Road deaths are declining in the U.S. and worldwide, but lower-income countries are not experiencing much of the improvement, according to a study published Monday in Lancet Public Health.
Global rates of road injuries and deaths each fell more than 30% between 1990 and 2023, the study found. However, pedestrian and vehicle occupant deaths rose in the United States during that period. More recent data indicates that road deaths have fallen in the U.S. in 2024 and 2025.
The World Health Organization (WHO) reported that road traffic deaths declined by 21% between 2011 and 2025. Despite this progress, traffic crashes still claimed over 1.1 million lives globally last year and remain the leading cause of death for children and young people aged 5 to 29 years.
Road deaths encompass fatal injuries to pedestrians, cyclists, and occupants of vehicles. Researchers from the University of Washington’s Institute for Health Metrics and Evaluation estimated data for countries with incomplete records. They noted that while road injury rates are higher in high-income countries, 90% of road deaths occur in low-income countries.
In many low-income nations, safety measures have not kept pace with rapid urbanization and increased use of motorized vehicles. Mandates for seat belts and advanced car safety features like airbags are more common in high-income countries, according to the study.
"Road injury outcomes are shaped not only by crashes, but by the systems designed to prevent them and protect people when they occur," said Liane Ong, the new paper's senior author.
Conflicting trends in the U.S. include the proliferation of larger passenger vehicles and "distracted driving," with thousands of deaths each year attributed to drivers using their phones, the authors noted.
Motor vehicle traffic fatalities in the U.S. rose in the last decade, peaking at more than 43,000 in 2021 before declining. The National Highway Traffic Safety Administration estimated the count fell to about 36,600 last year. The Governors Highway Safety Association reported that U.S. drivers hit and killed 7% fewer pedestrians on roads in 2025 compared to the previous year, marking the largest annual reduction in pedestrian deaths in three years, though still higher than pre-pandemic levels.
The WHO designated road safety as an international public health priority over two decades ago. The release of the Lancet report coincides with a United Nations high-level meeting in New York City focused on improving global road safety.