Road traffic injuries in an urban area in Mexico. An epidemiological and cost analysis

The objective of this study was to do an epidemiological and costs analysis of the impact of road traffic injuries on the demand for emergency room services at hospitals located in the city of Cuernavaca, Mexico. The studied population included injured people who demanded medical attention at the emergency room for injuries due to events in public places, occurring between February and April 2001. Trained interviewers collected the data at the emergency room, 24h a day. The statistical analysis included simple and bivariate analysis using chi(2) odds ratio (OR), and a confidence interval of 95%. The costs analysis included the expenses during the process of searching for and finding care for injuries. There were 433 injured people, 233 (54%) were victims of road traffic accidents, 72% of crashes, and 28% were injured pedestrian and cyclists. Variables associated with the demand of emergency care due to road traffic injuries in comparison with other accidents, were: severity of injuries (OR 2.60, CI 1.44-4.71), and thorax injury (OR 4.64, CI 1.03-20.89). Pedestrians had higher costs for health care and 80% of them had to pay out-of-pocket (P<0.05). Differences between patients injured by crashes or as a pedestrian, were: age under 14 years (OR 5.9, CI 2.5-13.9), being unemployed (OR 2.1, CI 1.20-3.96), and being an elementary school student (OR 13.9, CI 3.08-63.13). The present study is, so far, the only one in Mexico to include an epidemiological and costs analysis in approaching the problem of road traffic injuries. Similar methods must be used, especially in developing countries, to reduce this important public health problem.     

Perception of traffic risks for older and younger adults

The study examined differences in the perception of traffic risks for older and younger adults. Thirty-four younger participants (mean age 24.7 years) and 30 older participants (mean age 70 years) estimated the number of younger and older people (out of 100,000 people) that were injured in car and pedestrian crashes in a recent year. Both age groups viewed older adults’ risks in pedestrian crashes as higher than those of younger adults, and saw older adults’ risks in car crashes as identical to the risks for younger adults. Both age groups assessed the risks for their own group quite accurately, but erred in their assessment of the risk for the other group. Older participants tended to overestimate the risk for younger adults, and younger participants tended to underestimate the risk for older adults. These results point to the need to enhance awareness of the age-related increase in traffic risk, which could potentially promote more considerate driving behavior.     

Risk perception of traffic participants

This article analyzes the risk perception of traffic participants by making use of Prospect Theory. This methodology makes a conceptual distinction between the perception of risk and the perception of the outcome of an uncertain event. In the field of transport safety such a distinction is desirable, because risks are typically very low and thus sensitive to misperception by traffic participants. Taking into account such misperception will significantly improve estimates of the valuation of transport safety. The first empirical results show that the valuation of losses is well represented by a utility function that is concave in shape. Secondly, our preliminary results show that individuals base their choice mainly on the possible outcomes and not so much on probabilities whenever there are very small probabilities (say 相似文献   

Distinguishing traffic modes in analysing road safety development

Changes in mobility influence road safety. The effects of safety measures may even be overshadowed by the effects of temporary mobility fluctuations. Usually mobility is corrected for by defining risk as the ratio between fatalities and mobility. Due to lack of sufficient data, mobility is often approximated by car mobility. In this paper we will show that the resulting "general" risk is misleading. Stratification by traffic mode shows that the risk for car drivers, motorcyclists and truck drivers is roughly constant between 1950 and 1970 and that it has been decreasing exponentially afterwards. This contradicts the development of general risk, which has been decreasing the whole period between 1950 and today. Further stratification shows that stratification by traffic mode of the fatality alone is still insufficient. Changes in mobility of the other party in a crash are also important. The development of risk of car-car accidents differs significantly from that of single vehicle car accidents. A comparison between single vehicle motorcycle accidents and motorcycle-car accidents shows a similar discrepancy. Stratification of mobility by traffic mode, and of fatality data by the relevant traffic modes involved, can enhance the understanding of the influence of mobility on safety.     

Comparing the cost of alcohol-related traffic crashes in rural and urban environments

Context

Existing studies have identified that, although to a lesser extent than individual factors such as males and young people, rural (compared to urban) communities represent a disproportionately high-risk of alcohol-related traffic crashes (ARTCs). To date, however, few studies have attempted to apply different costs to alcohol crashes of different severity, to provide more precise, and practically useful, data on which to base public health policy and intervention decisions.

Objective

The aim of this study is to quantify the per capita prevalence and differential costs of alcohol crashes of different levels of severity to determine the extent to which urban and rural geographical areas may differ in the costs attributable to ARTCs.

Design

A cross-sectional analysis of alcohol-related traffic crash and costs data from 2001 to 2007.

Setting and participants

Data from New South Wales, Australia.

Main outcome measures

Modified routinely collected traffic accident data to which costs relevant to alcohol crashes of different severity are applied.

Results

Although the rate per 10,000 population of alcohol-related crashes is 1.5 times higher in rural, relative to urban, communities, the attributable cost is four times higher, which largely reflects that rural alcohol-fatalities are seven to eight times more prevalent and costly.

Conclusions

Given that per capita alcohol-related fatal crashes in rural areas account for a disproportionately large proportion of the harms and costs associated with alcohol-related traffic crashes, the cost-effectiveness of public health interventions and public policy initiatives should consider the relative extent of ARTC-harm in rural versus urban communities.     

Models relating traffic safety with road environment and traffic flows on arterial roads in Addis Ababa

This paper presents the study carried out to develop accident predictive models based on the data collected on arterial roads in Addis Ababa. Poisson and negative binomial regression methods were used to relate the discrete accident data with the road and traffic flow explanatory variables. Significant accident predictive models were found with a number of significant explanatory variables. The results show that the existing inadequate road infrastructure and poor road traffic operations are the potential contributors of this ever-growing challenge of the road transport in Addis Ababa. The results also indicate that improvements in roadway width, pedestrian facilities, and access management are effective in reducing road traffic accidents.     

Safety and accessibility effects of code modifications and traffic calming of an arterial road

The European Road E12 through the community center of Storuman, Sweden was reconstructed in 1999 and 2000. Pedestrian walkways, traffic islands, chicanes of a type referred to as "Danish buns", a roundabout and a two-directional cycle track along the E12 were installed. The purpose of the reconstruction was to improve safety for pedestrians and bicyclists, primarily for children, the elderly and the disabled, and to reduce the barrier effect of the E12 thoroughfare. In May 2000, the code governing the conduct of drivers at marked crosswalks in Sweden became stricter to improve safety and mobility for pedestrians. The combined effect of reconstructions and change of code was analyzed. Traffic behavior was studied at the intersection where the roundabout was constructed. Yield behavior towards pedestrians changed significantly. The difference was even greater with respect to yielding to child bicyclists - from 6% before to 84% after - even though the code change only related to pedestrians. Crash data analysis suggests a minor increase in fall injuries after reconstructions and change of code. Measures of speed, behavioral studies, questionnaires, face-to-face interviews and crash data analysis suggest that safety has increased not only along the E12 but also along adjacent roads. The final conclusion is that a bypass is not needed in a case like Storuman. Traffic calming of the main arterial through the town seems sufficient.     

Impact of road traffic injuries on disability rates and long-term care costs in Spain

Road traffic injuries are one of the leading causes of increasing disability-adjusted life expectancy. We analyze long-term care needs associated with motor vehicle crash-related disability in Spain and conclude that needs attributable traffic injuries are most prevalent during victims’ mid-life years, they create a significant burden for both families and society as a whole given that public welfare programmes supporting these victims need to be maintained over a long time frame. High socio-economic costs of road traffic accidents (in Spain 0.04% of the GDP in 2008) are clearly indicative of the need for governments and policymakers to strengthen road accident preventive measures.     

Prognostic factors for chronic neck pain in persons with minor or moderate injuries in traffic accidents

Prognostic factors for chronic neck pain were identified in a prospective Norwegian insurance cohort comprising 636 persons with minor or moderate traffic injuries. One questionnaire was used at baseline and another at 3 years post-injury. Daily severe or very severe neck pain at three years follow up was defined as chronic neck pain. Eight significant independent prognostic factors for chronic neck pain were identified: (1) rear-end or frontal and rear-end collision, odds ratio (OR): 4.10 (95% confidence interval (CI): 1.72-10.82); (2) neck and/or shoulder pain before the accident, OR: 2.38 (95% CI: 1.07-5.37); (3) post-accident (a) memory and concentration problems, OR: 4.62 (95% CI: 1.99-11.20), (b) bodily tension, OR: 3.43 (95% CI: 1.49-8.42), (c) difficulties to climb stairs, OR: 5.03 (95% CI: 1.77-14.95), (d) difficulties to bend forward, OR: 4.85 (95% CI: 2.06-11.79), (e) difficulties to do heavy labour, OR: 3.70 (95% CI: 1.24-11.64); (4) beliefs in future work disability, OR: 2.64 (95% CI: 1.11-6.48). The results indicate that development of chronic neck pain is influenced by pre-accident neck and/or shoulder pain, the impact of the collision, as well as post-accident symptoms, perceived impaired function and pessimism for the future ability to work.     

Distribution and characteristics of road traffic crashes in the Chaoyang District of Beijing, China

In many developing urban settings, economic growth and motorization are coupled with increasing rates of road traffic injuries (RTIs). By highlighting typical sites and circumstances at/in which car crashes occur, more specific targets for prevention can be identified. The study is based on police data for a 1-year period and covers the Chaoyang District, the biggest district of Beijing City. Focus is placed on crash patterns and their distribution by types of road and areas. Both fatal and non-fatal crashes are considered (n=754). In the main, the crashes occurred in relatively favorable driving circumstances (e.g., sunny weather, flat and straight roads, asphalted roads, and good traffic signals and road markings). They were also quite evenly distributed over time of day, day of week and season. Five crash patterns were highlighted, of which three were strongly associated with specific areas and four with specific types of road. The study supports the idea that type of road and RTI severity or pattern are closely related. It contributes to the development of context-relevant prevention measures aimed at reducing road crashes and minimizing their consequences and also supports safe planning of the road traffic environment.     

Comprehensibility of traffic signs among urban drivers in Turkey

Traffic signs are commonly used traffic safety tools, mainly developed to provide crucial information in a short time to support safe drive; but the success depends on their comprehensibility by the drivers. Also, a sudden change in the traditionally used and accepted signs can cause significant safety problem, as in the case of cancellation of red oblique bars in 2004 as a part of the European Union Harmonization Process of Turkey.     

Burden of road traffic injuries: Disability-adjusted life years in relation to hospitalization and the maximum abbreviated injury scale

Background

The consequences of non-fatal road traffic injuries (RTI) are increasingly adopted by policy makers as an indicator of traffic safety. However, it is not agreed upon which level of severity should be used as cut-off point for assessing road safety performance. Internationally, within road safety, injury severity is assessed by means of the maximum abbreviated injury scale (MAIS). The choice for a severity cut-off point highly influences the measured disease burden of RTI. This paper assesses the burden of RTI in terms of disability adjusted life years (DALYs) by hospitalization status and MAIS cut-off point in the Netherlands.

Methods

Hospital discharge register (HDR) and emergency department (ED) data for RTI in the Netherlands were selected for the years 2007–2009, as well as mortality data. The incidence, years lived with disability (YLD), years of life lost (YLL) owing to premature death, and DALYs were calculated. YLD for admitted patients was subdivided by MAIS severity levels.

Results

RTI resulted in 48,500 YLD and 27,900 YLL respectively, amounting to 76,400 DALYs per year in the Netherlands. The largest proportion of DALYs is related to fatalities (37%), followed by admitted MAIS 2 injuries (25%), ED treated injuries (16%) and admitted MAIS 3+ injuries (18%). Admitted MAIS 1 injuries only account for a small fraction of DALYs (4%). In the Netherlands, the diseases burden of RTI is highest among cyclists with 39% of total DALYs. One half of all bicycle related DALYs are attributable to admitted MAIS 2+ injuries, but ED treated injuries also account for a large proportion of DALYs in this group (28%). Car occupants are responsible for 26% of all DALYs, primarily caused by fatalities (66%), followed by admitted MAIS 2+ injuries (25%). ED treated injuries only account for 5% of DALYs in this group.

Conclusions

When using admitted MAIS 3+ or admitted MAIS 2+ as severity cut-off point, 54% and 80% of all DALYs are captured respectively. Assessing the influence of different severity cut-off points by MAIS on the proportion and number of DALYs captured gives valuable information for guiding choices on the definition of serious RTI.     

Powered two-wheelers road accidents and their risk perception in dense urban areas: Case of Paris

For a few years, the use of powered two-wheelers has taken off in Paris. It then became critical for the City of Paris to understand both the mechanisms leading to traffic accidents involving at least one powered two-wheelers user and the perception of their risk when riding in dense urban areas. In so doing, two studies were carried out along similar lines so that their results could be compared. The first study focused on the perception of situations where accidents are most likely to occur. The second one was an analysis of police reports of accidents involving at least one powered two-wheelers and the drawing-up of prototypical accident scenarios. Comparing the results of the two studies revealed a gap between perceived and objective risks of these users. In fact, they rather fear the situations during which a car driver is changing lanes, while accidents involving them occur more often when a car driver turns (right, left or U). Knowledge of this dissonance in terms of awareness of road risks for powered two-wheelers and equally, other road users, will give the City of Paris food for thought. The promising results of this study have encouraged the City of Paris to extend it to other types of users, such as cyclists or elderly pedestrians.     

The development and application of a proxy measure of alcohol-related traffic crashes for rural communities

Context

To date, no studies have adequately examined whether community-level, rather than individual-level, characteristics, are associated with high rates of alcohol-related traffic crashes (ARTC).

Objective

This study aims to identify a proxy measure of ARTC most appropriate to rural communities in New South Wales (NSW), Australia, and to identify community characteristics that predict higher rates of ARTC.

Methods

ARTC (2001–2007) incident data from 20 rural communities in NSW were obtained. Cost data were applied to take account of ARTCs of different severity.

Results

The method used to define a proxy measure of ARTCs for NSW generally was found to be inadequate when applied to local communities within NSW: specifically, two time periods were found to be alcohol-related for local communities only and seven time periods were found to be non-alcohol-related for local communities only. Applying a community-specific proxy measure of ARTCs to 20 communities identified substantial variation in ARTC cost-ratios, ranging from 1.20 to 0.15. Higher cost-ratios were statistically significantly predicted by the proportion of residents who were male and less than 25 years.

Conclusions

Proxy measures of ARTCs represent an ideal method of utilising routinely collected data to identify specific types of ARTCs that are most relevant to a defined community, identify community-specific factors associated with higher rates of ARTCs and measure the impact of interventions tailored to those risk factors. Such measures ought to be community-specific because these results suggest national or provincial-level definitions are not necessarily directly applicable to local communities. These results show substantial variability between communities in their rates of ARTC and identify communities with higher proportions of young males as being at increased risk.     

Gender differences in road traffic injury rate using time travelled as a measure of exposure

There is no consensus on whether the risk of road traffic injury is higher among men or among women. Comparison between studies is difficult mainly due to the different exposure measures used to estimate the risk. The measures of exposure to the risk of road traffic injury should be people's mobility measures, but frequently authors use other measures such population or vehicles mobility. We compare road traffic injury risk in men and women, by age, mode of transport and severity, using the time people spend travelling as the exposure measure, in Catalonia for the period 2004–2008. This is a cross-sectional study including all residents aged over 3 years. The road traffic injury rate was calculated using the number of people injured, from the Register of Accidents and Victims of the National Traffic Authority as numerator, and the person-hours travelled, from the 2006 Daily Mobility Survey carried out by the Catalan regional government, as denominator. Sex and age specific rates by mode of transport and severity were calculated, and Poisson regression models were fitted. Among child pedestrians and young drivers, males present higher risk of slight and severe injury, and in the oldest groups women present higher risk. The death rate is always higher in men. There exists interaction between sex and age in road traffic injury risk. Therefore, injury risk is higher among men in some age groups, and among women in other groups, but these age groups vary depending on mode of transport and severity.     

Addressing the road trauma burden in China: Exploring attitudes,behaviours, risk perceptions and cultural uniqueness

As China continues to motorise rapidly, solutions are needed to reduce the burden of road trauma that is spread inequitably across the community. Little is currently known about how new drivers are trained to deal with on-road challenges, and little is also known about the perceptions, behaviours and attitudes of road users in China. This paper reports on a pilot study conducted in a driver retraining facility in one Chinese city where people who have had their licence suspended for accrual of 12 demerit points in a one year period must attend compulsory retraining in order to regain their licence. A sample of 239 suspended drivers responded to an anonymous questionnaire that sought information about preferred driving speeds and perceptions of safe driving speeds across two speed zones. Responses indicated that speeds higher than the posted limits were commonly reported, and that there was incongruence between preferred and safe speeds, such that a greater proportion of drivers reported preferred speeds that were substantially faster than what were reported as safe speeds. Participants with more driving experience reported significantly fewer crashes than newly licensed drivers (less than 2 years licensed) but no differences were found in offences when compared across groups with different levels of driving experience. Perceptions of risky behaviours were assessed by asking participants to describe what they considered to be the most dangerous on-road behaviours. Speeding and drink driving were the most commonly reported by far, followed by issues such as fatigue, ignoring traffic rules, not obeying traffic rules, phone use while driving, and non-use of seatbelts, which attracted an extremely low response which seems consistent with previously reported low belt wearing rates, unfavourable attitudes towards seatbelt use, and low levels of enforcement. Finally, observations about culturally specific considerations are made from previous research conducted by the authors and others. Specifically, issues of saving face and the importance and pervasiveness of social networks and social influence are discussed with particular regard to how any future countermeasures need to be informed by a thorough understanding of Chinese customs and culture.     

Culture related to road traffic safety: A comparison of eight countries using two conceptualizations of culture

The majority of previous cross-country studies of human factors relevant to traffic safety have not operationalized and measured culture. Also studies in this vein have mostly been carried out in Europe and the United States. The aim of the study was to examine country cluster differences, based on the Culture's Consequences framework, in road traffic risk perception, attitudes towards traffic safety and driver behaviour in samples from Norway, Russia, India, Ghana, Tanzania, Uganda, Turkey and Iran. An additional aim was to examine cluster differences in road traffic culture as symbol use and to investigate whether this theoretical cultural framework predicts risk perception, attitudes towards traffic safety and driver behaviour in the country clusters. The sample consisted of a total of 2418 individuals who were obtained by convenience sampling in the different countries. The countries segmented into four Culture's Consequences clusters; Norway, Russia and India, Sub-Saharan Africa, and Near East countries. The findings showed that Norwegians reported overall safer attitudes towards traffic safety and driver behaviour than the remaining country clusters. Individuals in Africa reported the highest risk perception. The countries also differed substantially in road traffic culture as symbol use. Contrary to established cultural theory, prediction models revealed that cultural factors were stronger predictors of driver behaviour than of risk perception. Also, the social cognitive risk constructs (i.e. risk perception and attitudes) solely explained variance in driver behaviour in the Norwegian and Russia/India clusters. Previous empirical efforts, which aimed to demonstrate that culture is important for the risk perception criterion, may have focused on a criterion variable that is not strongly related to driver behaviour. Furthermore, countermeasures aimed to influence social cognition may have stronger applicability in countries with a more individualistic western cultural orientation.     

Bayesian spatial joint modeling of traffic crashes on an urban road network

This study proposes a Bayesian spatial joint model of crash prediction including both road segments and intersections located in an urban road network, through which the spatial correlations between heterogeneous types of entities could be considered. A road network in Hillsborough, Florida, with crash, road, and traffic characteristics data for a three-year period was selected in order to compare the proposed joint model with three site-level crash prediction models, that is, the Poisson, negative binomial (NB), and conditional autoregressive (CAR) models. According to the results, the CAR and Joint models outperform the Poisson and NB models in terms of model fitting and predictive performance, which indicates the reasonableness of considering cross-entity spatial correlations. Although the goodness-of-fit and predictive performance of the CAR and Joint models are equivalent in this case study, spatial correlations between segments and the connected intersections are found to be more significant than those solely between segments or between intersections, which supports the employment of the Joint model as an alternative in road-network-level safety modeling.     

Explicit and implicit processes in behavioural adaptation to road width

The finding that drivers may react to safety interventions in a way that is contrary to what was intended is the phenomenon of behavioural adaptation. This phenomenon has been demonstrated across various safety interventions and has serious implications for road safety programs the world over. The present research used a driving simulator to assess behavioural adaptation in drivers' speed and lateral displacement in response to manipulations of road width. Of interest was whether behavioural adaptation would occur and whether we could determine whether it was the result of explicit, conscious decisions or implicit perceptual processes. The results supported an implicit, zero perceived risk model of behavioural adaptation with reduced speeds on a narrowed road accompanied by increased ratings of risk and a marked inability of the participants to identify that any change in road width had occurred.     

The impact of young drivers’ lifestyle on their road traffic accident risk in greater Athens area

Young drivers (18–24) both in Greece and elsewhere appear to have high rates of road traffic accidents. Many factors contribute to the creation of these high road traffic accidents rates. It has been suggested that lifestyle is an important one. The main objective of this study is to find out and clarify the (potential) relationship between young drivers’ lifestyle and the road traffic accident risk they face. Moreover, to examine if all the youngsters have the same elevated risk on the road or not. The sample consisted of 241 young Greek drivers of both sexes. The statistical analysis included factor analysis and logistic regression analysis. Through the principal component analysis a ten factor scale was created which included the basic lifestyle traits of young Greek drivers. The logistic regression analysis showed that the young drivers whose dominant lifestyle trait is alcohol consumption or drive without destination have high accident risk, while these whose dominant lifestyle trait is culture, face low accident risk. Furthermore, young drivers who are religious in one way or another seem to have low accident risk. Finally, some preliminary observations on how health promotion should be put into practice are discussed.