Trick-or-treating is a rite of passage for some, but has the potential to become deadly, according to research published in JAMA Pediatrics.

John A. Staples, MD, MPH, of St Paul’s Hospital in Vancouver, British Columbia, and colleagues examined 4 decades of data to assess pedestrian fatality risks associated with Halloween celebrations.

Using data from the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System, Dr Staples and colleagues analyzed data from 1975 to 2016. Primary analysis compared pedestrian fatalities occurring between 5 PM and 11:59 PM on October 31st with pedestrian fatalities occurring during the same time frame 1 week earlier and later (October 24 and November 7, respectively). Pedestrian fatalities were stratified by clock time.

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Study data included 1,580,608 fatal traffic accidents involving 2,333,302 drivers and 268,468 pedestrians. In total, 608 pedestrian fatalities took place on Halloween; 851 took place on the 84 control evenings, with absolute mortality rates of 2.07 and 1.45 fatalities per hour, respectively. Relative risk of pedestrian fatality was 43% higher on Halloween vs on control evenings (odds ratio, 1.43; 95% CI, 1.29-1.59; P <.001).

The highest relative risk increase was among children; a 10-fold increase in children 4 to 8 years old was identified (odds ratio, 10.00; 95% CI, 5.23-19.11; P <.001). The highest risk was around 6 PM, with sensitivity analyses adjusting for Daylight Savings Time yielding similar results.

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“Prior studies of Halloween traffic risks have been limited to brief observations, failed to test for statistical significance, or lacked appropriate control groups,” the researchers noted.
“Halloween traffic fatalities are a tragic annual reminder of routine gaps in traffic safety.”

They continued, “Trick-or-treating should not be abolished in a misguided effort to eliminate Halloween-associated risk. Instead, policymakers, physicians, and parents should act to make residential streets safer for pedestrians on Halloween and throughout the year.”


Staples JA, Yip C, Redelmeier DA. Pedestrian fatalities associated with Halloween in the United States [published online October 30, 2018]. JAMA Pediatrics. doi:10.1001/jamapediatrics.2018.4052