more frequent use of public transportation and more walking and cycling to work and school. At the same time, crash severity and fatality rates were higher in rural areas, which may be related to traffic speed, lack of sidewalks and longer travel times to hospitals, they write.

“Some areas of the U.S. continue to have high rates, and too many kids are still getting hit by cars and trucks,” said coauthor Charles DiMaggio of the New York University Langone School of Medicine.

“These terrible injuries are preventable,” he told Reuters Health by email. “Those with children and grandchildren can get involved. Reach out to local groups.”

At the state level, the Governors Highway Safety Association is a good resource, and nationally, groups such as the Insurance Institute for Highway Safety and the National Safety Council are increasingly interested in pedestrian safety, DiMaggio added.

“It is important to continue expanding Safe Routes to Schools programs to improve child pedestrian and bicyclist safety,” said Robert Schneider of the University of Wisconsin’s Department of Urban Planning in Milwaukee, who wasn’t involved in the study.

“Improving sidewalks, street crossings, and low-stress bike infrastructure near schools; educating children about safe street behavior; and normalizing slower-speed driving and yielding to pedestrians near schools may help extend a positive traffic safety culture beyond school zones into the rest of a community,” he told Reuters Health by email.

SOURCE: bit.ly/33CzjXp Injury Prevention, online September 27, 2019.