August 1999 volume 15 number 8 Division of Public Health http://health.state.ga.us New On The Web This Month: Growth and Development Babies First Year . . . health.state.ga.us/org/ growthdev Recommended Guidelines for Perinatal Care in Georgia health.state.ga.us/manuals/ perinatal The Georgia Epidemiology Report is a publication of the Epidemiology Section of the Epidemiology and Health Information Branch, Division of Public Health, Georgia Department of Human Resources Pedestrian Fatalities Four Metropolitan Atlanta Counties, Georgia, 19941998 This study also appears in the Morbidity and Mortality Weekly Report (MMWR) 1999; 48 {No. 28}. In 1997, 5307 pedestrian fatalities occurred in the United States(U.S), accounting for 13% of motor-vehiclerelated deaths (1). The Atlanta metropolitan statistical area (MSA) is reported to be the third most dangerous metropolitan area for walking, behind Fort Lauderdale and Miami, Florida (2). This report summarizes the investigation of pedestrian fatalities in four central metropolitan Atlanta counties; the findings indicate that the annual pedestrian fatality rate* for these counties combined has been consistently higher than the national rate, and from 1994 to 1998 the four-county area rate has increased 13%. A pedestrian fatality was defined as a person on foot who died within 30 days after being struck on a public roadway by a motor vehicle during January 1, 1994 January December 31, 1998, in the Georgia counties of Cobb, DeKalb, Fulton, and Gwinnett. The four counties constitute 65% of the 20-county Atlanta MSA population. These are the only counties in the Atlanta MSA with medical examiners (MEs), and MEs were the only source identified with a complete record of pedestrian deaths through the end of 1998. Cases identified in ME databases were confirmed using police crash reports from the Georgia Department of Public Safety. Both ME data and police crash report data were used in the analysis. MEs assigned each person who died a race/ethnicity in the mutually exclusive categories of black, white, and Hispanic. The corresponding census groups used in calculating the rates were non-Hispanic black, non-Hispanic white, and Hispanic, respectively. Other races/ethnicities were not included in the analysis. Population estimates from the U.S. Census Bureau were used to calculate rates. However, because estimates of the 1998 population by age, race, and sex were not available for the counties, the 1996 population was used to calculate average annual rates for these variables. Pedestrian fatality rates for the United States were obtained from the National Highway Traffic Safety Administration, Fatality Analysis Reporting System. Director Kathleen E. Toomey, M.D., M.P.H. Epidemiology and Health Information Branch Acting Director Kathleen E. Toomey, M.D.,M.P.H. Acting State Epidemiologist Paul A. Blake, M.D.,M.P.H. Epidemiology Section Chief Paul A. Blake, M.D., M.P.H. Public Health Advisor Mel Ralston Georgia Epidemiology Report Editorial Board Carol A. Hoban, M.S., M.P.H. - Editor Kathryn E. Arnold, M.D. Jeffrey D. Berschling, M.P.H. Paul A. Blake, M.D., M.P.H. Jane E. Koehler, D.V.M., M.P.H. Kathleen E. Toomey, M.D., M.P.H. Angela Alexander - Mailing List Jimmy Clanton, Jr. - Graphics A total of 309 pedestrian fatalities occurred in the four-county area during 1994 1998. The pedestrian fatality rate (per 100,000 population) increased from 2.53 in 1994 to 2.85 in 1998 (Figure 1). In comparison, the U.S. pedestrian fatality rate decreased from 2.19 in 1993 to 1.98 in 1997. The pedestrian fatality rates for the two most central counties in the Atlanta MSA (DeKalb and Fulton) were higher than the rates for the other two counties studied (Cobb and Gwinnett) (Table 1). The pedestrian fatality rate for males was three times that for females. Rates for non-Hispanic blacks and Hispanics were two and six times greater, respectively, than for non-Hispanic whites. All rates for pedestrians aged 20 years were higher than for those aged <20 years, with the highest rate in the 4554 year group. Of the 266 pedestrians aged >15 years, alcohol test results were available for 219 (82%). Of these, 74 (34%) had a blood alcohol concentration (BAC) of >0.10 g/dL. Sixty-seven (22%) pedestrians died after being struck on interstate highways, 96 (31%) on state highways, 62 (20%) on county roads, and 84 (27%) on city streets. Thirtythree (11%) pedestrian deaths occurred after a person exited a privately owned vehicle in traffic; of these, 24 (73%) were on interstate highways. One hundred ninety-three (63%) pedestrians involved in fatal collisions were attempting to cross a street at the time they were struck; 28 (9%) were at crosswalks. The monthly number of pedestrian deaths varied considerably (mean: 5.1 deaths per month; range: 012). More pedestrian fatalities occurred on Saturday (64 [21%]) than any other day of the week. The number of fatal pedestrian incidents peaked from 6 p.m. Georgia Department of Human Resources Division of Public Health, Epidemiology Section Epidemiology & Health Information Branch Two Peachtree St., N.W., Atlanta, GA 30303 - 3186 Phone: (404) 657-2588 Fax: (404) 657-2586 through midnight, when 138 (45%) of the incidents occurred. According to police crash reports, 87 (44%) of 198 pedestrians struck after dark were on unlit roads. Street surface conditions were wet at the time 64 (21%) pedestrians were struck. Multiple motor vehicles were involved in 38 (12%) pedestrian fatalities. Of the 363 total drivers involved in the 309 pedestrian fatalities, information was available for 312 (86%); 217 (70%) were men; median age was 33 years (range: 1790 years). Fifteen (5%) drivers were cited for driving under the influence of alcohol. Forty-eight (16%) pedestrian fatalities involved a driver who fled or attempted to flee the scene. areas rapidly growing populations, pedestrian fatality rates reported here would be inflated. Fourth, blood alcohol levels were not obtained for drivers; the reported proportion of drivers cited for driving under the influence probably underestimates the true prevalence of alcohol use. Finally, race/ethnicity misclassification may have occurred. These findings and other reports suggest potential engineering, education, and enforcement measures to protect pedestrians (9). Engineering interventions should include: methods to separate pedestrians from traffic (e.g., sidewalks); traffic calming measures (e.g., speed bumps and lower posted speeds) (10); safer ways to cross streets (9); and improved street lighting. Reported by: R Hanzlick, M.D., D McGowan, Fulton County Medical On the basis of the data in this report, three educational inter- Examiners Office, Atlanta; J Havlak, DeKalb County Medical ventions were identified. First, drivers and passengers need to know Examiners Office; M Bishop, H Bennett, Cobb County Medical about the dangers of exiting a vehicle in traffic. In 1995, the Georgia Examiners Office; R Rawlins, Gwinnett County Medical Examiners Department of Transportation instituted the Highway Emergency Re- Office; B Raines, Georgia Dept of Public Safety; K DeBowles, Georgia sponse Operators (HERO) program to assist stranded motorists, pri- Dept of Administrative Svcs; D Graves, T Leet, D Crites, Georgia Dept marily on Atlantas interstate highways. During the study period, 25 of Transportation; S Davidson, M.Ed., M Schmertmann, M.P.H., K pedestrians died after exiting a vehicle on roads now covered by the Powell, M.D., M.P.H., Georgia Div of Public Health, Georgia Dept of HERO program. Increased awareness of the availability of this service Human Resources, Medical Examiner/Coroner Information Sharing has the potential to prevent pedestrian deaths and injuries. Second, Program, Surveillance Br, Div of Environmental Hazards and Health messages to increase awareness of the risk for injury to pedestrians who Effects, National Center for Environmental Health, Div of Uninten- have been drinking alcohol should be developed for both the public tional Injury Prevention, National Center for Injury Prevention and and establishments that serve alcohol (4). Third, pedestrians should be Control, State Br, Div of Applied Public Health Training, Epidemiol- made aware of the dangers of being struck even while crossing at cross- ogy Program Office, and EIS officers, CDC. walks. Stricter enforcement of driving laws (e.g., speeding, running a red-light, and yielding to pedestrians) and pedestrian regulations (e.g., Editorial Note: The findings in this study document that the pedestrian jaywalking) also may help protect pedestrians. The success of public fatality rate of the four most populous Atlanta MSA counties com- health measures to protect pedestrians will require involvement of lo- bined has remained higher than the national rate since at least 1994. cal community groups, evaluation to identify effective interventions, Moreover, the rate in these four counties has increased, while the over- and ongoing surveillance. all U.S. rate has declined. Characteristics of pedestrian fatalities in the four counties were similar to that of pedestrian fatalities nationwide References: (1,3,4). For example, higher pedestrian fatality rates have been reported 1 US Department of Transportation, National Highway Traffic previously for certain minority populations (5,6). Rate differences by Safety Administration. Traffic safety facts 1997. Washington, DC: race/ethnicity probably result, in part, from differences in walking pat- US DOT, National Highway Traffic Safety Administration, 1998. terns; the 1995 Nationwide Personal Transportation Survey showed 2 Chen BA, Wiles R, Campbell C, Chen D, Kruse J, Corless J of the that blacks walk 82% more than whites, and Hispanics walk 58% more Environmental Working Group and Surface Transportation than non-Hispanics (7). In other reports, one third of fatally injured Policy Project. Mean streets: pedestrian safety and reform of the pedestrians aged >15 years had BACs of >0.10 g/dL (4). In the United nations transportation law. Washington D.C, Environmental States during 19821992, the proportion of fatally injured pedestrians Working Group/The Tides Center, April 1997. Available at with BACs of 0.10 g/dL declined from 39% to 36%, compared with a http://www.ewg.org. Accessed December 15, 1998. decrease from 20% to 12% among drivers in such collisions (4). Also, 3 Baker SP, ONeill B, Ginsburg MJ, Li G. Injury fact book. 2nd the finding that pedestrian death rates were higher in the two most edition. New York, New York: Oxford University Press, 1992. central counties is consistent with previous reports of higher rates in 4 CDC. Alcohol involvement in pedestrian fatalitiesUnited States, more urban areas of the United States (3). 19821992. MMWR 1993;42:7169. 5 Harruff RC, Avery A, Alter-Pandya. Analysis of circumstances Half of all pedestrian fatalities in the four counties occurred and injuries in 217 pedestrian traffic fatalities. Accid Anal Prev on state or county roads. Generally, these roads have posted speeds of 1998 Jan; 30(1):11-20 3045 miles per hour (mph) and often do not provide physical separa- 6 CDC. Pedestrian fatalitiesNew Mexico, 19581987. MMWR tion between pedestrians and traffic. The risk of a pedestrian dying 1991;40:3124. from collisions increases rapidly as speeds exceed 25 mph (8). 7 Our nations travel: 1995 NPTS Early Results Report, 1991. US Department of Transportation, Federal Highway Administration, Fatalities typically represent only a small proportion of pedes- 1997. FHWA-PL-97-028. Available at http://www-cta.ornl.gov/ trian injuries (1). Data from police crash reports show that nonfatal npts. Accessed April 1999. pedestrian injuries also have increased in the four- county area. During 8 Anderson RW, McLean AJ, Framer MJB, Lee BH, Brooks CG. 19941997, the rate of all nonfatal pedestrian injuries increased 21% Vehicle travel speeds and the incidence of fatal pedestrian crashes. from 48.0 to 58.0 per 100,000 population (Georgia Department of Pub- Accid Anal Prev 1997; 29:66774. lic Safety, unpublished data, 1999). 9 Zegeer CV. Synthesis of safety researchpedestrians. US Depart- ment of Transportation. Federal Highway Administration, 1991; The findings in this report have at least five limitations. First, publication no. FHWA-SA-91-034. limited information was available about pedestrian characteristics (e.g., 10 Engel U, Thomasen LK. Safety effects of speed reducing measures color of clothing), driver behavior, environmental factors (e.g., avail- in Danish residential areas. Accid Anal Prev 1992;24:1728. ability of crosswalks and crossing signals), and pedestrian exposure in- formation (e.g., prevalence of walking). Second, only pedestrian fatali- *Dividing the number of pedestrian deaths from collisions in a ties were studied, and nonfatal incidents may have different modifiable county by the population of the county is not a rate because some risk factors. Third, if census estimates underestimated the four-county of the deceased may not be county residents. For simplicity and consistency with reporting of national crash data, the term rate - 2 - instead of ratio was used. TABLE 1. Distribution and rate* of pedestrian fatalities, by selected characteristics four metropolitan Atlanta counties, Georgia, January 1, 1994 December 31, 1998. Characteristic No. (%) Rate Year 1994 1995 1996 1997 1998 56 (18) 2.53 52 (17) 2.29 63 (20) 2.72 69 (22) 2.92 69 (22) 2.85 County Cobb DeKalb Fulton Gwinnett 34 (11) 1.26 104 (34) 3.55 140 (45) 3.92 31 (10) 1.30 Sex Female Male 81 (26) 1.36 228 (74) 4.04 Age group (yrs) 0 4 5 9 1014 1519 2024 2534 3544 4554 5564 6574 75 16 ( 5) 1.84 13 ( 4) 1.59 12 ( 4) 1.58 12 ( 4) 1.58 28 ( 9) 3.32 56 (18) 2.53 58 (19) 2.61 55 (18) 3.78 28 ( 9) 3.71 15 ( 5) 2.96 14 ( 5) 3.74 Race/Ethnicity** Black White Hispanic 140 (45) 3.85 117 (38) 1.64 40 (13) 9.74 *Per 100,000 population. Age-, race/ethnicity-, and sex-specific average annual rates were calculated using the 1996 population as the denominator. n=309 For two deaths, age was unknown. **There were 10 deaths of other race/ethnicities and two with unknown race/ethnicities... Figure 1. Pedestrian fatality rates* for four metropolitan Atlanta counties and the Untied States, 1993-1998. 3.5 3 Four Atlanta counties 2.5 Rate 2 United States 1.5 1 0.5 0 1993 * Per 100,000 Population 1994 1995 Year 1996 -3 - 1997 1998 The Georgia Epidemiology Report Epidemiology and Health Information Branch Two Peachtree St., NW Atlanta, GA 30303-3186 Bulk Rate U.S. Postage Paid Atlanta, Ga Permit No. 4528 August 1999 Volume 15 Number 8 Reported Cases of Selected Notifiable Diseases in Georgia Profile* for May 1999 Selected Notifiable Diseases Campylobacteriosis Chlamydia genital infection Cryptosporidiosis E. coli O157:H7 Giardiasis Gonorrhea Haemophilus influenzae (invasive) Hepatitis A (acute) Hepatitis B (acute) Legionellosis Lyme Disease Meningococcal Disease (invasive) Mumps Pertussis Rubella Salmonellosis Shigellosis Syphilis - Primary Syphilis - Secondary Syphilis - Early Latent Syphilis - Other** Syphilis - Congenital Tuberculosis Total Reported for May 1999 1999 49 5442 6 3 50 3138 11 45 9 0 0 10 2 3 0 114 16 6 15 32 25 0 69 Previous 3 Months Total Ending in May 1997 1998 1999 116 174 154 4429 6176 9772 2 24 48 11 3 5 121 220 198 4857 4972 5866 7 11 22 154 230 147 43 69 35 2 3 0 0 2 0 37 23 24 7 1 2 2 11 11 0 0 0 229 228 282 190 295 59 33 29 22 102 63 51 318 206 149 376 255 127 3 0 2 199 147 154 Previous 12 Months Total Ending in May 1997 1998 1999 710 836 781 14781 19540 28011 81 107 194 54 27 85 853 1002 1253 19292 18850 20818 43 50 77 504 883 766 117 280 153 2 7 5 1 12 1 120 108 81 17 2 3 29 22 40 0 0 0 1449 1357 1941 1256 1283 802 183 142 114 454 303 230 1310 961 730 1256 1017 669 22 14 18 749 616 612 * The cumulative numbers in the above table reflect the date the disease was first diagnosed rather than the date the report was received at the state office, and therefore are subject to change over time due to late reporting. The 3 month delay in the disease profile for a given month is designed to minimize any changes that may occur. This method of summarizing data is expected to provide a better overall measure of disease trends and patterns in Georgia. ** Other syphilis includes latent (unknown duration), late latent, late with symptomatic manifestations, and neurosyphilis. Report Period Latest 12 Months: 6/98 - 5/99 Five Years Ago: 6/93 - 5/94 Cumulative: 7/81 - 5/99 Total Cases Reported * AIDS Profile Update Percent Risk Group Distribution (%) Female MSM IDU MSM&IDU HS Blood Unknown Race Distribution (%) White Black Other 1516 22.6 35.1 14.1 4 13 1.3 32.5 21.7 76.1 2.2 2065 16.4 43.1 23.4 5.1 12.7 1.4 14.2 30.7 67.6 1.7 20805 15.6 50.2 19 5.8 12.2 1.9 10.9 37.6 60.4 2.1 MSM - Men having sex with men IDU - Injection drug users HS - Heterosexual * Case totals are accumulated by date of report to the Epidemiology Section - 4-