Traveling by Bus Instead of Car on Urban Major Roads: Safety Benefits for Vehicle Occupants,Pedestrians, and Cyclists

Some studies have estimated fatality and injury rates for bus occupants, but data was aggregated at the country level and made no distinction between bus types. Also, injured pedestrians and cyclists, as a result of bus travel, were overlooked. We compared injury rates for car and city bus occupants on specific urban major roads, as well as the cyclist and pedestrian injuries associated with car and bus travel. We selected ten bus routes along major urban arterials (in Montreal, Canada). Passenger-kilometers traveled were estimated from vehicle counts at intersections (2002–2010) and from bus passenger counts (2008). Police accident reports (2001–2010) provided injury data for all modes. Injury rates associated with car and bus travel were calculated for vehicle occupants, pedestrians, and cyclists. Injury rate ratios were also computed. The safety benefits of bus travel, defined as the number of vehicle occupant, cyclist, and pedestrian injuries saved, were estimated for each route. Overall, for all ten routes, the ratio between car and bus occupant injury rates is 3.7 (95% CI [3.4, 4.0]). The rates of pedestrian and cyclist injuries per hundred million passenger-kilometers are also significantly greater for car travel than that for bus travel: 4.1 (95% CI [3.5, 4.9]) times greater for pedestrian injuries; 5.3 (95% CI [3.8, 7.6]) times greater for cyclist injuries. Similar results were observed for fatally and severely injured vehicle occupants, cyclists, and pedestrians. At the route level, the safety benefits of bus travel increase with the difference in injury rate associated with car and bus travel but also with the amount of passenger-kilometers by bus. Results show that city bus is a safer mode than car, for vehicle occupants but also for cyclists and pedestrians traveling along these bus routes. The safety benefits of bus travel greatly vary across urban routes; this spatial variation is most likely linked to environmental factors. Understanding the safety benefits of public transit for specific transport routes is likely to provide valuable information for mobilizing city and transportation planners.     

A diary study of the risk perceptions of road users

Employing an in situ diary, 291 road users in Oxford (pedestrians, cyclists, motorcyclists, car drivers and bus drivers) recorded details of all journeys made during 1 week and noted any incidents and near-misses which occurred on these journeys. On average, pedestrians and cyclists reported 0.18 incidents per mile travelled (one incident every 5.59 miles) and motorcyclists, car drivers and bus drivers reported 0.02 incidents per mile travelled (one incident every 41.67 miles). Analysis revealed mutual conflict between cyclists and buses, and irritation on behalf of pedestrians towards cyclists on pavements. Only 35% of incidents involving cyclists occurred at junctions and the paper discusses likely reasons for the discrepancy between this and the usual two-thirds figure quoted in official accident records. While the rate of incident perception reflected the vulnerability of pedestrians and cyclists, the amount of distress experienced did not, as bus drivers rated more of their incidents as distressing than did any other group. When incident reporting was compared to accident figures, the data suggest that car drivers were paying more attention to near-misses with the less vulnerable road users (i.e. those who could harm them) than they were to near-misses with more vulnerable road users (i.e. those whom they could harm).     

Automobile safety regulations and death reductions in the United States.

The effectiveness of federal automobile safety standards was examined using detailed data on 236,000 vehicles in fatal crashes in the United States during 1975-1978. Controlling statistically for type of regulation, types of vehicles, and ages of vehicles, the federal motor vehicle safety standards were associated with substantial reductions in car occupant death per 100 million vehicle miles travelled, and some reductions in fatal collisions of the federally regulated vehicles with pedestrians, motorcyclists, and bicyclists. Some 37,000 fewer deaths occurred in 1975-1978 than would have been expected without the federal standards.     

Motor vehicle trauma in northeastern Ohio. I: Incidence and outcome by age, sex, and road-use category

Hospital emergency department visits for motor vehicle trauma occurring in a midwestern metropolitan region (Cleveland and Lorain-Elyria, Ohio Standard Metropolitan Statistical Areas; 2.2 million population) were analyzed to determine the incidence and outcome by age, sex, and road-use category. A 50% incidence sample (n = 20,752) of motor vehicle trauma events to residents of this region was identified from the emergency department records of 41 participating hospitals for a one-year period, 1977. These hospitals accounted for 98% of all emergency department cases in the region. The annual motor vehicle trauma incidence rate per 100,000 population was 1,871. The highest annual incidence rate (4,462) was for ages 20-24; the lowest rates were for infants under one year (837) and for the elderly over 74 years (667). Incidence rate rank-ordered road-use categories were as follows: passenger car occupant, motorized cycle rider, other enclosed vehicle occupant, pedestrian, and pedal cyclist. Above age 4, age-specific male incidence rates significantly exceeded female incidence rates for most road-use categories. There were 80 admissions and 7 fatalities per 1,000 motor vehicle trauma incidence cases. Case-admission ratios were highest for pedestrians (266), riders of motorized cycles (184), and pedal cyclists (115); they were lowest for occupants of partially or fully enclosed vehicles (65). Case-fatality ratios per 1,000 cases were also highest for pedestrians (43) and riders of motorized cycles (11). Male case-fatality ratios exceeded female ratios for each road-use category in nearly all age groups, and male case-admission ratios exceeded those for females ages 10-54. For ages 75 and over, the admission ratios and fatality ratios were nearly twice as high as in any other age group.     

Severe traffic injuries to children, Trent, 1992–7: time trend analysis

Objective   To examine trends in hospital admission rates and socio-economic gradients for traffic injuries in children, 1992–97.
Design and location   Analysis of hospital admission data, Trent, UK.
Participants   Children aged 0–14 years admitted to hospital for pedal, pedestrian or other transport-related injury.
Results   Admission rates for severe injuries among cyclists and pedestrians significantly increased during the study period. In 1992–93, admission rates (per 100 000) for severe injuries among child cyclists were 22.5. By 1996–97, these had increased to 28.3. The rates for pedestrians were 9.2 and 11.3, respectively. Other transport-related injuries decreased during the study period. Socio-economic gradients in admission rates did not change significantly.
Conclusions   Hospital admission rates for severe injuries to child cyclists and pedestrians increased in 1992–97, but not the rates for other transport-related injuries.     

Pedal cyclists, crash helmets and risk.

As a rate per million kilometres travelled, the 'risk' of cycling appears to be high in relation to other forms of transport. Yet, in absolute numbers, there are far fewer cyclist deaths than pedestrian or motor vehicle occupant deaths, and most deaths and serious injuries to pedal cyclists are caused by other road users--principally motor vehicles. The large majority of pedal cyclist deaths are due to head injuries after collision with a motor vehicle. It is therefore commonly proposed that cyclists should wear crash helmets for their own 'safety'. Helmets may protect against fall injuries, but current models are not designed to withstand the impact of collisions with motor vehicles. Evidence for the benefit of pedal cyclists wearing helmets is limited: the existing studies cannot exclude the possibility of different risk-taking behaviour, either by cyclists or by motor vehicle drivers, for helmet wearers compared with non-wearers. A public health policy towards reducing pedal cyclist deaths should seek prevention of accidents, rather than protection from their consequences. Cycling in greater safety would reduce the 'risk' per kilometre travelled, but more cycling might not reduce total cyclist deaths or injuries--because of greater exposure. The 'risk' of cycling--the risk of injury or death--is a complex mix of exposure, 'danger' of the environment, and the perceived risk affecting our precautionary preventive behaviour.     

Traffic accidents in a city in Southern Brazil: an evaluation of coverage and quality of data]

The aim of this study was to analyze police coverage and the validity of data on emergency and hospitalization records as well as on death certificates for traffic casualties in Londrina, Paraná State, Brazil. Victims (3,643) of road accidents during the first semester of 1996 were investigated and followed up after 180 days to confirm whether death was due to the accident. Police data recorded only 32.5% of the casualties, the coverage being higher for car occupants (71.6%) and lower for cyclists (8.1%) and pedestrians (24.8%). Agreement was low between original information and that derived from investigation of death certificates (Kappa coefficient 0.10; 95% CI: 0.02-0.17), fair for hospitalization records (Kappa coefficient 0.33; 95% CI: 0.27-0.40), and substantial for emergency records (Kappa coefficient 0.63; 95% CI: 0.61-0.65). Results suggest that police data underestimate the number of traffic casualties and that it is necessary to improve the validity of medical records.     

Risk to self versus risk to others: how do older drivers compare to others on the road?

BACKGROUND: The objective of this study was to assess the risk of death or nonfatal injury drivers aged >/=65 pose to themselves and to other road users as compared with drivers in younger age groups. METHODS: Crash-related deaths and injuries were separated into two categories: those occurring among the drivers themselves, and those occurring among others, such as passengers, bicyclists, or pedestrians. RESULTS: The number of deaths among others varied by driver's age, with deaths among others decreasing as the driver's age increased. The proportion of deaths among others compared with deaths among drivers also varied by age. For drivers in the youngest three age groups, about two thirds of the deaths were among others (ages 16 to 19, 63.1%; ages 20 to 34, 68.1%; and ages 35 to 59, 66.6%). This proportion declined with age, reaching a low among drivers aged >/=85 years (ages 60 to 74, 52.2%, ages 75 to 84, 37.9%, ages >/=85, 18.9%). When calculating deaths among others per 100 million miles driven, crashes among young (16 to 19) and older (aged >74) drivers were associated with more deaths to others than were crashes among drivers aged 20 to 74. The number of nonfatal injuries among others also declined as age of the driver increased. The number of injuries among others per 100 million miles driven was highest among the youngest (16 to 19) and oldest (>/=85) drivers. CONCLUSIONS: Our findings suggest that older drivers make relatively small contributions to crash-related morbidity and mortality; moreover, their contributions are generally a result of injuries to self rather than to others.     

Regional variations in pedal cyclist injuries in New Zealand: safety in numbers or risk in scarcity?

Objective: To assess regional variations in rates of traffic injuries to pedal cyclists resulting in death or hospital inpatient treatment, in relation to time spent cycling and time spent travelling in a car. Methods: Cycling injuries were identified from the Mortality Collection and the National Minimum Dataset. Time spent cycling and time spent travelling as a driver or passenger in a car/van/ute/SUV were computed from National Household Travel Surveys. There are 16 census regions in New Zealand, some of which were combined for this analysis to ensure an adequate sample size, resulting in eight regional groups. Analyses were undertaken for 1996–99 and 2003–07. Results: Injury rates, per million hours spent cycling, varied widely across regions (11 to 33 injuries during 1996–99 and 12 to 78 injuries during 2003–07). The injury rate increased with decreasing per capita time spent cycling. The rate also increased with increasing per capita time spent travelling in a car. There was an inverse association between the injury rate and the ratio of time spent cycling to time spent travelling in a car. The expected number of cycling injuries increased with increasing total time spent cycling but at a decreasing rate particularly after adjusting for total time spent travelling in a car. Conclusions: The findings indicate a ‘risk in scarcity’ effect for New Zealand cyclists such that risk profiles of cyclists are likely to deteriorate if fewer people use a bicycle and more use a car. Implications: Cooperative efforts to promote cycling and its safety and to restrict car use may reverse the risk in scarcity effect.     

Vital Signs: Restraint Use and Motor Vehicle Occupant Death Rates Among Children Aged 0–12 Years — United States, 2002–2011

Background

Motor vehicle crashes are a leading cause of death among children in the United States. Age- and size-appropriate child restraint use is the most effective method for reducing these deaths.

Methods

CDC analyzed 2002–2011 data from the Fatality Analysis Reporting System to determine the number and rate of motor-vehicle occupant deaths, and the proportion of unrestrained child deaths among children aged <1 year, 1–3 years, 4–7 years, 8–12 years, and for all children aged 0–12 years. Age group–specific death rates and proportions of unrestrained child motor vehicle deaths for 2009–2010 were further stratified by race/ethnicity.

Results

Motor vehicle occupant death rates for children declined significantly from 2002 to 2011. However, one third (33%) of children who died in 2011 were unrestrained. Compared with white children for 2009–2010, black children had significantly higher death rates, and black and Hispanic children both had significantly higher proportions of unrestrained child deaths.

Conclusions

Motor vehicle occupant deaths among children in the United States have declined in the past decade, but more deaths could be prevented if restraints were always used.

Implications for Public Health

Effective interventions, including child passenger restraint laws (with child safety seat/booster seat coverage through at least age 8 years) and child safety seat distribution plus education programs, can increase restraint use and reduce child motor vehicle deaths.     

Motor vehicle deaths among American Indian and Alaska Native populations

In the United States, the American Indian and Alaska Native (AI/AN) population has the highest motor vehicle death rate, which is significantly greater than that of any other race or ethnic group. To better understand why this significant disparity exists and how to eliminate it, the authors conducted a systematic review of the published scientific literature. Included studies were published between January 1, 1990, and January 31, 2011, and identified risk factors, or implemented and tested interventions, targeting motor vehicle deaths among the AI/AN population. Only 14 papers met the study's inclusion criteria. Most of the epidemiologic studies explored alcohol use as a risk factor for deaths of both motor vehicle occupants and pedestrians; few studies addressed risk factors specifically for pedestrians. All of the intervention studies focused on mitigating risks for motor vehicle occupants. On the basis of the authors' review, injury prevention interventions that are multifaceted and involve partnerships to change policy, the environment, and individual behavior can effectively mitigate motor-vehicle-related deaths among AI/ANs. Priority should be given to implementing interventions that address pedestrian safety and to sound investment in the states with the highest AI/AN motor vehicle death rates because reducing their burden can dramatically reduce the overall disparity.     

Incidence of fatal myocarditis: a population-based study in Finland

To study the incidence of fatal myocarditis in the general population, the authors retrospectively collected all death certificates recording myocarditis as the underlying cause of death in Finland in 1970-1998. The incidence of myocarditis and its proportion of all deaths were calculated from 141.4 million person-years and 1.35 million deaths. Myocarditis was recorded as the underlying cause of death in 639 cases. Thus, its death certificate-based incidence was 0.46 (95% confidence interval (CI): 0.43, 0.49) per 100,000 person-years, and it caused 0.47 (95% CI: 0.44, 0.51) of 1,000 deaths. The incidence of 0.51 (95% CI: 0.46, 0.56) in males was higher than the incidence of 0.42 (95% CI: 0.37, 0.47) in females, the odds ratio being 1.34 (95% CI: 1.15, 1.58) (p < 0.001). The proportion of deaths caused by myocarditis was highest (up to six of 1,000 deaths) in children and adults aged less than 45 years. Because previous histopathologic reanalysis showed that only 32% of cases fulfilled the Dallas criteria, the authors estimated the incidence of histopathologically certain fatal myocarditis to be 0.15 (95% CI: 0.13, 0.17) per 100,000. The death certificate-based incidence of fatal myocarditis was found to be 0.46 per 100,000, and the histopathologically corrected incidence was 0.15 per 100,000.     

Promoting walking to school: results of a quasi-experimental trial

STUDY OBJECTIVE: To assess the impact of a combined intervention on children's travel behaviour, stage of behavioural change and motivations for and barriers to actively commuting to school. DESIGN: A quasi-experimental trial involving pre- and post-intervention mapping of routes to school by active and inactive mode of travel and surveys of "stage of behaviour change" and motivations for and barriers to actively commuting to school. INTERVENTION: The intervention school participated in a school-based active travel project for one school term. Active travel was integrated into the curriculum and participants used interactive travel-planning resources at home. The control school participated in before and after measurements but did not receive the intervention. SETTING: Two primary schools in Scotland with similar socioeconomic and demographic profiles. PARTICIPANTS: Two classes of primary 5 children and their families and teachers. MAIN RESULTS: Post intervention, the mean distance travelled to school by walking by intervention children increased significantly from baseline, from 198 to 772 m (389% increase). In the control group mean distance walked increased from 242 to 285 m (17% increase). The difference between the schools was significant (t (38) = -4.679, p<0.001 (95% confidence interval -315 to -795 m)). Post intervention, the mean distance travelled to school by car by intervention children reduced significantly from baseline, from 2018 to 933 m (57.5% reduction). The mean distance travelled to school by car by control children increased from baseline, from 933 to 947 m (1.5% increase). The difference in the change between schools was significant (t (32) = 4.282, p<0.001 (95% confidence interval 445 to 1255 m)). CONCLUSIONS: Intervention was effective in achieving an increase in the mean distance travelled by active mode and a reduction in the mean distance travelled by inactive mode on school journey.     

Trends in motorcycle fatalities associated with alcohol-impaired driving--United States, 1983-2003

Motorcycles are the most dangerous type of motor vehicle to drive. These vehicles are involved in fatal crashes at a rate of 35.0 per 100 million miles of travel, compared with a rate of 1.7 per 100 million miles of travel for passenger cars. The National Highway Traffic Safety Administration (NHTSA) has reported increasing numbers of motorcycle deaths associated with alcohol-impaired driving in recent years, especially among persons aged > or =40 years. To determine trends by age group in motorcycle fatalities overall and in those involving alcohol impairment, CDC analyzed data from the NHTSA Fatality Analysis Reporting System (FARS) for 1983, 1993, and 2003. This report summarizes the results of that analysis, which indicated that, during 1983-2003, the overall prevalence of elevated blood alcohol concentrations (BACs) among motorcycle drivers who died in crashes declined; however, the peak rate of death among alcohol-impaired motorcycle drivers shifted from those aged 20-24 years to those aged 40-44 years. Strong enforcement of existing BAC laws, together with other public health interventions aimed at motorcyclists, might reduce the crash mortality rate, especially among older drivers.     

Trends in traffic accidents in Campinas, São Paulo State, Brazil: the increasing involvement of motorcyclists

In order to describe trends in traffic accidents, mortality, vehicle types, fleet sizes, and victims' characteristics in Campinas, S?o Paulo State, Brazil, from 1995 to 2008, this study analyzed vehicle rates, traffic accident rates per inhabitant and per vehicle, case-fatality rates, proportional mortality, mortality rates, and rates ratios. The motorcycle fleet increased 241%. Although the case-fatality rate of motorcycle users from 2000 to 2008 decreased, in 2008 they accounted for 49.3% of fatal accidents on public byways in Campinas. Motorcycles were responsible for the highest run-over rate (66.7 pedestrians/1,000 accidents) and highest pedestrian fatality rate (4 deaths/1,000 accidents). Men showed much higher mortality rates than women. Pedestrian victims were mainly elderly; most vehicle occupants in traffic accidents were in the 15 to 29-year age bracket. From 2006 to 2008, nearly 80% of vehicle users 15 to 39 years of age were motorcyclists. Motorcycle accident prevention should be a priority, using multi-institutional measures.     

Analysis of biases in epidemiological knowledge of road accidents in France

BACKGROUND: In France, as in many countries, road casualty statistics are mostly based on police reports. It is generally recognized that these data are incomplete but no measurement has been made of the degree of under-reporting and thus of associated biases. This study aims to demonstrate and quantify these biases. METHODS: The study compares, after data linkage, the 10,202 people reported injured or killed in 1996 in the medical road accident victims Register in the Département du Rh?ne (France), with the 4,572 victims reported by the police during the same year and in the same area. This Département was chosen, as it is the only region in France where these two independent data sources coexist. Two types of possible biases are studied: injury severity classification bias and selection bias induced by underreporting. RESULTS: The study shows that the definition of "serious injury" used by the police exaggerates the severity of the victim's condition in over half the cases. This bias depends on road user group. This bias is maximum for pedestrians: compared to a slightly injured car occupant, a pedestrian with the same injury severity level has significantly more chance to be considered as severely injured (RR=1.78; 95% CI: 1.11-2.87). Conversely, significant selection biases are related to data collection by the police. The multivariate analysis shows that the underreporting of victims increases if no third party is involved (i.e. without any other vehicle or pedestrian), and reduces with injury severity. It also varies by road user group (with the largest underreporting for cyclists). Among the most seriously injured in accidents involving third parties, motor cyclists and car users are the most reported category and pedestrians the least (RR=0.80; 95% CI: 0.70-0.92). Biases in Register selection are much more limited and basically concern underreporting of victims of minor accidents who did not require medical care. CONCLUSIONS: This study confirms and quantifies misleading distortions in police statistics used to assess road accidents. These results concern the relevant indicators to be used to define road safety issues.     

A case-control study of childhood pedestrian injuries in Perth, Western Australia.

STUDY OBJECTIVES: To identify the determinants of childhood pedestrian injuries, taking the child's exposure to the road environment into account. DESIGN: This was a case-control study. SETTING AND PARTICIPANTS: The study was conducted in Perth, Western Australia between 1991 and 1993. Altogether 100 injured and 400 uninjured child pedestrians aged 1 to 14 years were studied. Aspects of the child's social and physical environments, measures of his or her behaviour, cognitive skills, and "habitual" exposure to the road environment, as well as his or her knowledge of road safety, were recorded. MAIN RESULTS: The likelihood of injury increased by 12% with each 10,000 vehicles per day increase in the volume of traffic (odds ratio (OR) 1.12, 95% confidence interval (CI) = 1.05, 1.19) on roads most frequently crossed. In addition, the presence of visual obstacles on the verge of the child's street of residence increased the likelihood of injury by more than 2.6 times (OR 2.68, 95% CI = 1.42, 5.02). In contrast, the absence of footpaths was associated with a 52% reduction in the likelihood of injury compared with the presence of footpaths on the child's street of residence (OR 0.48, 95% CI = 0.27, 0.87). CONCLUSION: The amount of exposure to the road environment and the nature of the road environment to which the child pedestrian was exposed partly influenced the likelihood of injury in children from low socioeconomic areas, male children, and children aged 13 to 14 years. Until now, the excess incidence of childhood pedestrian injuries in these subgroups of the population had not been explained because the child's exposure per se had not been examined.     

Fatal occupational injuries associated with forklifts, United States, 1980-1994.

BACKGROUND: This paper describes deaths of American workers involving forklifts during the 15-year period from January 1, 1980 to December 31, 1994. METHODS: Death certificate data were obtained from the National Institute for Occupational Safety and Health's (NIOSH's) National Traumatic Occupational Fatality (NTOF) surveillance system. The narrative fields on the death certificate were searched for keywords indicating that a powered industrial vehicle (PIV) or forklift was involved in the death. This study examined the circumstances of the forklift-related deaths, the nature of the injury, and the decedent's age, gender, race, occupation, and industry. Average annual employment data from the Bureau of the Census were used to calculate civilian fatality rates by age, gender, industry, and occupation. RESULTS: A total of 1,021 deaths were identified. The average age of the fatally injured worker was 38 years; the 1,021 forklift-related deaths resulted in a total of 27,505 years of productive life lost. The three most common circumstances of the fatalities were forklift overturns (22%), pedestrian struck by forklifts (20%), and worker crushed by forklift (16%). The greatest proportion of the fatalities (37%) occurred to workers in Manufacturing, followed by Transportation, Communication, and Public Utilities, (TCPU), (17%), Construction (16%), Wholesale Trade (8%), and Agriculture, Forestry, and Fishing (AFF) (7%). The highest forklift-related fatality rates per ten million workers occurred among transport operatives (34.0) and laborers (32.0). CONCLUSIONS: Many of the fatalities resulting from forklift "overturns" might have been prevented if the operator had been restrained with a lap/shoulder belt. Careful consideration should be given to separating pedestrian and forklift traffic, and restricting the use of forklifts near time clocks, exits, and other areas where large numbers of pedestrians pass through an area in a short time. Additionally, systematic traffic control, including rules for pedestrian and forklift traffic, will be necessary to reduce the enormous injury and death toll associated with forklifts. Am. J. Ind. Med. 36:504-512, 1999. Published 1999 Wiley-Liss, Inc.     

Motor vehicle deaths: failed policy analysis and neglected policy

The author of a recent book inferred that the slowed decline in U.S. vehicle fatality rates in the 1990 s relative to other industrialized countries resulted from too much emphasis on vehicle factors. He claimed that Canada had the same vehicle mix but a lower fatality rate. Actually, U.S. death rates by make and model applied to Canadian vehicle sales indicates that Canada's death rate would be the same as the U.S. if Canada had the same vehicle mix and annual miles driven. The U.S. had much greater growth in sales of large SUVs and pickup trucks that are heavier and stiffer than passenger cars, contributing to excess deaths of other road users in collisions. They are also more unstable, contributing to excess deaths of their occupants in rollovers. Lack of policy regarding these vehicle characteristics is the primary reason for the attenuated decline in vehicular fatality rates.