Impact of improving vehicle front design on the burden of pedestrian injuries in Germany, the United States, and India

<p><b>Objective</b>: European car design regulations and New Car Assessment Program (NCAP) ratings have led to reductions in pedestrian injuries. The aim of this study was to evaluate the impact of improving vehicle front design on mortality and morbidity due to pedestrian injuries in a European country (Germany) and 2 countries (the United States and India) that do not have pedestrian-focused NCAP testing or design regulations.</p> <p><b>Methods</b>: We used data from the International Road Traffic and Accident Database and the Global Burden of Disease project to estimate baseline pedestrian deaths and nonfatal injuries in each country in 2013. The effect of improved passenger car star ratings on probability of pedestrian injury was based on recent evaluations of pedestrian crash data from Germany. The effect of improved heavy motor vehicle (HMV) front end design on pedestrian injuries was based on estimates reported by simulation studies. We used burden of disease methods to estimate population health loss by combining the burden of morbidity and mortality in disability-adjusted life years (DALYs) lost.</p> <p><b>Results</b>: Extrapolating from evaluations in Germany suggests that improving front end design of cars can potentially reduce the burden of pedestrian injuries due to cars by up to 24% in the United States and 41% in India. In Germany, where cars comply with the United Nations regulation on pedestrian safety, additional improvements would have led to a 1% reduction. Similarly, improved HMV design would reduce DALYs lost by pedestrian victims hit by HMVs by 20% in each country. Overall, improved vehicle design would reduce DALYs lost to road traffic injuries (RTIs) by 0.8% in Germany, 4.1% in the United States, and 6.7% in India.</p> <p><b>Conclusions</b>: Recent evaluations show a strong correlation between Euro NCAP pedestrian scores and real-life pedestrian injuries, suggesting that improved car front end design in Europe has led to substantial reductions in pedestrian injuries. Although the United States has fewer pedestrian crashes, it would nevertheless benefit substantially by adopting similar regulations and instituting pedestrian NCAP testing. The maximum benefit would be realized in low- and middle-income countries like India that have a high proportion of pedestrian crashes. Though crash avoidance technologies are being developed to protect pedestrians, supplemental protection through design regulations may significantly improve injury countermeasures for vulnerable road users.