Community vulnerability influences traffic safety differently in urban, suburban, and rural areas

Social vulnerability refers to the susceptibility of individuals or communities to harm and is influenced by various inequities related to resources, opportunities, and social conditions. This study aims to investigate the association of motor vehicle crash fatalities with community vulnerability and variations between urban, suburban, and rural areas. Negative binomial regression models were used to estimate cross-sectional associations of population-based motor vehicle crash fatality rates with the Centers for Disease Control and Prevention's Social Vulnerability Index (SVI) across all Census Tracts in the United States in 2018–2022. Associations were allowed to vary by area type. A decile increase in vulnerability was associated with 11% higher fatality rates in urban areas and 9% higher fatality rates in suburban areas (P < 0.001) but only a 1% higher fatality rate in rural areas (P = 0.08). When individual components of vulnerability were examined, fatality rates were most strongly associated with the racial and ethnic minority status theme of the SVI in urban areas but with the socioeconomic status theme in suburban areas and rural areas. Most dimensions of the vulnerability measure were associated more strongly with pedestrian fatalities than with total crash fatalities. Strategies to reduce roadway mortality should account for complex relationships between social vulnerability and geographic location. Future research examining these relationships may help develop interventions that go beyond improving traffic safety, such as addressing social and economic inequities.