Pedestrian and Bicyclist Crashes With Motor Vehicles by the Childhood Opportunity Index

BACKGROUND: Neighborhood socioeconomic context influences pediatric injury risk, yet few studies apply child-focused metrics to quantify disparities in pedestrian and bicyclist crashes. We hypothesized that lower childhood opportunity would be associated with higher crash incidence and more severe and hazardous crash characteristics. METHODS: This retrospective study examined pedestrian and bicyclist crashes involving children aged 0 to 17 years using Florida Signal Four Analytics (2015-2023) and the National Fatality Analysis Reporting System (2012-2023). The primary exposure was the crash zip code's Child Opportunity Index quintile. Florida crashes were used to estimate incidence, with national fatality data analyzed for replication. Incidence was modeled using negative binomial regression to estimate incidence rate ratios (IRRs) and 95% CIs. Injury severity and crash-level characteristics were assessed using logistic regression. RESULTS: A total of 18 272 crashes (49.6% pedestrian, 50.4% bicyclist) were identified; more than 60% occurred in low- or very low-opportunity neighborhoods. Incidence increased stepwise as opportunity declined (very low vs very high IRR 1.35 [95% CI 1.21-1.51]). Nationally, 3612 pediatric fatalities showed a similar pattern (very low vs very high IRR 2.82 [95% CI 2.65-3.00]). Very low-opportunity neighborhoods had higher odds of incapacitating injury (adjusted odds ratio [aOR] 1.71, 95% CI 1.34-2.16) and of improper actions (aOR 1.48, 95% CI 1.31-1.67). CONCLUSIONS: Lower neighborhood opportunity is associated with higher pediatric pedestrian and bicyclist crash incidence, more severe injuries, and more hazardous crash contexts, supporting targeted prevention efforts in disadvantaged communities.