New York pedestrian fatalities often involve alcohol and drugs

In New York State, 44% of pedestrian deaths involved alcohol or drug use by the pedestrian, suggests a retrospective analysis published online in the journal Injury Prevention.

Pedestrian injuries are the seventh leading cause of injury-related death in New York State, USA. There are approximately 15 000 pedestrian injuries annually of which 3000 require hospitalisation.

Most public safety campaigns focus on drinking and driving whereas pedestrian substance use and impairment is a relatively neglected issue.

The researchers analysed data from the Fatality Analysis Reporting System, a national database covering all motorised vehicle traffic-involved fatalities on a public roadway. This includes deaths that occur within 30 days of the crash as well as alcohol and drug test results reported as part of post-mortem examinations.

During a three-year study period, between 2018 and 2020, there were 771 pedestrian deaths recorded in New York State as a result of a collision with a vehicle. Substance use, defined as the presence of alcohol, drugs, or both was recorded in 338 of the pedestrians who died (44%).

Nearly one in five fatalities (18%) involved drugs alone, while 12% involved both alcohol and drugs. Alcohol use (defined as a blood alcohol concentration of 0.01% or more) was recorded in 14% of the pedestrian deaths.

The researchers, from the Bureau of Occupational Health and Injury Prevention at New York State Department of Health and Columbia University, write, “Alcohol and drug co-use is particularly concerning, as poly-substance use has been linked to more severe impairments in cognitive function and neurocognitive deficits compared with single drug use.”

They say further research is needed to understand better the role of polysubstance use in pedestrian injuries and fatalities.

The number of deaths was highest among men (63%) and those aged 65 and older (34%).

Hispanic males had the highest proportion of substance-involved deaths (58%). However, a large proportion of pedestrians (57%) did not have their race and ethnicity recorded which limits interpretation of this finding.

The study found that substance-involved deaths were most likely to occur between the hours of 6pm and 6am. Overall, the largest number of pedestrian deaths occurred on Saturday evenings.

Pedestrians who had taken drugs were more likely to be on a road and not on a crosswalk when struck by a vehicle.

Based on their findings, the researchers suggest that substance use may contribute to riskier crossing behaviors and a reduction in visibility at night may give drivers insufficient time to react and avoid a collision.

A limitation of the study is that the analysis only examined fatalities and the findings cannot necessarily be extrapolated to non-fatal injuries. Additionally, the researchers coded an individual as negative for alcohol and drugs when testing was not conducted or results were unavailable which may have underestimated the true prevalence of substance use.

The researchers note that the presence of alcohol or drugs does not necessarily mean that impairment was solely responsible for the fatality or that it directly contributed to the crash.

Nevertheless, they say impairment such as impaired decision making and walking, may have played a role in the sequence of events leading to a fatal motor vehicle crash. They call for strategies that promote safe drinking practices and encourage safe travel home for anyone who may be impaired from alcohol or drugs.