There has been a structural change in mobility in major Spanish cities in recent decades, with a switch to the pattern followed in other countries in the area. A shift has taken place from a traditional Mediterranean model to a North American city stereotype, with uncontrolled motorization and major implications for public health. This article specifically analyzes negative road safety-related externalities that result from this process, given that the trend seems to show a steady decline in road safety accidents on urban roads in Spain, with major differences among NUTS-3 provinces. The objective is to evaluate the factors that empirically explain these differences for the 2003-2013 period using a panel data analysis. (...)