Italian roads are mostly either tiny city streets or safe motorways. Deaths in vehicles I imagine are often on the intermediate roads where speed is high enough to kill but it’s not a motorway with on ramps and separators.

For example, it’s hard to find a large multi-lane 4-way intersection in Italy where both roads are over 70km/h (45mph) , meaning there is a risk of a T collision if a driver goes through the red light.

In the US this kind of intersection is pretty common, which surprises me when I drive there.

The conversion of intersections to safer roundabouts also seems to be stuck at a low % in the US compared to Europe, Italy included.

The design of roads and intersections is a great point. I've seen a number of them in the US that I found hard to believe had ever been through any kind of planning / design phase.