The objective of this study was to determine the incidence of aortic transaction in relation to age, and to examine possible reasons for the observed differences. Data from the North Carolina Medical Database over a 7-year period were examined for the total number of motor vehicle accident victims and for the subset with aortic rupture, based on age at presentation. Data were then divided into 10-year intervals and the differences analyzed using chi-square analysis. Differences among various age groups were statistically significant (P = 0.0001). The highest rate was in the 21-30-year-old age group and average incidence for all ages was 0.7%. High incidence of aortic transaction in the 21-30-year-old group may be due to an increase in high-risk behaviors in such persons, to an improved survival compared with other age ranges, or to an inherent susceptibility of the aorta at this stage of life. These data have important implications for the diagnosis and treatment of aortic transaction and should be taken into account when developing practice guidelines for its management.