Pedestrian fatality in global context: Economic growth, urbanization, and the role of inequality

Pedestrian mortality remains an underemphasized component of worldwide health disparity, specifically affecting vulnerable populations within rapidly transforming urban areas. Understanding the socioeconomic determinants of these issues is crucial to addressing the health effects of urbanization and inequality. This study examines the effects of income inequality, economic growth, and urbanization on pedestrian fatality rates using panel data from 152 countries over 1996–2021. Fixed-effects negative-binomial panel regression models estimate the long-run and non-linear effects across different income groups. The result shows divergent development paths. In middle- and high-income countries, pedestrian mortality follows a Kuznets-type trajectory—rising and then falling with economic growth. In low-income countries, there is a U-pattern, where initial progress in safety is undermined by unplanned urbanization and institutional vulnerability to crisis. Income inequality invariably increases risk in all environments. Economic growth alone does not guarantee safe mobility. Pedestrian safety depends on equitable urban governance, redistributive infrastructure investment, and the integration of transport and health systems that prioritize vulnerable road users. Pedestrian fatality thus reflects systemic inequity and global health inequity—an urgent challenge to achieving the United Nation Sustainable Development Goal of halving road fatalities by 2030. • Pedestrian fatality is a marker of structural injustice, not random chance. • A “pedestrian Kuznets curve” exists, with distinct paths by income group. • Income inequality consistently increases pedestrian fatality risk. • Urbanization can increase or decrease risk, depending on governance. • Economic growth alone is insufficient for creating safe pedestrian environments.