Police Pursuit Fatalities in the US, 2009 to 2023.

Importance: Police pursuits account for approximately 1% of motor vehicle fatalities and expose suspects, officers, and bystanders to preventable harm. Contemporary population-based estimates of fatality trends and context-specific risk remain limited. Objective: To evaluate the characteristics of and trends in fatal vehicle crashes involving police pursuit in the US between 2009 and 2023 and the factors associated with these crashes. Design, Setting, and Participants: This cross-sectional study used National Highway Traffic Safety Administration Fatality Analysis Reporting System (FARS) data between January 2009 and December 2023. These nationwide, population-based data included individuals involved in fatal motor vehicle crashes involving police pursuits. The data analysis was performed between August 2025 and February 2026. Exposures: Police motor vehicle pursuits, as documented in the FARS database. Main Outcomes and Measures: The primary outcomes were pursuit-related motor vehicle crash fatalities per year and associated factors, including urban vs rural settings, interstate vs noninterstate roads, US census regions, time of day, and day of the week. A negative binomial regression was used to model fatality rates controlling for population and crash frequency. Results: Between 2009 and 2023, there were 5425 fatal police pursuit-related crashes involving 8307 vehicles and 14 497 persons, resulting in 6352 deaths (mean [SD], 423 [84] deaths per year). Fatal crashes occurred most often in urban settings (3069 [57%]), at night (3794 [70%]), on noninterstate roads (4825 [89%]), and with documented speeding (4183 [77%]). Nonmotor vehicle occupants represented 270 fatalities (4%). When controlling for population and crashes, fatalities increased by 2% (95% CI, 1%-3%; P < .001) annually. Compared with the Northeast, fatalities were significantly higher in the South (difference, 336% [95% CI, 284%-395%]; P < .001), the Midwest (difference, 110% [95% CI, 84%-140%]; P < .001), and the West (difference, 95% [95% CI, 70%-123%]; P < .001). Conclusions and Relevance: In this cross-sectional study of the FARS database from 2009 to 2023, police pursuit-related fatalities increased over 15 years. Higher rates of fatal crashes were concentrated in identifiable settings including nighttime hours, urban corridors, noninterstate roadways, and southern states. The findings support risk-based restrictions, mandatory national pursuit reporting, and investment in nonpursuit alternatives among US police.