On average, drivers of large trucks travel many more miles than passenger vehicle drivers, and a larger proportion of those miles are on interstates, which are the safest roads. In 2017, large trucks accounted for 4 percent of registered vehicles and 9 percent of vehicle miles traveled. Truck driver fatigue is a known crash risk. Under federal hours-of-service regulations, drivers of large trucks are allowed to be behind the wheel for as long as 11 hours at a stretch.

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In 2018, 4,136 people died in crashes involving large trucks. Sixteen percent of these deaths were truck occupants, 67 percent were passenger vehicle occupants and 15 percent were pedestrians, bicyclists or motorcyclists. In fatal two-vehicle crashes involving a passenger vehicle and a large truck, 96 percent of the deaths were occupants of the passenger vehicles. Large trucks were involved in 11 percent of all motor vehicle crash deaths and 22 percent of passenger vehicle occupant deaths in multiple-vehicle crashes.

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​Most deaths in large truck crashes are passenger vehicle occupants. Large trucks often weigh 20-30 times as much as passenger vehicles. They are taller and have greater ground clearance than cars, which means that lower-riding vehicles can slide beneath truck trailers, with deadly consequences. Strong underride guards can prevent that from happening.