Walking, cycling and transport safety: an analysis of child road deaths

OBJECTIVE: To examine trends in road death rates for child pedestrians, cyclists and car occupants. DESIGN: Analysis of road traffic injury death rates per 100 000 children and death rates per 10 million passenger miles travelled. SETTING: England and Wales between 1985 and 2003. PARTICIPANTS: Children aged 0-14 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Death rates per 100,000 children and per 10 million child passenger miles for pedestrians, cyclists and car occupants. RESULTS: Death rates per head of population have declined for child pedestrians, cyclists and car occupants but pedestrian death rates remain higher (0.55 deaths/100,000 children; 95% confidence interval [CI] 0.42 to 0.72 deaths) than those for car occupants (0.34 deaths; 95% CI 0.23 to 0.48 deaths) and cyclists (0.16 deaths; 95% CI 0.09 to 0.27 deaths). Since 1985, the average distance children travelled as a car occupant has increased by 70%; the average distance walked has declined by 19%; and the average distance cycled has declined by 58%. Taking into account distance travelled, there are about 50 times more child cyclist deaths (0.55 deaths/10 million passenger miles; 0.32 to 0.89) and nearly 30 times more child pedestrian deaths (0.27 deaths; 0.20 to 0.35) than there are deaths to child car occupants (0.01 deaths; 0.007 to 0.014). In 2003, children from families without access to a vehicle walked twice the distance walked by children in families with access to two or more vehicles. CONCLUSIONS: More needs to be done to reduce the traffic injury death rates for child pedestrians and cyclists. This might encourage more walking and cycling and also has the potential to reduce social class gradients in injury mortality.     

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.     

Drivers of advanced age in traffic accidents

The elderly are vulnerable and potentially unpredictable active participants in traffic who deserve special attention. Longer life expectancy entails a greater number of senior drivers, that is, persons with various health problems and difficulties accompanying old age. At the turn of the millennium, the share of population aged 65 or more in Slovenia was around 13%, and in 25 years it will be near as much as 19%. The share of drivers from this age group was 28% a year ago, and it is expected to reach about 54%. Numerous studies have shown that there are many differences in driving attitude between the young and the elderly. The young are by large active victims, and their main offense and cause of accident is speeding, while the elderly are more passive and their main offense is ignoring and enforcing the right of way. This paper focuses on the differences in the occurrence and type of injuries between the young and the elderly drivers, based on an analysis of all road accidents in Slovenia in the period between 1998-2000. Older people (over 65) caused only 4.7% of all road accidents (16.7% of all accidents involving pedestrians, 11.5% of all involving cyclists, 2.7% involving motorcyclists and 5% of all accidents involving car drivers). Of all accidents, 89.3% were without injuries, and the fatal outcome was registered in 0.4% accidents. Among the elderly (65-74 years of age), however, this share was 1%, and rising to 2.7% with the age 75 and above. By calculating the weight index, which discriminates between minor and severe injuries, and the fatal outcome, it was established that age groups 65-74 and > or = 75 cause three and five times greater damage, respectively than age groups from 18 to 54 years. With years, psychophysical changes lead to a drop in driving ability, which in turn increases the risk of road accidents. It is true that elderly people cause less traffic accidents (and also drive less) than the young, but when they are involved in an accident, as a rule the consequences are more tragical. A research of this increasing group traffic participants (in the role of drivers as well) could provide an important contribution to their safety and to the safety of all people involved in road traffic.     

Characteristics of the victims of traffic accidents in a city of the southern region of Brazil

OBJECTIVE: To evaluate the magnitude of morbidity and mortality and describe some of the characteristics of road accident victims. METHODS: The study population was composed of 3,643 victims of road accidents which occurred in Londrina, PR (Brazil), during the first semester of 1996. There were included victims from accidents registered by the Military Police, those who died at the accident scenario or on their way to the hospital, those who received emergency care or were hospitalized through the Unified Care System. It was observed a period of 180 days for death verification. RESULTS: The mean incidence and mortality rates were 1,582.2 and 29. 0 per 100,000 inhabitants, respectively. These rates, however, have demonstrated great variability in relation to several characteristics (place of residence, gender, age and the victim's mode of transport). The majority of victims were motorcyclists, followed by cyclists and pedestrians who, altogether, accounted for 76.9% of the total, and 81.5% of those who died. CONCLUSIONS: These results suggest that road accidents constitute a major cause of morbidity and mortality and that specific preventive measures should be considered in order to reduce such accidents, especially those that involve the most vulnerable road passers.     

The risk of accidents among older drivers

The number of older persons holding a driver's license is rapidly increasing, as is the number of older persons driving a car. This paper examines driver accident risk by age group, focusing on the older driver. Two different measures of accident risk are used; involvement in personal injury traffic accidents per million kilometers driven, and involvement in traffic accidents where one or more pedestrians were injured per million kilometers driven. The latter measure is used to refute the assumption that the elderly's risk of being involved in personal injury accidents might, to some extent, be explained by the fact that older drivers generally tend to run a higher risk than younger drivers of being injured in the event of a traffic accident. Another motive is that it provides a measure of the extent to which drivers of different ages present a risk to their fellow road users. This study shows that drivers in the 75-84 age group are at four to six times greater risk than are middle-aged drivers of being involved in personal injury traffic accidents.     

Severe traumatic brain injuries from motor vehicle‐related events in New Caledonia: epidemiology,outcome and public health consequences

Objective: Traumatic brain injuries (TBI), which are mostly due to road traffic crash (RTC), are a major public health concern. This article describes the incidence, severity and outcome of TBI caused by RTC in New Caledonia over a five‐year period. Methods: Data of all individuals admitted in intensive care unit with severe TBI (Glasgow Coma Scale score ≤8 at admission) caused by RTC in New Caledonia from 2008 to 2012 were analysed. Causes and severity of trauma, demographic data, and short‐term as well as last available long‐term outcome of patients were analysed. Five types of road users were compared (car drivers, car passengers, motorcyclists, bicyclists and pedestrians). Outcome was defined according to the Glasgow Outcome Scale classification. Results: A total of 109 patients were included in the study. The median age of patients was 24 [IQR18–33] years with a sex ratio of 2.8 (80 men/29 women). The rate of 44 among Melanesian males was two times higher that among 16 European males (22/100,000 people vs 11/100,000 people). The total survival at the Intensive Care Unit discharge (short‐term outcome) was 84%, being the highest among passengers (88%) and the lowest among motorcyclists (69%). Of the patients tested for psychoactive substances, half tested positive. Lost to follow‐up rate was 67%. Conclusion: Poor outcome occurs in patients with RTC‐related TBI, with young Melanesian men being the most affected. Public health action should focus on this group using culturally appropriate messages.     

Analysis of the occurrence of traffic injuries and related factors according to the National Household Sample Survey (PNAD) Brazil, 2008

The study describes the estimates of occurrence of injury due to traffic accidents among the Brazilian population based on data obtained from the National Household Sample Survey (PNAD). It is a probabilistic sample, in which 391,868 people were interviewed. in three stages, namely municipalities, census sectors and households. The traffic accident (TA) and the safety belt usage variables were described according to socio-demographic variables and region of residence. Proportions, 95% confidence intervals, χ2 tests and p values were calculated. 2.5% (CI95% 2.4-2.6%) of the population reported higher traffic accident (TA) incidence among males (3.5%; CI95%: 3.4-3.6), youths (4.4%; CI95%: 4.2-4.6) and residents in the Central-West region (3.3% CI95%3.0-3.6). Most of the events involved drivers or passengers of cars or vans (53.9%), followed by motorcyclists or pillion passengers (30.1%), cyclists (7.6%) and pedestrians (5.25%). The front seat safety belt is used by 73.2% (CI95% 72.2-74.2) and the rear seat safety belt is only used by 37.4% (CI95% 36.6-38.2). Traffic accidents led to the abandonment of their habitual activities by 30.7% of those involved. The severity of injuries in traffic accidents demands further preventive and legislative measures to reduce such incidents.     

Differences between males and females in traffic accident risk in France

BACKGROUND: In France 7,720 people were killed in traffic accidents in 2001, 75% of which were men; the number of injured people is estimated at 153,945, of which 65% were men. The objective of the study is to describe differences between males and females regarding accidents, and to explain the main reasons for these differences. METHODS: Analysis is conducted from both national police data (2001) and data from the Rhone medical road accident trauma Register (1996-2001). RESULTS: The male/female incidence rate is 3.1 for mortality (95% CI: 3.0-3.3) and 1.7 for morbidity (95% CI: 1.7-1.8). Two-wheel motorised vehicle accidents are very specific to males, which explains part of this overrepresentation. The fatality rate and the severe injuries rate among survivors are higher for males. This is true for every main user group (car users, motorised two-wheelers, cyclists, pedestrians) after adjusting for accident circumstances and age of casualties. Males are more severely injured for all body regions and have more often severe after-effects. CONCLUSIONS: This paper shows the mechanisms leading to this unfavourable outcome for men. They correspond to differences in the number of trips, in the choice of road transport types, and moreover to differences in risk-taking behaviours. Underlying these behaviours, deep-rooted, strong and rather invariant differences between genders are to be found in the values associated with risk-taking on the road.     

珠海市交通事故意外伤害人群分析

目的分析交通事故意外伤害人群特点,为健康教育提供参考.方法从珠海市公安交通警察支队获取近4 a的交通意外伤害资料,进行统计分析.结果在交通意外伤害中,男性的死伤百分比是女性的2～3倍;16～40岁之间的5个年龄组段,车祸死伤百分比较高,超过了10%;机动车司机死伤人员中,二轮摩拖车司机占的百分比最高;非机动车驾驶者死伤人员中,以骑自行车所占百分比最高;在交通事故中,马路上步行者比乘车者更易引起死亡;以外来工为主的外地人在交通事故中的死伤百分比和死伤率(每10万)均高于本地人.结论应根据珠海市交通事故死亡人员的人群特点有针对性的加强健康教育.     

DETERMINANTS OF ROAD TRAFFIC CRASH FATALITIES ACROSS INDIAN STATES

This article explores the determinants of road traffic crash fatalities in India. In addition to income, the analysis considers the sociodemographic population structure, motorization levels, road and health infrastructure and road rule enforcement as potential factors. An original panel data set covering 25 Indian states is analyzed using multivariate regression analysis. Time and state fixed‐effects account for unobserved heterogeneity across states and time. The rising motorization, urbanization and accompanying increase in the share of vulnerable road users, that is, pedestrians and two‐wheelers, are the major drivers of road traffic crash fatalities in India. Among vulnerable road users, women form a particularly high‐risk group. Higher expenditure per police officer is associated with a lower fatality rate. The results suggest that India should focus, in particular, on road infrastructure investments that allow the separation of vulnerable from other road users on improved road rule enforcement and should pay special attention to vulnerable female road users. Copyright © 2012 John Wiley & Sons, Ltd.     

Are primary school children gaining heart health benefits from their journeys to school?

Summary Information was collected in relation to 1133 children, aged 4–11 years, regarding methods of travel to and from school, together with distances involved. Ninety-seven per cent of the children walked, travelled by car or alternated between these 2 methods of travel. Some 584 children (51·5%) walked to school every day with an average one-way-distance of less than half a mile. It would seem therefore that few primary school children are walking far enough to gain heart health benefits from their journeys to school. Reasons are given, however, as to why it is important for young children to be encouraged to walk to school providing adequate safety considerations are taken into account.     

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.     

南京市不同人群道路交通伤害知识、信念、行为调查研究

目的 了解南京市不同人群预防道路交通伤害的知识、信念、行为情况,比较事故驾驶员、非事故驾驶员和社区居民中非驾驶人员知识、信念、行为的不同,为开展道路交通安全健康教育工作提供参考。方法 采用问卷调查方法 ,收集事故驾驶员和非事故驾驶员以及社区居民中非驾驶人员知识、信念、行为情况。结果 调查了170名事故驾驶员、167名非事故驾驶员和175名社区居民中的非驾驶员。事故驾驶员与非事故驾驶员预防和控制道路交通伤害的知识、态度、行为均存在一定的差异。事故驾驶员的知识知晓率和交通安全相关行为遵守情况均低于非事故驾驶员（P〈0.01）,态度方面认知率高于非事故组驾驶员（P〈0.01）。非驾驶员的社区居民观看过道路交通安全的宣传片和愿意接受道路安全的免费教育的人数低于其他两组（分别为62.86%和75.43%）。结论 不同人群道路交通伤害知识、态度、行为存在差异,事故驾驶员的道路交通知识知晓率和遵守道路交通安全相关行为低于非事故驾驶员,是导致道路交通伤害的危险因素。     

Minute ventilation of cyclists, car and bus passengers: an experimental study

Background  

Differences in minute ventilation between cyclists, pedestrians and other commuters influence inhaled doses of air pollution. This study estimates minute ventilation of cyclists, car and bus passengers, as part of a study on health effects of commuters' exposure to air pollutants.     

Motor vehicle crash injury rates by mode of travel, United States: using exposure-based methods to quantify differences

The authors used traffic exposure data to calculate exposure-based fatal and nonfatal traffic injury rates in the United States. Nationally representative data were used to identify fatal and nonfatal traffic injuries that occurred from 1999 to 2003, and the 2001 National Household Travel Survey was used to estimate traffic exposure (i.e., person-trips). Fatal and nonfatal traffic injury rates per 100 million person-trips were calculated by mode of travel, sex, and age group. The overall fatal traffic injury rate was 10.4 per 100 million person-trips. Fatal injury rates were highest for motorcyclists, pedestrians, and bicyclists. The nonfatal traffic injury rate was 754.6 per 100 million person-trips. Nonfatal injury rates were highest for motorcyclists and bicyclists. Exposure-based traffic injury rates varied by mode of travel, sex, and age group. Motorcyclists, pedestrians, and bicyclists faced increased injury risks. Males, adolescents, and the elderly were also at increased risk. Effective interventions are available and should be implemented to protect these vulnerable road users.     

2006-2010年宁波市居民交通运输伤害死亡特征分析

目的：分析宁波市2006-2010年交通运输伤害死亡特征,为伤害干预工作提供依据。方法：死亡数据来源于2006-2010年宁波市死因监测系统,研究对象为户籍居民。通过计算死亡率、死亡构成比等指标进行数据分析。结果：2006-2010年宁波市居民交通运输伤害死亡率平均为18.59/10万,男性高于女性,男性死亡率随年度变化呈现下降趋势。不同交通运输方式发生的伤害死亡,以道路上为主（占伤害死亡的97.83%）,其次为水上（占2.11%）。以行人、骑摩托车者和骑脚踏车者死亡居多。死亡发生月份集中在10-12月。结论：道路伤害是交通运输伤害的主要类型,需针对发生特点采取措施。     

Road traffic injuries: a major global public health crisis

Evidence suggests that the present and projected global burden of road traffic injuries is borne disproportionately by countries that can least afford to meet the health service, economic and societal challenges. Although the evidence base on which these estimates are made remains somewhat precarious in view of the limited data systems in most low- and middle-income countries, these projections highlight the essential need to address road traffic injuries as a public health priority. Most well-evaluated effective interventions do not focus directly on efforts to protect vulnerable road users, such as motorcyclists and pedestrians. However, these groups comprise the majority of road traffic victims in low- and middle-income countries, and consequently the majority of road traffic victims globally. Responding appropriately to the disparities in available evidence and prevention efforts is necessary in order to address this global public health crisis comprehensively.     

Driving experience and the risk of traffic accident among motorcyclists

In a case-control study on the risk of traffic accidents among motorcyclists in Singapore, we demonstrated an inverse monotonic relationship between accident risk and driving experience. As compared to drivers with less that 1 yr of driving experience, the odds ratios (adjusted for race, age and frequency of riding) for those with driving experience of 1-4, 5-9 and 10 yr or more were 0.60, 0.50 and 0.36, respectively. We propose that intensive in-circuit training of learner motorcyclists should replace the conventional on-the-road training on the basis that the former serves to increase their driving experience without subjecting the learner motorcyclists to the risk of sustaining road accident.     

Traffic accidents resulting in injuries: underreporting,characteristics, and case fatality rate

In order to describe traffic accidents in a medium-sized Brazilian city and compare the risks of injury and death among different types of vehicles and pedestrians, all traffic accidents identified through police and hospital emergency records were registered for two years Deaths by such accidents were identified and confirmed through the coroner's office. The number of registered vehicles in the municipality was obtained through the State traffic authority. Morbidity and mortality rates were calculated and tests of association between selected variables performed. There was a relevant underreporting of accidents by the police (up to 53%), which varied according to the type of accident and time of occurrence. The highest case fatality rate was observed among bicyclists and pedestrians (around 5%), followed by motorcyclists (3%). Pedestrians formed the highest contingent of deaths. Motorcyclists had an eightfold risk of dying, a fourfold risk of injury, and a twofold risk of running over pedestrians as compared to automobile drivers. We conclude that pedestrians and motorcyclists are priority groups for interventions aimed at reducing injury and death from traffic accidents.     

A cluster analysis of road traffic-related childhood knee injuries

BACKGROUND: Knee injuries represent an important category of road traffic injuries among children, and they are heterogeneous in their aetiology. The aims of this study were to estimate the incidence of road traffic childhood knee injuries in Greece by age and gender, point out their time, place and person co-ordinates and identify clusters with distinct characteristics with a view to potential preventive interventions. METHODS: During a 3-year period, 305 children with knee injuries resulting from a road traffic accident were identified among the 66,870 children with injuries recorded in the Emergency Department Injury Surveillance System (EDISS) of Greece. Using previously derived sampling ratios and national data on childhood population, incidence data by age and gender were estimated. Hierarchical analysis was undertaken for cluster identification. RESULTS: The incidence of road traffic knee injuries was 97.5 per 100,000 children-years. The incidence increased with age and was higher among boys than among girls. Most childhood knee injuries (50.2%) occur among pedestrians, and the majority (90.9%) of the children or their guardians admitted responsibility in crossing the road. Of the 31 children injured as car passengers, the vast majority (87.1%) were unrestrained, and a large fraction (38.7%) were front seat passengers. Two clusters were identified: the first consisted of younger children who resided mostly in the Athens area and suffered less serious knee injuries as pedestrians or car passengers during the colder months; the second consisted of older children, frequently tourists, who suffered more serious injuries as cyclists while vacationing. CONCLUSIONS: Many of the children who suffered road traffic knee injuries as pedestrians admitted responsibility in road crossing, whereas a large proportion of children who were injured as car passengers were injured while improperly seated in the front and without seatbelt protection. Older children, frequently tourists, were at high risk of knee injuries while using motorcycles and bicycles.