It found that the most dangerous cities were those in the South and West that had sprawling development. Such land-use patterns favor the automobile and make walking difficult. According to the Insurance Institute for Highway Safety, pedestrians are the second largest category of motor vehicle deaths, after occupants, and account for about 13 percent of motor vehicle deaths. The problem is worst among the elderly. There were 447 auto-pedestrian deaths in Texas in 1997.
Pedestrian deaths are principally an urban problem.
Many pedestrians are killed at crosswalks, sidewalks, median strips, and traffic islands. For those not killed, serious injuries often result from pedestrians being thrown onto the hoods, windshields, or tops of vehicles. Serious injuries to people's head, pelvis, and legs are common. Physical separations like overpasses, underpasses, and barriers can reduce the problem of auto-pedestrian injuries. Warning signs and pavement markings at intersections also can be effective.