These are the most dangerous U.S. cities for pedestrians

In 2014, 13 pedestrians were struck and killed by a car every day in the U.S., 105 more people than the year before. Walkers in this country are now seven times more likely to be killed walking than in a natural disaster. This is nothing less than a public health epidemic—and it’s getting worse.

The annual “Dangerous by Design” study by Smart Growth America’s National Complete Streets Coalition assigns each of the 104 largest cities in the country what’s called a Pedestrian Danger Index (PDI). This is calculated by comparing the number of residents who walk to work and the rate of pedestrian fatalities.

Not surprisingly, the deadliest places for walkers are in car-dependent communities with little pedestrian infrastructure and extra wide streets:

1. Cape Coral-Fort Myers, Florida
2. Palm Bay-Melbourne-Titusville, Florida
3. Orlando-Kissimmee-Sanford, Florida
4. Jacksonville, Florida
5. Deltona-Daytona Beach-Ormond Beach, Florida
6. Lakeland-Winter Haven, Florida
7. Tampa-St. Petersburg-Clearwater, Florida
8. Jackson, Mississippi
9. Memphis, Tenneseee-Mississippi-Arkansas
10. North Port-Sarasota-Bradenton, Florida
11. Miami-Fort Lauderdale-West Palm Beach, Florida
12. Bakersfield, California
13. Birmingham-Hoover, Alabama
14. Little Rock-North Little Rock-Conway, Arkansas
15. Houston-The Woodlands-Sugar Land, Texas
16. Phoenix-Mesa-Scottsdale, Arizona
17. Detroit-Warren-Dearborn, Michigan
18. Riverside-San Bernardino-Ontario, California
19. Baton Rouge, Louisiana
20. McAllen-Edinburg-Mission, Texas

Almost half of the 20 most dangerous cities are in Florida, the state which has topped the charts for the past four years. (Check out a more detailed breakdown of the data at Smart Growth America.) But the cities on this list have one more thing in common—with the exception of Detroit, they’re all Sun Belt cities with higher populations of elderly Americans. This group, Americans over 65, has the highest risk of being killed while walking, as do lower-income Americans and people of color.

Smart Growth America

Now for comparison, look at the 10 safest cities for walkers:

1. Colorado Springs, Colorado
2. Portland-South Portland, Maine
3. Madison, Wisconsin
4. Boston-Cambridge-Newton, Massachusetts-New Hampshire
5. Provo-Orem, Utah
6. Syracuse, New York
7. Lancaster, Pennsylvania
8. Seattle-Tacoma-Bellevue, Washington
9. Pittsburgh, Pennsylvania
10. New York-Newark-Jersey City, New York-New Jersey-Pennsylvania

These are largely dense communities with human-scale streets (some with colleges in their urban centers) which have made commitments to the type of complete streets principles that keep walkers—and everyone else on the road—safer. In fact, about 1,200 communities nationwide have some kind of complete streets policy, according to the report; the problem is updating the infrastructure. In a high-profile case last week, New York City was held liable for poor street design that put a boy in a coma after a crash. It shouldn’t come to that in order for cities to make real changes on the ground.

The problem is likely going to keep getting worse before it gets better. Although the national figures are not out yet, 2016 saw a record high number of traffic fatalities on U.S. streets. And as our population ages dramatically, cities aren’t planning for seniors, who will be physically unable to drive. Meaning more elderly Americans than ever will find themselves vulnerable on U.S. streets, unless cities step up to protect them.