Neighborhood Opportunity and Fatal Police Pursuits in the US.

IMPORTANCE: On average, 1 person dies daily from police vehicle pursuits in the US. Whether neighborhood conditions are associated with incidence rates of fatal police pursuits remains unknown. OBJECTIVE: To examine the longitudinal association between neighborhood opportunity and county-level incidence rates of fatal police pursuits. DESIGN, SETTING, AND PARTICIPANTS: This longitudinal cohort study performed an ecological population-based analysis of US county data from January 1, 2017, to December 31, 2021. A total of 15 570 county-year observations across 3114 US counties were included. All analyses were performed between January 2 and June 24, 2026. EXPOSURE: County-level neighborhood opportunity was measured using the Childhood Opportunity Index 3.0, classified as low (≤40th percentile), moderate (>40th to ≤60th percentile), or high (>60th percentile). Secondary exposures included domain-specific scores for education, health and environment, and social and economic resources. MAIN OUTCOME AND MEASURE: Count of fatal police pursuit incidents occurring in each county-year according to the Fatal Police Pursuits Database, capturing the geographic distribution of fatal pursuit events across US counties. RESULTS: A total of 15 570 county-year observations across 3114 US counties were included in the analysis. After adjusting for rural or urban residence, demographic characteristics, and rates of violent crime, counties with low neighborhood opportunity had a 63% higher incidence rate of fatal police pursuits than counties with high neighborhood opportunity (adjusted incidence rate ratio [AIRR], 1.63 [95% CI, 1.37-1.94]). Similar patterns were observed for the education (AIRR, 1.59 [95% CI, 1.35-1.87]), health and environment (AIRR, 1.66 [95% CI, 1.37-2.01]), and social and economic resources (AIRR, 1.69 [95% CI, 1.42-2.01]) domains. CONCLUSIONS AND RELEVANCE: In this ecological cohort study, low neighborhood opportunity was associated with a higher county-level concentration of fatal police pursuit incidents. These patterns persisted above and beyond residence, demographic characteristics, and violent crime rates. These findings document the geographic concentration of fatal police pursuit incidents and identify low-opportunity communities as disproportionately affected. As data on total pursuit frequency become available, future research should examine whether the observed concentration of fatal pursuit incidents in low-opportunity communities reflects differences in pursuit frequency, pursuit lethality, or both.