Accident Analysis and Prevention 32 (2000) 533 – 540

www.elsevier.com/locate/aap

Fatalities to occupants of cargo areas of pickup trucks

Craig L. Anderson a,*, Phyllis F. Agran b, Diane G. Winn a, Sander Greenland c
a
Health Policy and Research, 100 Theory Dr., Suite 110, Uni6ersity of California, Ir6ine, CA 92697 -5800, USA
b
Department of Pediatrics and Health Policy and Research, 100 Theory Dr., Suite 110, Uni6ersity of California, Ir6ine, CA 92697 -5800, USA
c
Department of Epidemiology, Uni6ersity of California, Box 951772, Los Angeles, CA 90095 -1772, USA

Received 22 February 1999; received in revised form 12 May 1999; accepted 18 May 1999

Abstract

We sought to describe the fatalities to occupants of pickup truck cargo areas and to compare the mortality of cargo area
occupants to passengers in the cab. From the Fatality Analysis Reporting System (FARS) files for 1987 – 1996, we identified
occupants of pickup trucks with at least one fatality and at least one passenger in the cargo area. Outcomes of cargo area
occupants and passengers in the cab were compared using estimating equations conditional on the crash and vehicle. Thirty-four
percent of deaths to cargo occupants were in noncrash events without vehicle deformation. Fifty-five percent of those who died
were age 15–29 years and 79% were male. The fatality risk ratio (FRR) comparing cargo area occupants to front seat occupants
was 3.0 (95% Confidence Interval [CI] = 2.7–3.4). The risk was 7.9 (95% CI = 6.2 – 10.1) times that of restrained front seat
occupants. The FRR ranged from 92 (95% CI = 47–179) in noncrash events to 1.7 (95% CI = 1.5 – 1.9) in crashes with severe
vehicle deformation. The FRR was 1.8 (95% CI = 1.4–2.3) for occupants of enclosed cargo areas and 3.5 (95% CI = 3.1 –4.0) for
occupants of open cargo areas. We conclude that passengers in cargo areas of pickup trucks have a higher risk of death than front
seat occupants, especially in noncrash events, and that camper shells offer only limited protection for cargo area occupants.
© 2000 Elsevier Science Ltd. All rights reserved.

Keywords: Motor vehicles; Pickup truck; Cargo area; Estimating equation

1. Introduction average of 188 deaths to pickup truck cargo area

Over the past several years, pickup trucks have be-
come increasingly popular vehicles in the US. Nation-
wide, pickup truck registrations have risen from 28
million in 1987 (Bureau of the Census, 1995) to 37
million in 1996 (Teets, 1997). During this period much
attention has been directed toward improving occupant
protection in the passenger compartment. Yet the cargo
area, which is not designed to protect occupants, is also
used to transport passengers.
There are no published estimates of the proportion of
pickup truck occupants who ride in cargo areas. In the
United States from 1994 to 1996, there was an annual

An earlier version of this report was presented at the 126th
annual meeting of the American Public Health Association, 16 – 19
November 1998, Washington, DC.
* Corresponding author. Tel.: + 1-949-824-1065; fax: + 1-949-824-
3388.
E-mail address: clanders@uci.edu (C.L. Anderson)
occupants, about 3% of all deaths to pickup truck
occupants (National Highway Traffic Safety Adminis-
tration, NHTSA, 1996–1998). Data on the extent of
morbidity are more limited. In California in 1990, 1071
cargo area passengers were injured in events reported to
the police (Agran et al., 1994). Head injuries are the
most frequent diagnosis for cargo area passengers
(Woodward and Bolte, 1990; Ferrer and Archer, 1997).
Passengers in cargo areas are more often ejected or
fall from the pickup truck than passengers in the cab
(Agran et al., 1990; Hamar et al., 1991; Agran et al.,
1994). Many of these falls and ejections occur without
a collision (Agran et al., 1990, 1994; Hamar et al., 1991;
Bucklew et al., 1992). Cargo area occupants also have
more injuries and deaths than do cab occupants in the
same vehicles (Agran et al., 1990, 1994; Hamar et al.,
1991). Previous reports have not examined the effect of
enclosures on the risk to cargo area occupants, except
to note that camper shells may become detached in
crashes (Agran et al., 1990).

0001-4575/00/$ - see front matter © 2000 Elsevier Science Ltd. All rights reserved.
PII: S 0 0 0 1 - 4 5 7 5 ( 9 9 ) 0 0 0 7 5 - 5
534 C.L. Anderson et al. / Accident Analysis and Pre6ention 32 (2000) 533–540
Earlier studies identified several issues that must be
addressed to obtain valid comparisons of outcomes to
cargo area and cab occupants. Age and sex may con-
found comparisons. Youths, young adults and males
are disproportionately involved in these cargo area
incidents (Hamar et al., 1991; Bucklew et al., 1992;
Agran et al., 1994), and young adults and males also
have higher survival rates from similar injuries (Baker
et al., 1974; Evans, 1988). Even if comparisons are
restricted to crashes with both front seat and cargo area
passengers, comparisons could also be confounded if
more severe crashes had proportionately more cargo
area occupants. Finally, comparisons should be pre-
sented as risk ratios, rather than odds ratios, because
the outcome is not rare in the crashes studied.
The purpose of this report is to describe the fatalities
to cargo area occupants over a 10-year period, to
compare the mortality of cargo area occupants to occu-
pants in the cab, and to examine the effect of enclosures
on the mortality of cargo area occupants. We used
comparisons conditional on the vehicle and modeled
the effects of age, sex, and seating position to estimate
the effect of riding in the cargo area on mortality in a
crash. Thus cargo area occupants were compared to
other occupants in the same vehicle. We used risk ratios
to estimate the number of deaths attributable to travel
in the cargo area.
2. Methods
We identified all pickups with one or more deaths to
occupants and one or more occupants of cargo areas
from FARS for the years 1987 – 1996. Pickup trucks
were identified by the body type as recorded on the
police report. Pickup trucks with slide-in campers were
excluded because campers ‘provide facilities for human
habitation’ (California Vehicle Code, 1991), and are
thus very different from other pickup truck enclosures.
Pickup-style vehicles of unknown type were also ex-
cluded. Occupants of cargo areas were defined as occu-
pants with a seating position recorded as ‘other
passenger or cargo area.’ We described all fatalities to
cargo area occupants in these crashes.
To avoid potential biases, we adopted several restric-
tions for the data and compared the fatality risk of
cargo area occupants only to that of front seat occu-
pants. We included only vehicles that were identified as
a pickup truck both on the police report and by the
FARS decode of the Vehicle Identification Number.
We excluded vehicles for which the number of occu-
pants was missing, because this may indicate that some
occupants were not reported. We also excluded vehicles
for which any occupant had any missing data on age,
sex, seating position, or injury. All occupants in these
excluded vehicles were excluded because data are more
often missing for surviving occupants, and excluding
only occupants with missing data might introduce a
bias. For the comparison that included restraint use, we
excluded vehicles that had any airbag deployment or
missing data on restraint use for any occupant.
2.1. Definitions
Road function was grouped in three categories: (1)
arterials, which include highways, are designed for long
trips and inter-city travel; (2) collector streets and
roads, which collect and disperse traffic between the
arterials and the local streets and roads; and (3) local
streets and roads, which serve mainly to provide access
to individual addresses (Tessmer, 1996; Teets, 1997).
Urban land use is defined by the Federal Highway
Administration (FHWA) boundaries (Tessmer, 1996),
which include any city, town, or census-designated
place with a population of 5000 or more, adjacent
developed areas, and areas included within an urban
place to smooth boundaries (FHWA, 1991; Teets,
1997). All other areas are classified as rural.
The first harmful event is the event that began the
crash sequence. The most harmful event is the event
that caused the greatest harm to the vehicle and its
occupants, and is coded by the FARS analysts in each
state. Because it is defined at the level of the vehicle, the
most harmful event may not be the cause of the most
severe injury to every occupant (Tessmer, 1996). We
reported overturning and falling from the vehicle as
separate categories. The category ‘other non-collisions’
included fire, immersion, and gas inhalation. Collision
with a motor vehicle includes collisions with vehicles in
transport, on another roadway, or parked. Collision
with other object includes all other collisions with any
natural or man-made object.
The extent of deformation is coded by the investigat-
ing officer. Deformation is classified as none, minor,
moderate, or severe, or in some jurisdictions as none,
other, functional, or disabling. In FARS the two sets of
categories are combined (Tessmer, 1996).
We created a crash variable from the first harmful
event, the most harmful event and the extent of defor-
mation. A noncrash event was defined as an event
coded as a fall or other noncollision (excluding over-
turns) for both the first harmful event and the most
harmful event, which resulted in no vehicle deforma-
tion. Crashes were defined as events coded as an over-
turn or collision for the first harmful event or the most
harmful event, or which resulted in vehicle deforma-
tion. Crashes were classified into two categories based
on the severity of vehicle deformation, none to moder-
ate and severe.
In FARS, ejection is defined as ‘totally or partially
thrown from the vehicle as a result of an impact or
rollover’ (NHTSA, 1994). Although some deaths in
 C.L. Anderson et al. / Accident Analysis and Pre6ention 32 (2000) 533–540
events for which the most harmful event was falling
from the vehicle were coded by FARS as ejected, such
deaths do not appear to meet the FARS definition of
ejection. For the description of the fatalities, we com-
bined falls, identified from the most harmful event, and
ejections, identified from the ejection variable.
Enclosed and open cargo areas were defined by the
FARS seating position variable. In 25 pickup trucks,
different occupants in the same vehicle were reported as
seated in enclosed and open cargo areas. For the calcu-
lation of fatality risk ratios, all cargo area occupants in
these crashes were assigned a value of unknown for the
enclosure variable to avoid misclassification in the open
and enclosed categories
Restraint use includes lap, shoulder, and lap-shoulder
belts; child safety seats; and unspecified restraints. We
did not analyze the effect of restraint use by 7 (0.2%) of
cargo area occupants because there are no standards
for restraints in cargo areas.
2.2. Statistical analysis
Frequencies and cross tabulations are presented to
describe the fatalities to occupants of cargo areas in
pickup trucks. To measure the effect of cargo area
occupancy on mortality, we used an estimating equa-
tion (pseudo-likelihood) method to fit log-linear models
for fatality risk ratios (Stijnen and van Houwelingen,
1993). The variance was calculated using method A of
Stijnen and van Houwelingen (1993). The analysis was
programmed on a personal computer using GAUSS
(Aptech Systems, Inc., Maple Valley, WA), a matrix-
oriented mathematical programming language. The es-
timating equation program is available from the
authors.
A quadratic spline was used to fit the effect of age on
mortality in the log-linear models (Greenland, 1995).
We began with one knot at 10 years, and added knots
at 10-year intervals if their inclusion altered the log risk
ratio for cargo area occupants by 5% or more.
The attributable fraction in the exposed was calcu-
lated as (FRR− 1)/FRR, where FRR is the fatality risk
ratio (Rothman and Greenland, 1998). It is an estimate
of the excess caseload due to the exposure and is
analogous to effectiveness measures for protective
devices. The number of excess fatalities was calculated
as the attributable fraction in the exposed times the
number of exposed cases.
3. Results
We identified 2379 pickup trucks in the 1987 –1996
FARS data with one or more deaths to occupants and
one or more cargo area occupants. (This total excludes
73 pickup trucks with slide-in campers and 22 pickup
535
trucks of unknown type.) These vehicles were involved
in 2379 separate events. There were 888 deaths to front
seat occupants and 1979 deaths to cargo area occupants
in these events.
The characteristics of deaths to cargo area occupants
are shown in Table 1. Two-thirds of the deaths oc-
curred between 12:00 and 23:59 h. Two-thirds occurred
in rural areas and one-third occurred on local roads.
Forty-three percent of the deaths occurred on streets
and roads with a speed limit of 80 km/h or less. In 34%
of the deaths the most harmful event was a fall from
the vehicle and in 31% it was the pickup truck over-
turning. The 55 deaths (3%) in the other noncollision
category included 13 deaths with fire as the most harm-
ful event, five with gas inhalation, and two with immer-
sion. Eighty-seven percent of the deaths involved a fall
or ejection from the vehicle. Fifty percent of those who
died were age 19 years or younger, and 79% were male.
Eighty-four percent of the deaths were to occupants of
open cargo areas.
We compared cargo area occupant deaths resulting
from noncrash events to cargo area occupant deaths
resulting from crashes (Table 1). The crashes were
further divided into those with vehicle deformation
classified as none to moderate and those with severe
vehicle deformation. Twenty-five crash deaths with un-
known extent of deformation are excluded from Table
1.
Thirty-four percent of the deaths to cargo area occu-
pants were in noncrash events. More than half involved
severe vehicle deformation. A higher proportion of
deaths in noncrash events than in crashes occurred
between 12:00 and 17:59 h. A smaller proportion of
deaths in noncrash events and in crashes with deforma-
tion classified as none to moderate were in rural areas.
More noncrash deaths were on local streets and roads,
and more occurred at sites with speed limits of 48 km/h
or less. A higher proportion of deaths in crashes with
severe deformation involved overturns. Nearly all cargo
area occupants who died in noncrash events fell or were
ejected from the pickup truck. A higher proportion in
noncrash events than in crashes were age 20–64 years
and a higher proportion were male. In each category
most of the deaths involved open cargo areas. This was
greatest for noncrash events, in which 94% of those
who died were occupants of open cargo areas.
To compare the fatality risk of cargo area passengers
to that of front seat occupants, we analyzed the 8798
occupants in 1972 vehicles which had no missing data
on number of occupants or on age, sex, seating position
or injury of any occupant. As shown in Table 2, these
crashes resulted in 761 deaths to front seat occupants
and 1618 deaths to cargo area occupants. The percent
of fatalities ranged from 8% for restrained front seat
occupants to 39% for occupants of open cargo areas.
536 C.L. Anderson et al. / Accident Analysis and Pre6ention 32 (2000) 533–540

The fatality risk ratio (FRR) comparing cargo area
occupants to front seat occupants was modeled with the
estimating equation. Terms were included for cargo
area seating position, sex, and age as a quadratic spline
with a knot at 10 years. Additional knots at 20, 30, 40,
and 50 years did not alter the log risk ratio for cargo
area occupants and were not used. We also examined
the effect of a separate term for drivers. Their FRR
(compared to front seat passengers) was 0.9 (95%
Confidence Interval [CI]=0.8 – 1.0). With the driver
term included, the FRR comparing cargo area occu-
pants to front seat passengers was 2.9 (95%CI=2.5–
3.2). The driver term was not included in subsequent
comparisons.
As shown in Table 3, the FRR comparing cargo area
occupants to all front seat occupants was 3.0 (95%CI=
2.7–3.4). Sixty-seven percent of risk to cargo area
occupants was attributable to higher fatality risk for
cargo area occupants compared to front seat occupants.
This excess risk accounted for 1084 deaths. The fatality

Table 1
Percent distribution of characteristics of deaths to cargo area occupants of pickup trucks, all deaths and by crash and extent of vehicle
deformation (US, 1987–1996)

Variable Number missing Value Percent distribution

All deaths Noncrash, no Crash, no to moderate Crash, severe

n =1979 deformation deformation n = 235 deformation
n =669 n = 1050

Time 5 00:00–05:59 h 23 16 23 27*

06:00–11:59 h 12 12 12 11
12:00–17:59 h 33 38 29 30
18:00–23:59 h 33 33 36 33
Land use 4 Urban 33 39 39 28*
Rural 67 61 61 72
Road function 14 Arterial 44 30 42 53*
type
Collector 23 26 21 21
Local 33 43 37 26
Speed limit at 62 16–48 km/h 17 26 17 11*
site
56–80 km/h 26 29 26 23
89–121 km/h 58 45 57 66
Most harmful 1 Fell from vehicle 34 94 12 1**
event
Overturn 31 35 50
Other noncolli- 3 6 2 1
sion
Collision with 18 32 25
motor vehicle
Collision with 15 19 23
other object
Fell or ejected 9 Yes 87 96 86 81*
No 13 4 14 19
Age of decedent 7 B14 years 21 15 23 24*
15–19 29 24 30 32
20–29 26 29 27 23
30–39 14 18 12 11
40–64 10 12 6 9
\65 1 1 2 1
Sex of decedent 1 Male 79 83 81 76***
Female 21 17 19 24
Cargo area en- 179 Open 84 94 84 78*
closure
Enclosed 16 6 16 22

* PB0.0001, chi-square test of independence by three crash-deformation categories.

** PB0.0001, chi-square test of independence by two deformation categories among crashes.
*** P =0.003, chi-square test of independence by three crash-deformation categories.
 C.L. Anderson et al. / Accident Analysis and Pre6ention 32 (2000) 533–540 537

Table 2
Number and percent of fatalities by seating location, restraint use, and cargo area enclosure, among occupants of 1972 pickup trucks with one
or more deaths, one or more cargo area occupants, and no missing data on key variable (US, 1987–1996)

Location Restraint use Cargo area enclosure Occupants Fatalities

Number %

Front seat Yes 1099 90 8

No 2747 606 22
Unknowna 540 65 12
Subtotal 4386 761 17
Cargo area Enclosed 703 218 31
Open 3183 1232 39
Unknown 526 168 32
Subtotal 4412 1618 37
Total 8798 2379 27
a
Missing restraint information for any front seat occupant in vehicle.

risk to cargo occupants was 7.9 times that of restrained
front seat occupants in 1705 vehicles with known re-
straint use for all front seat occupants.
The fatality risk ratio varied markedly between crashes
and noncrashes and by the extent of vehicle deformation.
The FRR ranged from 92 in noncrash events to 1.7 in
crashes with severe vehicle deformation. Thus, cargo area
occupants were at a much greater disadvantage in
noncrash events. For noncrashes, almost all the deaths
were attributable to the increased risk to cargo area
occupants, but for crashes with severe vehicle deforma-
tion, only 41% of the deaths were attributable to this
increased risk. Noncrash events accounted for 33% of
deaths to cargo area occupants, but 50% of the excess
fatalities attributable to the increased risk to cargo area
occupants.
The FRR for occupants of enclosed cargo areas was
3.5 and the FRR for occupants of open cargo areas was
1.8 (Table 3). However, these FRRs are not comparable
because they are based on different sets of crashes with
different distributions of the crash and deformation
variables, as shown in Table 1. Seventy-two percent of
the risk to occupants of open cargo areas was attributable
to the higher fatality risk for occupants of open cargo
areas compared to front seat occupants.
We also examined the fatality risk ratio by crash,
deformation, and cargo area enclosure. In noncrash
events with an enclosed cargo area, there were few deaths
to occupants of cargo areas and no deaths to front seat
occupants for comparison. Among crashes, the FRR for
occupants of enclosed cargo areas was less than the FRR
for occupants of open cargo areas in both categories of
deformation.
We examined the numbers of front seat and cargo area
occupants to learn how many cargo occupants could
have been accommodated in the front seat (Table 4). We
did not determine the seating accommodations of indi-
vidual pickups, but we assumed that each truck could
accommodate two or three passengers in the front seat.
Thus, 12% of the pickups had one front seat occupant
and one cargo occupant, and could definitely have
accommodated both occupants in the front seat. Twenty-
two percent of pickup trucks had a total of three
occupants, which perhaps could have been accommo-
dated in the front seat. Eight percent of pickup trucks
had five or more occupants in the cargo area.
4. Discussion
We used a new statistical method that has not previ-
ously been applied to injuries. It allows comparisons
conditional on the vehicle, in this case comparisons of
cargo area occupants to front seat occupants in the same
vehicle. It is the only conditional method that can be used
to model risk in crash data with more than two occupants
per vehicle. Thus, it has broad applications to crash data,
as well as other data where subjects can be stratified by
an unmeasured covariate. Previous methods applied to
crash data stratified by event and vehicle are limited:
pairwise methods (Evans, 1986; Greenland, 1994) allow
only pairwise comparisons; conditional logistic regres-
sion estimates the odds ratio rather than the risk ratio.
Occupants of cargo areas appear to be three times as
likely to die in a crash as similar passengers in the front
seat, and nearly eight times as likely to die as restrained
front seat occupants. It appears that two-thirds of these
deaths could have been prevented if these cargo area
occupants were in the cab (based on average restraint
use), and seven-eighths could have been prevented if the
occupants had been in the cab and restrained. Cargo area
fatalities disproportionately affect the young; one-half of
all the fatalities were 19 years or younger and 79% were
male.
The risk of death for cargo area occupants compared
to cab occupants was substantially higher in less severe
crashes than for more severe crashes. Although the risk
 538
Table 3
Fatality risk ratio and fatalities attributable to travel in the cargo area of pickup trucks, by cargo area enclosure, and by crash and vehicle deformation, among occupants of 1972 pickup trucks
with one or more deaths, one or more cargo area occupants, and no missing data on key variables (US, 1987–1996)

C.L. Anderson et al. / Accident Analysis and Pre6ention 32 (2000) 533–540

Category Cargo area Cargo area Front seat Front seat Fatality risk ratio 95% CI Attributable fraction in Excess fatalities
occupants fatalities occupants fatalities the exposed

All 4412 1618 4386 761 3.0 2.7–3.4 0.67 1084

Compared to restrained front 3863 1376 1099 90 7.9 6.2–10.1 0.87 1201
seat occupantsa
By crash and deformation
Noncrash, none 907 525 962 9 92 47–179 0.99 519
Crash, none to moderate 520 195 521 54 5.7 4.1–7.9 0.82 161
Crash, severe 2930 878 2837 684 1.7 1.5–1.9 0.41 364
Unknown 55 20 66 14
By cargo area enclosure
Enclosed 703 218 587 148 1.8 1.4–2.3 0.44 96
Open 3183 1232 3250 492 3.5 3.1–4.0 0.72 884
Unknown 526 168 549 121
By crash, deformation, and enclosure
Noncrash, none, enclosed 48 26 44 0 Undefined
Noncrash, none, open 794 464 844 8 90 44–183 0.99 459
Crash, none to moderate, en- 81 29 65 8 2.9 1.4–6.2 0.65 19
closed
Crash, none to moderate, open 391 152 411 38 6.6 4.5–9.7 0.85 129
Crash, severe, enclosed 568 162 472 138 1.4 1.1–1.9 0.30 49
Crash, severe, open 1967 603 1964 442 1.8 1.6–2.1 0.45 274
Unknown crash or enclosure 563 182 586 127

a
In 1705 vehicles with one or more fatalities, one or more cargo area occupants, and known restraint use for all front seat occupants.
 C.L. Anderson et al. / Accident Analysis and Pre6ention 32 (2000) 533–540 539

persisted in severe crashes, the ratio was smaller
(FRR =1.7). This is as expected, as the limits of any
protective compartment and restraint system may be
exceeded in severe crashes, and the risk ratio must
decline as the baseline risk becomes large.
About one-third of the deaths of cargo area occu-
pants, and nearly half the preventable deaths, occurred
in noncrash events. The fatality risk for cargo area
occupants in noncrash events was 92 times that in the
front seat of the cab. This marked increase in risk
demonstrates the failure of protection of an open vehic-
ular space unintended for passenger travel, even in the
absence of a crash. On the other hand, there were very
few deaths to front seat occupants in noncrash events.
Almost all the noncrash deaths were due to a falling
out of the vehicle, and many occurred at sites with low
speed limits and on local roads. Strategies to reduce
injuries to occupants of cargo areas must encompass
noncrash events.
Occupants of enclosed cargo areas and occupants of
open cargo areas were involved in different sets of
crashes. Thus, unlike the comparison of cargo area
occupants to front seat occupants, comparisons of the
fatality risk ratios for occupants of open and enclosed
cargo areas are confounded by differences in crash
severity between the two sets of crashes. The crash and
vehicle deformation variables provide an indication of
crash severity, but we could not assess the FRR for
enclosed cargo areas in noncrash events because there
were no deaths to front seat occupants in these events.
Furthermore, if there were misclassification of the indi-
cators of crash severity, confounding would not be
completely controlled (Rothman and Greenland, 1998).
Even with these limitations, it is clear that occupants
of enclosed cargo areas had a higher fatality risk than
front seat occupants. A camper shell does not prevent
the occupant from impact with an interior portion of
the cargo area. Furthermore, a camper shell does not
necessarily prevent ejection from the vehicle. There has
been adequate documentation of disengagement of a
camper shell in a crash, ejection of the occupants and
the potential for the shell landing on an ejected occu-
pant (Agran et al., 1990). Thus, even if enclosed with a
camper shell, cargo area travel poses unacceptable risks
for death.
Carbon monoxide exposure is another hazard to
occupants in enclosed cargo areas (Anonymous, 1991;
Hampson and Norkool, 1992; Mofenson and Caraccio,
1992). Deaths due to carbon monoxide poisoning have
occurred with both camper shells and tarpaulins. Even
in the absence of a leak, exhaust exiting the rear of the
vehicle can be drawn back into the cargo area (Anony-
mous, 1991). Carbon monoxide poisonings may not be
investigated by police agencies as traffic events, so the
FARS data do not reflect the incidence of these cases.
In addition to their increased risk of death in a crash,
large numbers of cargo area passengers may increase
the probability of a crash. Both the additional weight of
cargo area occupants, and the shifting nature of unre-
strained human loads contribute to rollover instability
(National Transportation Safety Board, 1981). Eight
percent of pickup trucks in our study had five or more
cargo area occupants, which could indicate a loose load
of 750 pounds or more.
Errors in routine data collection and coding may
have influenced our results in unknown ways. For
example, we assumed that for a pickup truck, ‘other
passenger or cargo area’ is the cargo area, which may
have led to misclassification. Nonetheless, the observed
associations are too strong to be entirely or largely due
to such errors.
5. Conclusions
This study provides quantitative estimates of the risk
to cargo area occupants and data that should lead to
policy measures in all states. Occupants of cargo areas
of pickup trucks face a higher risk of death than
occupants of the cab, especially in noncrash events.
Prevention of these deaths requires eliminating travel in
cargo areas, even under circumstances that would not
be expected to result in serious injury to occupants of
passenger areas. The cargo area is not protected and

Table 4
Number (and percent) of pickup trucks by numbers of front seat and cargo area occupants, among 1972 pickup trucks with one or more deaths,
one or more cargo area occupants, and no missing data on key variables (US, 1987–1996)

Front seat occupants Cargo area occupants

1 2 3 4 5 or more Total

1 231 (12) 89 (5) 25 (1) 15 (1) 13 (1) 373 (19)

2 335 (17) 341 (17) 148 (8) 60 (3) 63 (3) 947 (48)
3 159 (8) 170 (9) 95 (5) 43 (2) 47 (2) 514 (26)
4 or more 45 (2) 31 (2) 21 (1) 14 (1) 27 (1) 138 (7)
Total 770 (39) 631 (32) 289 (15) 132 (7) 150 (8) 1972 (100)
540 C.L. Anderson et al. / Accident Analysis and Pre6ention 32 (2000) 533–540
not intended for passenger travel. Regulations for the
safe transport of passengers in areas of vehicles unin-
tended for passengers are non-existent. The dramatic
excess risk of death to cargo area occupants in the
absence of a crash, and in low speed minor crashes
should alone provide impetus for mandating a prohibi-
tion of occupant travel. Camper shells do not provide
adequate protection based on our analyses, and the
presence of a shell should not alter the policy recom-
mendation of eliminating travel in cargo areas of
pickup trucks.
Acknowledgements
This study was supported by Grant Number P49/
CCR 91269-02 from the US Centers for Disease Con-
trol and Prevention. Its contents are solely the
responsibility of the authors and do not necessarily
represent the official views of the Centers for Disease
Control and Prevention. The authors would like to
thank Raymond Luong for his assistance with data
management.
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