This article examines crash statistics and provides a comprehensive analysis of the types, causes, and consequences of road accidents in Japan, focusing on accidents between two vehicles in the central Kansai region (Kyoto-Osaka metropolitan area) with a focus on accidents involving trucks. The data covered the years 2019 to 2022 with 1,296,450 traffic accident records for the whole of Japan and 185,980 in the central Kansai region, which was enriched with measured road data such as traffic volumes. A first analysis with data from the whole of Japan examined the correlation between the collision direction and the fatality. It showed significant differences, with frontal collisions being the most fatal ones (0.77%), followed by side-end (0.26%) and rear-end (0.03%) collisions. Then, two multinominal logistic regression models (MNL, p<0.001) were built, one for studying collisions on road segments and the other for collisions at intersections with the collision direction as outcome variable. These models identified several road features such as guardrails, traffic lights or speed limits which reduce the likelihood of frontal collisions and their installation can therefore be recommended. We were also able to show that several critical factors are related to the drivers. In a final step, based on an analysis of truck route choice preferences, we then aim to bring the results the results together to derive implications as to how road infrastructure improvements would not only directly alter accident likelihoods but also have indirect positive and negative impacts due to resulting changes in routes taken by large vehicles.