Economic development and the shifting distribution of road traffic fatalities between children and older adults: Evidence from a global panel.

INTRODUCTION: Road traffic fatalities and injuries remain a leading cause of death worldwide, with risks varying significantly across age groups. While existing research primarily focuses on aggregate fatality trends, limited attention has been given to how socioeconomic development reshapes the distribution of fatality risk between children and older adults. This study examines this relationship across countries over time. METHOD: Using panel data from 160 countries over a 30-year period, a fixed-effects analytical approach was employed to assess the relationship between development and age-specific road mortality. The child-to-older adult death ratio (CTODR) was used as the key outcome measure to capture the relative distribution of fatalities between children (aged 0-14 years) and older adults (aged 60 years and above). RESULTS: Higher levels of socioeconomic development were associated with improvements in road infrastructure, traffic regulation, and post-crash care, which disproportionately reduced exposure and fatality risk among children relative to older adults. Population aging further reinforced this pattern by increasing the relative vulnerability of older road users. Urbanization and income inequality were also linked to lower CTODR values, indicating comparatively higher risks for older adults in more urbanized and unequal societies. Additionally, a negative time trend suggested that road safety improvements over time have benefited children more than older adults. CONCLUSIONS: The findings provide evidence of a "transitional risk shift," whereby the burden of road mortality shifts from children to older adults as societies develop. This indicates that road safety improvements are not distributionally neutral and may inadvertently increase relative risks for older populations. PRACTICAL APPLICATIONS: Policymakers should consider age-specific interventions in road safety strategies. As countries develop, targeted measures to protect older road users-such as safer urban design, improved pedestrian infrastructure, and tailored post-crash care-are essential to address the shifting burden of road mortality.