Crash incompatibility: Cars versus light trucks and vans

Background: In crashes between a car and a light truck or van (LTV), car occupants are more likely to be killed than LTV occupants. The extent to which this is due to the greater harm imposed by LTVs on cars or to the greater protection they offer their own occupants is not known. The combined effect of these two factors is also unknown.Objective: To estimate the harm imposed and protection offered by LTVs compared to cars, the joint effect of these on the risk of crash death, and the effects of two LTV design features: bumper height and frame type (unibody versus body-on-frame).Methods: Case-control analyses of two-vehicle collisions involving passenger vehicles in the United States.Findings: Adjusted for the type of vehicle they were riding in and for other confounders, occupants of any vehicle that collided with LTVs were at higher risk of death compared with occupants who collided with a car. For the six types of LTV, the adjusted odds ratios (aOR) ranged from 1.8 (95% confidence interval 1.5 to 2.1) for collision with a compact pickup to 4.8 (3.9 to 5.8) for collision with a full-size van. Occupants of LTVs were at lower risk of death compared with car occupants. For the six types of LTV, the aOR ranged from 0.32 (0.25 to 0.41) for occupants of full-size pickups to 0.76 (0.66 to 0.87) for occupants of compact SUVs. Compared to crashes between two cars, the joint relative risk of death in crashes between any other combination of two vehicle types ranged from 1.0 to 2.6, suggesting that occupants in crashes between two cars have the lowest risk of death. SUVs and pickups with bumpers that matched car bumpers in height posed lower risk to car occupants in side crashes (aOR 0.72 (0.54 to 0.95)), but there was little evidence of a beneficial effect in head-on crashes (a0R 1.20 (0.65 to 2.21)). Unibody SUVs posed less risk to occupants of other vehicles than did body-on-frame SUVs (aOR, 0.83 (0.73 to 0.94)), while also protecting their own occupants better (aOR 0.85 (0.70 to 1.03)).Conclusion: Although LTVs protect their own occupants better than cars do, LTVs are associated with an excess total risk of death in crashes with cars or other LTVs.