This study aimed to evaluate developments in car crash safety in cars launched since the 1980s based on real-world crashes occurring years 2000–2019, with focus on the number of injuries leading to permanent medical impairment to different body regions, separated for gender and age. Police-reported two-car crashes were used to calculate relative risk of any injury, fatal and serious injury and fatality, and together with occupant injuries reported by Swedish emergency care centres the risk for permanent medical impairment was assessed. The cars were categorised in ten-year periods according to year of introduction.

It was found that vehicle crashworthiness has improved steadily since the 1980s, with largest improvements for serious and fatal injuries and for injuries leading to PMI. Females were found to have higher injury risk for all types of injury severity studied (except for fatal injuries). The risk for serious and fatal injuries and fatal injuries alone was higher for occupants older than 50 years of age compared to those younger than 50. For male occupants, as well as for occupants younger than 50 years, the risk for injury leading to PMI to the cervical spine was found to increase in modern cars. Older occupants were also found to have an increased risk for injuries to the thoracic and lumbar spine.