Governance of Road-Safety Inequality: Spatiotemporal Patterns and Pedestrian Vulnerability in Medellín, Colombia

Background: Urban road-traffic fatalities are a public health burden and a governance challenge because protection is uneven across urban space and time. Methods: We analyzed 702,540 administrative road-incident records from Medellín, Colombia (2008–2025), identified 2762 fatal cases, standardized incident categories, and harmonized time and coordinate fields. Spatial analyses were based on 2507 geocoded fatalities. We combined descriptive profiling, chi-square tests, logistic regression comparing pedestrian-strike and collision fatalities, sensitivity analyses using grouped time periods and a pandemic-period indicator, and spatial autocorrelation measures using Moran’s I and Getis–Ord Gi*. Results: Incident type composition did not differ significantly between daytime and nighttime, but it varied across districts (comunas). Each later hour was associated with slightly higher odds that a fatality would be classified as a pedestrian strike rather than a collision (OR = 1.033), and fatalities in the urban core had nearly threefold higher odds of being classified as pedestrian strikes (OR = 2.953). Sensitivity analyses did not materially alter these associations. Spatial statistics showed strong clustering among the dominant fatality classes and identified 129 significant hotspot cells. Conclusions: Fatal road-traffic harm in Medellín is spatially concentrated and varies by incident mechanism, with pedestrian fatalities disproportionately concentrated in central areas of intense pedestrian–vehicle interaction. These findings show that transparent surveillance analytics can inform governance prioritization while also underscoring the need to improve data completeness, incorporate exposure measures, and interpret pandemic-period patterns with caution.