Associations between National walkability Index and Traffic-Related pedestrian Deaths, United States, 2017–2019

• The National Walkability Index ranks block groups by features that promote walking. • Block group traffic-related pedestrian fatality rates increase with increasing rank. • Urbanicity modifies the impact of National Walkability Index on fatality rates. • The National Walkability Index may be useful for prioritizing safety improvements. Despite increased investment in infrastructure designed to promote and protect walking, rates of traffic related pedestrian deaths have increased by 87.8% between 2010 and 2022 in the United States. This study aims to investigate how comprehensive measures of built environmental features that encourage walking impact pedestrian risks overall and across levels of urbanicity. Using data from the Environmental Protection Agency’s National Walkability Index (NWI) and National Highway Traffic Safety Administration 2017–2019 Fatality Analysis Reporting System, multilevel negative binomial regression models were used to examine the relationship between walkability score (range 1–20, with higher scores indicating the presence of built environment characteristics that increase the likelihood that people will walk for transportation) and pedestrian death rates by resident population at the census block group level. In adjusted, block group level models, a 5-point higher NWI score was associated with a 29% increase in the rate of pedestrian deaths (IRR: 1.29, 95% CI: 1.27 – 1.32). Models stratified by urbanicity showed a stronger association of NWI in urban block groups (IRR: 1.34, 95% CI: 1.31 – 1.37) and an inverse association of NWI in isolated rural town block groups (IRR: 0.56, 95% CI: 0.43 – 0.72). These results suggest that built environment interventions which promote walking behavior may benefit from additional pedestrian safety improvements. Current nationwide walkability data do not accurately characterize pedestrian safety; however, these data may be used to identify places to be prioritized for pedestrian safety interventions.