A new challenge to child and adolescent survival in urban Africa: an increasing burden of road traffic injuries

OBJECTIVES: To develop an epidemiological profile and present the burden of urban road-traffic injuries (RTI) in children and adolescents in urban Sub-Saharan Africa. METHOD: A systematic review of published and gray literature of children and adolescents < or =19 years old involved in RTI in urban regions in Sub-Saharan Africa from January 1980-December 2003. RESULTS: The mean annual incidence for urban road-traffic injuries was 109.8 per 100,000 children, and males were twice as involved as their female counterparts. Children between 10 to 14 years constitute the most frequent group involved in road crashes (36%) while pedestrians represent an average of 68% of all childhood RTI cases. Twenty Healthy Life Years per 1,000 children and adolescents are being lost annually in the region from RTI. CONCLUSIONS: There is an urgent need to develop a regional health research agenda to generate an accurate estimate of the burden of road-traffic injuries on children. This is a new challenge for child health and there is a need to raise awareness among policy makers to promote appropriate interventions.     

Field data: a study on trend and prediction of fatal traffic injuries prevalence in Shanghai

OBJECTIVE: The main objectives of the study are to analyze fatal traffic-injury trends in 1987-2003 in Shanghai and predict its prevalence in near future and provide scientific data for the local governmental decision on developing practical working methods on traffic-injury prevention and control. METHODS: In this study, epidemiological method and Grey dynamic model GM (1,1) were introduced to analyze and forecast traffic-injury mortality rates respectively. RESULTS: There was an apparent increasing trend of traffic-related injuries in Shanghai from 1987 to 2003 with the rate of growth in motorization. The average rates of annual increase are 3.59% in fatalities (from 7.78 per 100,000 population to 14.18 per 100,000 population) during the period. Pedestrians were the most common type of victims (29.6%), followed by bicyclists (25.1%), and motorcyclists (24.1%). Males accounted for the majority of all victims, over 69%. The population of high-school and lower high-school education level represented 66.4% victims of total road-traffic injuries. And if no special factors effect its development, the traffic fatalities would be up to 17.84 per 100,000 population in 2010, when calculating from equations we found and validated Y(t) = 359.90 x e0.027(t-1)-352.13, (t = 1, 2, ..., N) for Shanghai. CONCLUSION: Our data indicate the risk of fatal traffic injuries has increased in recent years and will go on growing in the near future in Shanghai. The findings showed that Grey dynamic model GM (1,1) is eligible on the prediction and can be a tool for injuries forecasting, implementing effective policies, programs, and interventions for reducing traffic injuries in the big cities.     

Pedestrian Casualties and Fatalities in Road Traffic Crashes in a South African Municipality

A study of the pedestrian casualties and fatalities in road traffic crashes in Durban, a South African municipality, for 1999 was undertaken using official road traffic accident data. The pedestrians age 25 to 44, although only 23.9% of the population, were 39.3% of the casualties and 48.2% of the fatalities. The most vulnerable pedestrians were those 30 to 34 years old who were 6.1% of the population, 11.7% of the casualties, and 14.6% of the fatalities; 35- to 39-year-olds who were 6% of the population, 8.8% of the casualties, and 13.5% of the fatalities; and the 40- to 44-year-olds who were 4.9% of the population, 7.5% of the casualties, and 10.2% of the fatalities. Cars were involved in 52% of the vehicle-pedestrian crashes but had fewer crashes than minibuses and buses, and fewer casualties and fatalities than minibuses, buses, and motorcycles. Minibuses recorded the most crashes at 1,037 per 100 million km, the highest casualty rate of 268 per 100 million km, and highest fatality rate of 17 per 100 million km. Buses, which were involved in 3% of the vehicle-pedestrian crashes, had 951 crashes per 100 million km, 182 casualties per 100 million km, and 11 fatalities per 100 million km. Motorcycles were involved in 1% of the vehicle-pedestrian crashes and had per 100 million km 508 crashes, 192 casualties, and 7 fatalities. There was no statistically significant difference in the monthly distribution of the road traffic crashes.     

Pedestrian casualties and fatalities in road traffic crashes in a South African municipality

A study of the pedestrian casualties and fatalities in road traffic crashes in Durban, a South African municipality, for 1999 was undertaken using official road traffic accident data. The pedestrians age 25 to 44, although only 23.9% of the population, were 39.3% of the casualties and 48.2% of the fatalities. The most vulnerable pedestrians were those 30 to 34 years old who were 6.1% of the population, 11.7% of the casualties, and 14.6% of the fatalities; 35- to 39-year-olds who were 6% of the population, 8.8% of the casualties, and 13.5% of the fatalities; and the 40- to 44-year-olds who were 4.9% of the population, 7.5% of the casualties, and 10.2% of the fatalities. Cars were involved in 52% of the vehicle-pedestrian crashes but had fewer crashes than minibuses and buses, and fewer casualties and fatalities than minibuses, buses, and motorcycles. Minibuses recorded the most crashes at 1,037 per 100 million km, the highest casualty rate of 268 per 100 million km, and highest fatality rate of 17 per 100 million km. Buses, which were involved in 3% of the vehicle-pedestrian crashes, had 951 crashes per 100 million km, 182 casualties per 100 million km, and 11 fatalities per 100 million km. Motorcycles were involved in 1% of the vehicle-pedestrian crashes and had per 100 million km 508 crashes, 192 casualties, and 7 fatalities. There was no statistically significant difference in the monthly distribution of the road traffic crashes.     

An examination of the increases in pedestrian motor-vehicle crash fatalities during 2009–2016

IntroductionPedestrian fatalities increased 46% in the United States during 2009–2016. This study identified circumstances under which the largest increases in deaths occurred during this period.MethodAnnual counts of U.S. pedestrian fatalities and crash involvements were extracted from the Fatality Analysis Reporting System and General Estimates System. Poisson regression examined if pedestrian fatalities by various roadway, environmental, personal, and vehicle factors changed significantly during 2009–2016. Linear regression examined changes over the study period in pedestrian deaths per 100 crash involvements and in horsepower per 1000 pounds of weight among passenger vehicles involved in fatal single-vehicle pedestrian crashesResultsPedestrian deaths per 100 crash involvements increased 29% from 2010, when they reached their lowest point, to 2015, the most recent year for which crash involvement data were available. The largest increases in pedestrian deaths during 2009–2016 occurred in urban areas (54% increase from 2009 to 2016), on arterials (67% increase), at nonintersections (50% increase), and in dark conditions (56% increase). The rise in the number of SUVs involved in fatal single-vehicle pedestrian crashes (82% increase) was larger than the increases in the number of cars, vans, pickups, or medium/heavy trucks involved in these crashes. The power of passenger vehicles involved in fatal single-vehicle pedestrian crashes increased over the study period, with larger increases in vehicle power among more powerful vehicles.ConclusionsEfforts to turn back the recent increase in pedestrian fatalities should focus on the conditions where the rise has been the greatest.Practical applicationsTransportation agencies can improve urban arterials by investing in proven countermeasures, such as road diets, median crossing islands, pedestrian hybrid beacons, and automated speed enforcement. Better road lighting and vehicle headlights could improve pedestrian visibility at night.     

The effects of mobile speed camera introduction on road traffic crashes and casualties in a rural county of England

PROBLEM: This study assesses the impact of crash and casualty numbers in correspondence to the introduction of mobile speed cameras in the rural county of Norfolk, England. METHOD: Road traffic accident casualty and crash data were collected for two years before the introduction of cameras and two years subsequently. The casualties and crashes occurring at 29 camera sites were identified and separated from those occurring in the rest of the county. Trends in crashes and casualties, and their severity, were examined graphically and comparisons were made between before and after periods. The regression to the mean effect at individual sites was estimated. RESULTS: After the introduction of cameras, overall crashes declined by 1% and crashes involving fatalities or serious injuries declined by 9% on the roads without cameras. At the camera sites, crashes decreased by 19% and fatal and serious crashes by 44%. The reduction in total crashes was significantly greater than that expected from the effect of regression to the mean in 12 out of 20 sites tested. SUMMARY: The introduction of cameras appears to have resulted in real and measurable reductions in crash risk in this rural county. IMPACT ON INDUSTRY: Our results suggest the deployment of mobile speed cameras is an effective tool for organizations wishing to reduce road traffic casualties in areas where high crash rates have been associated with excessive vehicle speeds.     

Older drivers’ involvement in fatal RTCs. Do crashes fatal to them differ from crashes involving them but fatal to others?

In several countries, older drivers are disproportionately involved in fatal road traffic crashes (RTCs) for various reasons. This study maps the circumstances of occurrence of crashes involving older drivers that are fatal to either them or other road users and highlights differences between them. Sweden’s national in-depth studies of fatal RTCs archive was used and focus was placed on crashes in which a driver aged 65 years or older was involved between 2002 and 2004 (n = 197). Thirteen driver and crash characteristics were analyzed simultaneously and typical crash patterns (classes) were highlighted. For each pattern, the proportions of crashes fatal to the older driver vs. to someone else were compared. Four patterns were identified: (1) crashes on low-speed stretches, involving left turn and intersections; (2) crashes involving very old drivers and older vehicles, (3) rear-end collisions on high-speed stretches; and (4) head-on and single-vehicle crashes in rural areas. Older drivers dying in the crash were over-represented in classes 2 and 4. The study shows that when older drivers are involved in fatal RTCs, they are often the ones who die (60%). Typical circumstances surrounding their involvement include manoeuvring difficulties, fast-moving traffic, and colliding in an old vehicle. Preventing fatal RTCs involving older drivers requires not only age-specific but also general measures.     

Teenage driver crash incidence and factors influencing crash injury by rurality

BackgroundPrevious research has identified teenage drivers as having an increased risk for motor-vehicle crash injury compared with older drivers, and rural roads as having increased crash severity compared with urban roads. Few studies have examined incidence and characteristics of teen driver-involved crashes on rural and urban roads.MethodsAll crashes involving a driver aged 10 through 18 were identified from the Iowa Department of Transportation crash data from 2002 through 2008. Rates of overall crashes and fatal or severe injury crashes were calculated for urban, suburban, rural, and remote rural areas. The distribution of driver and crash characteristics were compared between rural and urban crashes. Logistic regression was used to identify driver and crash characteristics associated with increased odds of fatal or severe injury among urban and rural crashes.ResultsFor younger teen drivers (age 10 through 15), overall crash rates were higher for more rural areas, although for older teen drivers (age 16 through 18) the overall crash rates were lower for rural areas. Rural teen crashes were nearly five times more likely to lead to a fatal or severe injury crash than urban teen crashes. Rural crashes were more likely to involve single vehicles, be late at night, involve a failure to yield the right-of-way and crossing the center divider.ConclusionsIntervention programs to increase safe teen driving in rural areas need to address specific risk factors associated with rural roadways.Impact on IndustryTeen crashes cause lost work time for teen workers as well as their parents. Industries such as safety, health care, and insurance have a vested interest in enhanced vehicle safety, and these efforts should address risks and injury differentials in urban and rural roadways.     

Probationary and non-probationary drivers' nighttime crashes in Western Australia, 1996-2000

INTRODUCTION: This study was designed to explore the temporal aspects of crashes for probationary and non-probationary drivers. METHODS: Data from the West Australian Road Injury Database from 1996-2000 were used to calculate age-sex-specific crash rates per 100,000 person-days and to plot proportions of fatal and hospital crashes by time for probationary and non-probationary drivers. The population attributable risk was used to estimate the potential number of lives saved by nighttime driving restriction in the probationary period. RESULTS: Probationary drivers were seven times more likely to crash than non-probationary drivers. While the highest number of crashes was in the daytime, probationary drivers had a higher proportion of fatal or hospitalization crashes at night than non-probationary drivers. CONCLUSION: Restrictions on driving at night could form part of graduated driver training. Even if some probationary drivers disobeyed the restriction, a substantial reduction in car occupant fatalities and hospitalizations could result.     

Using medico-legal data to investigate fatal older road user crash circumstances and risk factors

Objective: This study used medico-legal data to investigate fatal older road user (ORU, aged 65 years and older) crash circumstances and risk factors relating to 4 key components of the Safe System approach (e.g., roads and roadsides, vehicles, road users, and speeds) to identify areas of priority for targeted prevention activity.

Method: The Coroners' Court of Victoria's (CCOV) Surveillance Database was searched to identify and describe the frequency and rate per 100,000 population of fatal ORU crashes in the Australian state of Victoria for 2013–2014. Information relating to the deceased ORU, crash characteristics and circumstances, and risk factors was extracted and analyzed.

Results: One hundred and thirty-eight unintentional fatal ORU crashes were identified in the CCOV Surveillance Database. Of these fatal ORU crashes, most involved older drivers (44%), followed by older pedestrians (32%), older passengers (17%), older pedal cyclists (4%), older motorcyclists (1%), and older mobility scooter users (1%). The average annual rate of fatal ORU crashes per 100,000 population was 8.1 (95% confidence interval [CI], 6.0–10.2). In terms of the crash characteristics and circumstances, most fatal ORU crashes involved a counterpart (98%), of which the majority were passenger cars (50%) or fixed/stationary objects (25%), including trees (46%) or embankments (23%). In addition, most fatal ORU crashes occurred close to home (73%), on-road (87%), on roads that were paved (94%), on roads with light traffic volume (37%), and during low-risk conditions: between 12 p.m. and 6 p.m. (44%), on weekdays (80%), during daylight (75%), and under dry/clear conditions (81%). Road user (RU) error was identified by the police and/or the coroner for the majority of fatal crashes (55%), with a significant proportion of deceased ORUs deemed to have failed to yield (54%) or misjudged (41%).

Conclusions: RU error was the most significant factor identified in fatal ORU crashes, which suggests that there is a limited capacity of the road system to fully accommodate RU errors. Initiatives related to safer roads and roadsides, vehicles, speed zones, as well as behavioral approaches are key areas of priority for targeted activity to prevent fatal ORU crashes in the future.     

Nighttime pedestrian fatalities: A comprehensive examination of infrastructure,user, vehicle,and situational factors

Introduction: Pedestrian fatalities in the United States increased 45.5% between 2009 and 2017. More than 85% of those additional pedestrian fatalities occurred at night. Method: We examine Fatality Analysis Reporting System (FARS) data for fatal pedestrian crashes that occurred in the dark between 2002 and 2017. Within-variable and before/after examinations of crashes in terms of infrastructure, user, vehicle, and situational characteristics are performed with one-way analysis of variance (ANOVA) and two-sample t-tests. We model changes in crash characteristic proportions between 2002–2009 and 2010–2017 using linear regressions and test for autocorrelation with Breusch-Godfrey tests. Results: The increase in fatal nighttime pedestrian crashes is most strongly correlated with infrastructure factors: non-intersection unmarked locations (saw 80.8% of additional fatalities); 40–45 mph roads (54.6%); five-lane roads (40.7%); urban (99.7%); and arterials (81.1%). In addition, SUVs were involved in 39.7% of additional fatalities, overrepresenting their share of the fleet. Increased pedestrian alcohol and drug involvement warrant further investigation. The age of pedestrians killed increased more (18.1%) than the national average (3.2%). Conclusions: By identifying factors related to the increase in nighttime pedestrian fatalities, this work constitutes a vital first step in making our streets safer for pedestrians. Practical Applications: More research is needed to understand the efficacy of different solutions, but this paper provides guidance for such future research. Engineering solutions such as road diets or traffic calming may be used to improve identified infrastructure issues by reducing vehicle speeds and road widths. Rethinking vehicle design, especially high front profiles, may improve vehicle issues. However, the problems giving rise to these pedestrian fatalities are likely a result of not only engineering issues but also interrelated social and political factors. Solutions may be correspondingly comprehensive, employing non-linear, systems-based approaches such as Safe Systems.     

The effectiveness of electronic stability control (ESC) in reducing real life crashes and injuries

Electronic Stability Control (ESC) was introduced on the mass market in 1998. Since then, several studies showing the positive effects of ESC have been presented. OBJECTIVE: In this study, data from crashes occurring in Sweden during 1998 to 2004 were used to evaluate the effectiveness of ESC on real life crashes. The effectiveness was analyzed for different road conditions, and some accident types and injury levels. METHODS: The study used statistical analysis. To control for exposure, induced exposure methods were used, where ESC-sensitive to ESC-insensitive crashes and road conditions were matched in relation to cars equipped with and without ESC. Cars of similar or, in some cases, identical make and model were used to isolate the role of ESC. RESULTS: The study shows a positive and consistent effect of ESC overall and in circumstances where the road has low friction. The overall effectiveness on all injury crash types, except rear end crashes, was 16.7 +/- 9.3%, while for serious and fatal crashes; the effectiveness was 21.6 +/- 12.8%. The corresponding estimates for crashes with injured car occupants were 23.0 +/- 9.2% and 26.9 +/- 13.9%.For serious and fatal loss-of-control type crashes on wet roads the effectiveness was 56.2 +/- 23.5% and for roads covered with ice or snow the effectiveness was 49.2 +/- 30.2%. It was estimated that for Sweden, with a total of 500 vehicle related deaths annually, that 80-100 fatalities could be saved annually if all cars had ESC.CONCLUSIONS: ESC was found to reduce crashes with personal injuries, especially serious and fatal injuries. The effectiveness ranged from at least 13% for car occupants in all types of crashes with serious or fatal outcome to a minimum of 35% effectiveness for single/oncoming/overtaking serious and fatal crashes on wet or icy road surface. No difference in deformation pattern was found for cars with or without ESC.     

The potential of vehicle and road infrastructure interventions in fatal bicyclist accidents on Swedish roads—What can in-depth studies tell us?

Abstract

Objective: The objective of this article is to describe the characteristics of fatal crashes with bicyclists on Swedish roads in rural and urban areas and to investigate the potential of bicycle helmets and different vehicle and road infrastructure interventions to prevent them. The study has a comprehensive approach to provide road authorities and vehicle manufacturers with recommendations for future priorities.

Methods: The Swedish Transport Administration’s (STA) in-depth database of fatal crashes was used for case-by-case analysis of fatal cycling accidents (2006–2016) on rural (n?=?82) and urban (n?=?102) roads. The database consists of information from the police, medical journals, autopsy reports, accident analyses performed by STA, and witness statements. The potential of helmet use and various vehicle and road infrastructure safety interventions was determined retrospectively for each case by analyzing the chain of events leading to the fatality. The potential of vehicle safety countermeasures was analyzed based on prognoses on their implementation rates in the Swedish vehicle fleet.

Results: The most common accident scenario on rural roads was that the bicyclist was struck while cycling along the side of the road. On urban roads, the majority of accidents occurred in intersections. Most accidents involved a passenger car, but heavy trucks were also common, especially in urban areas. Most accidents occurred in daylight conditions (73%). Almost half (46%) of nonhelmeted bicyclists would have survived with a helmet. It was assessed that nearly 60% of the fatal accidents could be addressed by advanced vehicle safety technologies, especially autonomous emergency braking with the ability to detect bicyclists. With regard to interventions in the road infrastructure, separated paths for bicyclists and bicycle crossings with speed calming measures were found to have the greatest safety potential. Results indicated that 91% of fatally injured bicyclists could potentially be saved with known techniques. However, it will take a long time for such technologies to be widespread.

Conclusions: The majority of fatally injured bicyclists studied could potentially be saved with known techniques. A speedy implementation of important vehicle safety systems is recommended. A fast introduction of effective interventions in the road infrastructure is also necessary, preferably with a plan for prioritization.     

Pedestrians under influence (PUI) crashes: Patterns from correspondence regression analysis

Introduction: Alcohol-related impairment is a key contributing factor in traffic crashes. However, only a few studies have focused on pedestrian impairment as a crash characteristic. In Louisiana, pedestrian fatalities have been increasing. From 2010 to 2016, the number of pedestrian fatalities increased by 62%. A total of 128 pedestrians were killed in traffic crashes in 2016, and 34.4% of those fatalities involved pedestrians under the influence (PUI) of drugs or alcohol. Furthermore, alcohol-PUI fatalities have increased by 120% from 2010 to 2016. There is a vital need to examine the key contributing attributes that are associated with a high number of PUI crashes. Method: In this study, the research team analyzed Louisiana’s traffic crash data from 2010 to 2016 by applying correspondence regression analysis to identify the key contributing attributes and association patterns based on PUI involved injury levels. Results: The findings identified five risk clusters: intersection crashes at business/industrial locations, mid-block crashes on undivided roadways at residential and business/residential locations, segment related crashes associated with a pedestrian standing in the road, open country crashes with no lighting at night, and pedestrian violation related crashes on divided roadways. The association maps identified several critical attributes that are more associated with fatal and severe PUI crashes. These attributes are dark to no lighting, open country roadways, and non-intersection locations. Practical Applications: The findings of this study may be used to help design effective mitigation strategies to reduce PUI crashes.     

Characteristics of vehicle-animal crashes in which vehicle occupants are killed

During the past 10 years almost 1,500 people have been killed in motor vehicle collisions with animals. Police reports on 147 fatal vehicle-animal crashes during 2000-2002 were obtained from nine states. The goal was to determine common crash types, types of animals involved, and steps that could be taken to reduce the crashes and injuries. Seventy-seven percent of the struck animals were deer, but six other types of animals were involved including small ones such as dogs. Eighty percent of the crashes were single-vehicle events. In most of these cases a motorcycle struck an animal and the rider came off the vehicle, or a passenger vehicle struck an animal and then ran off the road; in a few cases the animal went through the windshield. Multiple-vehicle crashes included vehicles striking deer that went through the windshields of oncoming vehicles, vehicles striking animals and then colliding with other vehicles, and vehicles striking animals that subsequently were struck by other vehicles. Crashes occurred primarily in rural areas, on roads with 55 mph or higher speed limits, during evening or nighttime hours, and in darkness. Greater application of deer-vehicle collision countermeasures known to be effective is needed, but it is noteworthy that a majority of fatalities occurred from subsequent collisions with other vehicles or objects, not from animal contacts. Sixty-five percent of motorcyclists killed were not wearing helmets, and 60% of vehicle occupants killed were unbelted; many of these fatalities would not have occurred with proper protection.     

Impact of primary safety belt laws on alcohol-related front-seat occupant fatalities: five case studies

OBJECTIVE: Impaired drivers and other high-risk road users are less likely to use their safety belts, thus increasing the risk of fatal injury in the event of a crash. Although safety belt laws have been shown to increase wearing rates for daytime non-crash-involved drivers and their front-seat passengers, little evidence is available on the effect these laws have on belt usage by crash-involved drinking drivers and their passengers. METHODS: This study evaluated the influence of primary safety belt law upgrades from secondary laws on front-seat occupants of passenger cars driven by drinking drivers in fatal crashes in five states: California, Illinois, Maryland, Michigan, and Washington. The outcome measures used to evaluate these law upgrades were (1) the change in safety belt usage rates of front-seat occupants in passenger cars driven by drinking drivers in fatal crashes and (2) the change in alcohol-related front-seat occupant fatalities in passenger cars driven by drinking drivers. RESULTS: Four of the five states demonstrated increases in safety belt use by front-seat occupants of passenger cars of drinking drivers in fatal crashes following the upgrade to primary safety belt laws. Three states (California, Michigan, and Washington) experienced significant reductions in the number of front-seat occupant fatalities in vehicles driven by drinking drivers. CONCLUSIONS: The adoption of primary law upgrades was associated with significant increases in safety belt use (four of five states) and significant reductions in fatalities among high-risk occupants (i.e., front-seat occupants involved in fatal crashes in vehicles driven by drinking drivers) in three of the five states studied.     

Traumatic brain injury mortality among U.S. children and adolescents ages 0–19 years, 1999–2017

IntroductionTo examine recent traumatic brain injury (TBI) mortality changes among Americans aged 0–19 years by sex, age, urbanicity, state, and intent/causes of injury. Method: TBI mortality per 100,000 population and average annual percent changes (AAPCs), plus 95% confidence intervals (CIs) based on Joinpoint regression models. Results: Age-adjusted TBI mortality among Americans aged 0–19 years declined consistently, though at varying rates between 1999 and 2013 (AAPC = −4.8%, 95%CI: −6.3%, −3.2%), and then significantly increased from 4.42 per 100,000 population in 2013 to 5.17 per 100,000 population in 2017 (AAPC = 3.4%, 95% CI: 1.7%, 5.1%). During the study time period, boys, rural children, and youth aged 15–19 years had higher TBI mortality rates than girls, urban children, and younger children, respectively. TBI mortality from unintentional transport crashes decreased substantially in all age groups between 1999 and 2017, and especially from 1999 to 2010. TBI mortality from suicide increased significantly from 2008 to 2017 in the 10–14-year age group (AAPC = 14.6%, 95% CI: 12.6%, 16.6%) and from 2007 to 2017 in the 15–19-year age group (AAPC = 6.3%, 95% CI: 3.8%, 8.7%). Unintentional transport crashes were the leading cause of TBI-related mortality in 46 states in 1999, but by 2017, suicide became the first leading cause in 14 states. Conclusions: Pediatric TBI mortality declined consistently between 1999 and 2013 and increased significantly from 2013 to 2017, driven primarily by the mortality decrease from unintentional transport crashes and increase in suicide mortality. The spectrum of leading causes of pediatric TBI mortality changed across age groups and over time from 1999 to 2017. Practical Applications: TBI mortality increases in the United States since 2013 are driven primarily by increasing suicide rates, a trend that merits the attention of policy-makers and injury researchers. Action should be taken to curb growing TBI mortality rates among adolescents aged 10–19 years.     

Continued trends in older driver crash involvement rates in the United States: Data through 2017–2018

Introduction: With the growing older adult population due to the aging baby-boom cohort, there was concern that increases in fatal motor-vehicle crashes would follow. Yet, previous analyses showed this to be untrue. The purpose of this study was to examine current trends to determine if previous declines have persisted or risen with the recent increase in fatalities nationwide. Methods: Trends among drivers ages 70 and older were compared with drivers 35–54 for U.S. passenger vehicle fatal crash involvements per 100,000 licensed drivers from 1997 to 2018, fatal and all police-reported crash involvements per vehicle miles traveled using the 1995, 2001, 2009, and 2017 National Household Travel Surveys, and driver deaths per 1,000 crashes. Results: Since the mid-1990s, fatal crashes per licensed driver trended downward, with greater declines for drivers ages 70 and older than for middle-aged drivers (43% vs. 21%). Fatal crash rates per 100,000 licensed drivers and police-reported crash rates per mile traveled for drivers ages 70–79 are now less than those for drivers ages 35–54, but their fatal crash rates per mile traveled and risk of dying in a crash remain higher as they drive fewer miles. As the economy improved over the past decade, fatal crash rates increased substantially for middle-aged drivers but decreased or remained stable among older driver age groups. Conclusions: Fatal crash involvements for adults ages 70 and older has recently increased, but they remain down from their 1997 peak, even as the number of licensed older drivers and the miles they drive have increased. Health improvements likely contributed to long-term reductions in fatal crash rates. As older drivers adopt vehicles with improved crashworthiness and safety features, crash survivability will improve. Practical Application: Older adults should feel confident that their independent mobility needs pose less risk than previously expected.     

国外乡村公路交通安全水平

收集和整理了美国、加拿大、英国、澳大利亚等国关于乡村公路交通安全的管理和研究成果;归纳国外乡村公路的定义;分析乡村公路在交通事故数量、伤亡人数、死伤率等方面的基本情况。笔者通过对国外乡村公路交通安全水平研究,有如下3个结论:第一,目前还没有一个被普遍接受的乡村公路的定义;第二,乡村公路的交通事故后果比城市道路严重得多;第三,乡村公路交通安全水平提高的速度比城市道路慢;吸取国外乡村公路交通安全管理经验,为我国农村公路交通安全水平的改善提供有益的借鉴。     

Influence of built environment and roadway characteristics on the frequency of vehicle crashes caused by driver inattention: A comparison between rural roads and urban roads

Introduction: With prevalent and increased attention to driver inattention (DI) behavior, this research provides a comprehensive investigation of the influence of built environment and roadway characteristics on the DI-related vehicle crash frequency per year. Specifically, a comparative analysis between DI-related crash frequency in rural road segments and urban road segments is conducted. Method: Utilizing DI-related crash data collected from North Carolina for the period 2013–2017, three types of models: (1) Poisson/negative binomial (NB) model, (2) Poisson hurdle (HP) model/negative binomial hurdle (HNB) model, and (3) random intercepts Poisson hurdle (RIHP) model/random intercepts negative binomial hurdle (RIHNB) model, are applied to handle excessive zeros and unobserved heterogeneity in the dataset. Results: The results show that RIHP and RIHNB models distinctly outperform other models in terms of goodness-of-fit. The presence of commercial areas is found to increase the probability and frequency of DI-related crashes in both rural and urban regions. Roadway characteristics (such as non-freeways, segments with multiple lanes, and traffic signals) are positively associated with increased DI-related crash counts, whereas state-secondary routes and speed limits (higher than 35 mph) are associated with decreased DI-related crash counts in rural and urban regions. Besides, horizontal curved and longitudinal bottomed segments and segments with double yellow lines/no passing zones are likely to have fewer DI-related crashes in urban areas. Medians in rural road segments are found to be effective to reduce DI-related crashes. Practical Applications: These findings provide a valuable understanding of the DI-related crash frequency for transportation agencies to propose effective countermeasures and safety treatments (e.g., dispatching more police enforcement or surveillance cameras in commercial areas, and setting more medians in rural roads) to mitigate the negative consequences of DI behavior.