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Introduction Motor vehicle crashes (MVCs) remain the leading cause of injury and death among U.S. teens. Although disparities in crash fatalities by sex and race/ethnicity are well documented, few studies have focused specifically on teens and teen drivers. This study examined national trends in MVC fatality rates among teens aged 15–19 years in the United States by sex and race/ethnicity. Methods We conducted a retrospective analysis using 2015–2023 data from the Fatality Analysis Reporting System (FARS). Fatalities included all teens aged 15–19 who died in MVCs, regardless of role (driver, passenger, or non-driver). Negative binomial regression models estimated rate ratios (RRs) and 95% confidence intervals (CIs) for annual fatality rates per 100,000 population, adjusted for sex, race/ethnicity, and COVID-19 period (pre-, during-, and post-pandemic). Results Among 22,997 teen fatalities, 67% were male, 52% White, 15% Black, and 22% Hispanic; 55% were drivers. Male teens (RR = 1.8, 95% CI: 1.4–2.4) and male teen drivers (RR = 2.6, 95% CI: 1.9–3.4) had significantly higher fatality rates than females. American Indian/Alaska Native teens had the highest fatality rates across all racial groups. Black male teens had higher rates than White male teens, although Black teen drivers in both sexes had significantly lower MVC fatality rates than White teen drivers. No significant differences were observed between Hispanic and non-Hispanic groups. Fatality rates increased during the COVID-19 pandemic, peaking in 2021, though changes across periods were not statistically significant. Discussion Male and American Indian/Alaska Native teens remain disproportionately affected by MVC-related deaths in the United States, underscoring persistent disparities by sex and race/ethnicity. In contrast, lower fatality rates observed among Black teen drivers relative to White teen drivers may reflect differences in licensure rates, vehicle access, and driving exposure. Targeted interventions that promote equitable access to driver education, such as driving school vouchers, and providing financial support for vehicle maintenance and safety checks are essential to reducing these disparities and improving safety among high-risk teen populations.