This research provides an epidemiologic analysis of pedestrian-related injury discharges from The Children’s Hospital of Alabama in Birmingham, utilizing a case-control design. Evidence is provided supporting the racial disproportionality of serious, nonfatal pedestrian injuries in children. These data indicate that pedestrian injuries resulting in hospitalization are more common among black children than among white children (odds ratio = 2.95) when compared with an age- and gender-matched control group of other hospitalized injuries. This racial association with pedestrian injury remained significant when the data were stratified by payment class, a proposed surrogate measure of socioeconomic status (adjusted odds ratio = 2.59). A catalog of harmful environmental factors that may be pervasive in black children’s lives is provided as an aid in planning intervention programs and their evaluation. © Lippincott-Raven Publishers.