OBJECTIVE:

To identify and prioritize risk factors for passenger death.

DESIGN:

Retrospective cohort captured in 2 databases: US census of fatal crashes (Fatality Analysis Reporting System) and US-representative sample of police-reported crashes (National Automotive Sampling System Crash Data System).

SETTING:

Crashes in 50 states and the District of Columbia from January 1, 2000, to December 31, 2005.

PARTICIPANTS:

A total of 45 560 passengers aged 8 to 17 years in crashes, representing 2 545 168 passengers (weighted). Main Exposures Age and sex of driver, vehicle and road type, restraint use, seating position, day of week, month, time of day, and speed limit. Outcome Measure Passenger fatality.

RESULTS:

Approximately 424 000 passengers (aged 8-17 years) annually were in tow-away crashes and experienced a fatality rate of 3.9 per 1000. Just more than three-quarters as many passengers (aged 8-17 years) were in crashes with 16- to 19-year-old drivers as with all adult drivers (those aged > or =25 years), with double the passenger fatality rate. For drivers aged 16 to 17 years, passenger fatalities doubled between passenger ages 11 to 12 years and increased to a peak at a passenger age of 16 years. Of crashes with child passenger fatality, 21.2% involved alcohol. In crashes with drivers younger than 18 years, the greatest risk factors for death for passengers aged 8 to 17 years were drivers younger than 16 years, restraint nonuse, and high-speed roads (> or =55 and 45-54 mph).

CONCLUSIONS:

While passenger risks because of restraint nonuse require continued attention, interventions must be developed to address risk because of travel on high-speed roads and riding with drivers younger than 16 years. For safety, child passengers and their parents should monitor these characteristics of the drive and the driver. Anticipatory guidance about passenger risks should begin by the age of 11 years.