Area-Wide Traffic-Calming Zone 30 Policy of Japan and Incidence of Road Traffic Injuries Among Cyclists and Pedestrians

Road traffic safety for older adults: an emerging public health challenge in Thailand

BACKGROUND

Road safety for older adults should receive more attention in low-income and middle-income countries with rapidly ageing populations.

METHODS

Using injury surveillance data from Khon Kaen Regional Hospital in northeastern Thailand, we calculated the proportion of older adults in the total number of patients who were fatally and non-fatally injured in road traffic crashes in each year from 2001 to 2020 and the proportion of road user type in the fatal and non-fatal patients by age groups for the entire study period to examine the extent to which older adults were involved in the crashes and with what mode of transportation.

RESULTS

During the 20-year period, there were 5046 fatal and 180 353 non-fatal patients of whom 509 (10%) and 6087 (3%) were aged 65 years or older, respectively. From 2001 to 2020, this proportion increased from 3% to 20% among the fatal patients and from 1% to 6% among the non-fatal patients. Of the fatal and non-fatal patients aged 65 years or older, 50% and 54% were involved in road traffic crashes while driving motorcycles and 28% and 22% while riding bicycles or walking, respectively. Compared with patients aged 65-74 years, those aged 75 years or older tended to be bicyclists or pedestrians in the crashes, though as high as 40% of them were motorcycle drivers.

CONCLUSION

Older adults are increasingly injured in road traffic crashes as vulnerable road users in Thailand. Therefore, road safety efforts should consider their presence on the road.

Aberrant behaviors of drivers involved in crashes and related injury severity: Are there variations between the major cities in the same country?

INTRODUCTION

Crash data analyses based on accident datasets often do not include human-related variables because they can be hard to reconstruct from crash data. However, records of crash circumstances can help for this purpose since crashes can be classified considering aberrant behavior and misconduct of the drivers involved.

METHOD

In this case, urban crash data from the 10 largest Italian cities were used to develop four logistic regression models having the driver-related crash circumstance (aberrant behaviors: inattentive driving, illegal maneuvering, wrong interaction with pedestrian and speeding) as dependent variables and the other crash-related factors as predictors (information about the users and the vehicles involved and about road geometry and conditions). Two other models were built to study the influence of the same factors on the injury severity of the occupants of vehicles for which crash circumstances related to driver aberrant behaviors were observed and of the involved pedestrians. The variability between the 10 different cities was considered through a multilevel approach, which revealed a significant variability only for the inattention-related crash circumstance. In the other models, the variability between cities was not significant, indicating quite homogeneous results within the same country.

RESULTS

The results show several relationships between crash factors (driver, vehicle or road-related) and human-related crash circumstances and severity. Unsignalized intersections were particularly related to the illegal maneuvering crash circumstance, while the night period was clearly related to the speeding-related crash circumstance and to injuries/casualties of vehicle occupants. Cyclists and motorcyclists were shown to suffer more injuries/casualties than car occupants, while the latter were generally those exhibiting more aberrant behaviors. Pedestrian casualties were associated with arterial roads, heavy vehicles, and older pedestrians.

Global burden and trends of three common road injuries from 1990 to 2019 and the implications for prevention and intervention

BACKGROUND

Analysis on the burden of specific types of road injuries (RIs) in the previous Global burden of disease (GBD) studies is lacking. The present work aimed to analyze the burden of three common RIs using the updated data of the GBD 2019, which would inform policy-making.

METHODS

Data on cyclist road injuries (CRIs), motorcyclist road injuries (MRIs), and motor vehicle road injuries (MVRIs) were extracted from the GBD 2019. Trends of age-standardized rate (ASR) were predicted using estimated annual percentage change (EAPC) from 1990 to 2019.

RESULTS

Over the past three decades, the global incident ASRs of CRIs and MRIs presented increasing trends, but that of MVRIs declined slightly. However, trends of death and disability adjusted life years (DALYs) caused by three common RIs decreased in most regions and countries. Particularly, trends in ASRs of years of life lost (YLLs) cuased by RIs decreased more pronouncedly than that of years of life lived with disability (YLDs). The burden of three common RIs showed significant social and demographic characteristics. Low-middle and middle socio-demographic index (SDI) areas had a heavy burden of RIs, particularly CRIs and MRIs. However, the high SDI area undertook a relatively low burden, and presented more pronounced downward trends in death and DALYs.

CONCLUSIONS

The burden and changing trends of three common RIs were geographically heterogeneous. The findings highlighted that increasing incident trends of RIs needed more cost-effective measures of prevention and intervention.

A systematic review of the evidence for effectiveness of interventions to address transport and other unintentional injuries among adolescents

INTRODUCTION

Globally, injuries are a leading cause of mortality and morbidity for adolescents, which disproportionately affect the disadvantaged. To build an investment case for adolescent injury prevention, evidence is needed as to effective interventions.

METHODS

A systematic review of peer-reviewed original research published between 2010-2022 was conducted. CINAHL, Cochrane Central, Embase, Medline and PsycINFO databases were searched for studies reporting the effectiveness of unintentional injury prevention interventions for adolescents (10-24 years), with assessment of study quality and equity (e.g., age, gender, ethnicity, socio-economic status).

RESULTS

Sixty-two studies were included; 59 (95.2%) from high-income countries (HIC). Thirty-eight studies (61.3%) reported no aspect of equity. Thirty-six studies (58.1%) reported prevention of sports injuries (commonly neuromuscular training often focused on soccer-related injuries, rule changes and protective equipment). Twenty-one studies (33.9%) reported prevention of road traffic injury, with legislative approaches, commonly graduated driver licensing schemes, found to be effective in reducing fatal and nonfatal road traffic injury. Seven studies reported interventions for other unintentional injuries (e.g., falls).

DISCUSSION

Interventions were strongly biased towards HIC, which does not reflect the global distribution of adolescent injury burden. Low consideration of equity in included studies indicates current evidence largely excludes adolescent populations at increased risk of injury. A large proportion of studies evaluated interventions to prevent sports injury, a prevalent yet low severity injury mechanism. Findings highlight the importance of education and enforcement alongside legislative approaches for preventing adolescent transport injuries. Despite drowning being a leading cause of injury-related harm among adolescents, no interventions were identified.

CONCLUSION

This review provides evidence to support investment in effective adolescent injury prevention interventions. Further evidence of effectiveness is needed, especially for low- and middle-income countries, populations at increased risk of injury who would benefit from greater consideration of equity and for high lethality injury mechanisms like drowning.

Association between mandatory cognitive testing for license renewal and motor vehicle collisions and road injuries

BACKGROUND

We examined whether the policy amendment from March 2017 for a cognitive screening test for older drivers at driver's license renewal was associated with the decreased risk of motor vehicle collisions for drivers and the increased risk of injuries for pedestrians and cyclists among older people.

METHODS

This was a controlled interrupted time-series study. We used police-reported data on the number of collisions as drivers and injuries as pedestrians and cyclists among people aged 70 years or older in Japan from July 2012 to December 2019. As the outcome measures, we used the ratio of the monthly number of collisions per population among drivers of three groups aged 75 years or older (75-79, 80-84, and ≥85 years), who were targeted or exposed by the policy, to that among drivers aged 70 to 74 years, who were unaffected or unexposed by the policy and would serve as controls. The ratio of pedestrian and cyclist injuries was also calculated, as previous studies have shown a concomitant increase in these injuries after the introduction of cognitive screening for driver's licenses.

RESULTS

During the study period, there were 602,885 collisions as drivers and 196,889 injuries as pedestrians and cyclists among people aged 70 years or older. After the policy amendment in March 2017, collisions decreased among male drivers, and injuries increased among some age subgroups in both sexes. Cumulative estimated changes in the numbers of collisions and injuries from March 2017 to December 2019 were -3670 (95% confidence interval: -5125, -2104) and 959 (95% confidence interval: 24, 1834), respectively.

CONCLUSIONS

Following the policy amendment, there was a decrease in motor vehicle collisions as drivers and an increase in road injuries as pedestrians and cyclists among older people.

Reduced road injuries while commuting due to heavy snowfall and ensuing modal shifts among junior high school students in Japan

Background

Modal shifts in transport may reduce overall road injuries. Cyclist junior high school students are at a high risk of road injuries while commuting in Japan, and injuries among junior high school students could be reduced if the cyclists switch to other transport modes.

Methods

We estimated the change in the incidence of road deaths and serious injuries while commuting in months with heavy snowfall, when cyclists are likely to switch to other transport modes. Using police data on the monthly number of road injuries while commuting among junior high school students in Japan between 2004 and 2013 and corresponding population statistics and snowfall data, we calculated the monthly injury rate (number of deaths and serious injuries divided by population) at the prefecture level. We conducted Poisson regression analysis to estimate the change in the rate in months with a snowfall of ≥100 cm, compared to months without snowfall.

Results

A total of 3,164 deaths and serious injuries occurred during 2004 to 2013. The injury rate among cyclists was almost zero in months with a snowfall of ≥100 cm. That among cyclists and pedestrians in these months was reduced by 68% (95% confidence interval, 43–82%).

Conclusion

In months with heavy snowfall, road injuries while commuting were reduced due to the near-elimination of cycling injuries among junior high school students in Japan. Switching from cycling to other transport modes would reduce overall road injuries among this population, and inducing modal shifts can be an important tool for road safety.

The unknown denominator problem in population studies of disease frequency

Problems related to unknown or imprecisely measured populations at risk are common in epidemiologic studies of disease frequency. The size of the population at risk is typically conceptualized as a denominator to be used in combination with a count of disease cases (a numerator) to calculate incidence or prevalence. However, the size of the population at risk can take other epidemiologic properties in relation to an exposure of interest and the count outcome, including confounding, modification, and mediation. Using spatial ecological studies of injury incidence as an example, we identify and evaluate five approaches that researchers have used to address "unknown denominator problems": ignoring, controlling for a proxy, approximating, controlling by study design, and measuring the population at risk. We present a case example and recommendations for selecting a solution given the data and the hypothesized relationship between an exposure of interest, a count outcome, and the population at risk.

Increased traffic injuries among older unprotected road users following the introduction of an age-based cognitive test to the driver's license renewal procedure in Japan

BACKGROUND

To deal with the increasing number of motor vehicle collisions (MVCs) among older drivers, a cognitive test has been introduced to a license renewal procedure for drivers aged ≥75 years since June 2009. This might have prompted the reduction or cessation of driving by older drivers. We therefore examined whether older drivers' chance of experiencing MVCs as unprotected road users has increased after the test was introduced.

METHODS

Using police-reported national data on MVCs from January 2005 through December 2016, we calculated the monthly injury rates (including deaths, severe injuries, and minor injuries) among unprotected road users (bicyclists and pedestrians) by sex and age group (70-74, 75-79, 80-84, and ≥85 years). The ratios of the injury rates of unprotected road users in the three oldest age groups (who were subjected to the test) to those aged 70-74 years (not subjected to the test) were also calculated. Then, we conducted an interrupted time-series analysis based on the injury rate ratios to control for extraneous factors affecting MVCs over the study period.

RESULTS

There was a significant increase in traffic injuries of unprotected road users at the time the test was introduced among females aged 75-84 years, and at a later time among males aged ≥80 years and females aged ≥85 years.

CONCLUSION

Licensing policies for older drivers should be rigorously evaluated, taking into account the safety of older unprotected road users, and should be balanced against it.