A neglected risky behavior among children and adolescents: underage driving and injury in New South Wales,Australia

PROBLEM: Among different causes of injury, roads and traffic-related incidents contributed most to all child deaths. The majority of childhood and adolescent traffic-related deaths are young people killed as pedestrians or bicyclists. Underage driving is a particular risky behavior much neglected. This study aimed to describe some characteristics related to motor-vehicle crashes and crash-related injury in which the vehicle was driven by a young person who was under the legal age of obtaining a learner license in New South Wales, Australia. METHODS: Data used in this study were made available from the Roads and Traffic Authority of NSW for the period between 1996 and 2000. Crash information was collected and reported by NSW police at the scene of these motor-vehicle crash incidents. RESULTS: There were 526 crashes involving an underage driver recorded within the study period. The majority (79.5%) of these underage drivers were males with slightly more than half (58.0%) aged 15 years, and nearly 30% aged 14 years. Among these, 83.6% involved the driver of the vehicle being killed or injured. Among the injured or killed passengers, 128 (73.6%) were nonadult passengers under the age of 18 years. Seventy of these crashes occurred while the car was in pursuit by police. The adjusted relative risk of injury to at least one occupant in the vehicle should a crash occur for female underage drivers was two times (OR=2.01, 95% CI=1.27-3.20) as compared to male underage drivers. DISCUSSION: Underage driving poses a serious problem in terms of crash outcomes. Experimental driving and late-night outings for adolescents should be discouraged. Well-designed studies are required to further investigate the relationship between underage driving and on road risk-taking behavior among licensed adolescents. IMPACT ON INDUSTRY: Data obtained from this study indicate that adults, particularly parents, should discourage underage adolescents from experimenting driving and should actively cultivate a positive attitude toward driving.     

Bicycle helmet use among persons 5 years and older in the United States, 2012

IntroductionIn 2013, injuries to bicyclists accounted for 925 fatalities and 493,884 nonfatal, emergency department-treated injuries in the United States. Bicyclist deaths increased by 19% from 2010 to 2013. The greatest risk of death and disability to bicyclists is head injuries. The objective of this study was to provide estimates of prevalence and associated factors of bicycle riding and helmet use among children and adults in the United States.MethodCDC analyzed self-reported data from the 2012 Summer ConsumerStyles survey. Adult respondents (18 + years) were asked about bicycle riding and helmet use in the last 30 days for themselves and their children (5 to 17 years). For bicycle riders, CDC estimated the prevalence of helmet use and conducted multivariable regression analyses to identify factors associated with helmet use.ResultsAmong adults, 21% rode bicycles within the past 30 days and 29% always wore helmets. Respondents reported that, of the 61% of children who rode bicycles within the past 30 days, 42% always wore helmets. Children were more likely to always wear helmets (90%) when their adult respondents always wore helmets than when their adult respondents did not always wear helmets (38%). Children who lived in states with a child bicycle helmet law were more likely to always wear helmets (47%) than those in states without a law (39%).ConclusionsDespite the fact that bicycle helmets are highly effective at reducing the risk for head injuries, including severe brain injuries and death, less than half of children and adults always wore bicycle helmets while riding.Practical applicationStates and communities should consider interventions that improve the safety of riding such as policies to promote helmet use, modeling of helmet wearing by adults, and focusing on high risk groups, including Hispanic cyclists, occasional riders, adults, and children ages 10 to 14.     

Functional outcomes of motor vehicle crash thoracic injuries in pediatric and adult occupants

Objective: Characterization of the severity of injury should account for both mortality and disability. The objective of this study was to develop a disability metric for thoracic injuries in motor vehicle crashes (MVCs) and compare the functional outcomes between the pediatric and adult populations.

Methods: Disability risk (DR) was quantified using Functional Independence Measure (FIM) scores within the National Trauma Data Bank for the most frequently occurring Abbreviated Injury Scale (AIS) 2–5 thoracic injuries. Occupants with thoracic injury were classified as disabled or not disabled based on the FIM scale, and comparisons were made between the following age groups: pediatric, adult, middle-aged, and older occupants (ages 7–18, 19–45, 46–65, and 66+, respectively). For each age group, DR was calculated by dividing the number of patients who were disabled and sustained a given injury by the number of patients who sustained a given injury. To account for the effect of higher severity co-injuries, a maximum AIS adjusted DR (DR_MAIS) was also calculated for each injury. DR and DR_MAIS could range from 0 to 100% disability risk.

Results: The mean DR_MAIS for MVC thoracic injuries was 20% for pediatric occupants, 22% for adults, 29% for middle-aged adults, and 43% for older adults. Older adults possessed higher DR_MAIS values for diaphragm laceration/rupture, heart laceration, hemo/pneumothorax, lung contusion/laceration, and rib and sternum fracture compared to the other age groups. The pediatric population possessed a higher DR_MAIS value for flail chest compared to the other age groups.

Conclusion: Older adults had significantly greater overall disability than each of the other age groups for thoracic injuries. The developed disability metrics are important in quantifying the significant burden of injuries and loss of quality life years. Such metrics can be used to better characterize severity of injury and further the understanding of age-related differences in injury outcomes, which can influence future age-specific modifications to AIS.     

General health status and functional disability following injury in traffic crashes

OBJECTIVE: With increasing rates of survival associated with traffic crashes, a shift to understand the consequences of injury has risen to prominence. This prospective cohort study set out to examine general health status and functional disability at 2 months and 6-8 months post-crash. METHODS: Participants were otherwise healthy adults aged 18-59 years admitted to hospitals, excluding those with moderate-severe head injury and spinal cord injury. Sixty-two adults completed interviews prior to discharge and at 2 months and 8 months post-discharge. RESULTS: By 8 months post-crash, 89 percent had resumed employment and or study, two thirds rated the resolution of their medical problems to be excellent (14.5 percent) or good (53 percent), and 82 percent were considered to be fully self-sufficient with respect to activities of daily living. Despite this, results from the SF-36 indicated significant reductions in health status at 2 and 8 months post-crash relative to pre-crash health, with domain scores up to 26 percent lower than pre-crash scores, while assessment of activities of daily living indicated residual functional disability at both follow-up times. Self-reported pain was higher for both males and females at both follow-up times compared with pre-crash self-reported pain. CONCLUSION: This study demonstrated significant, ongoing loss of health-related quality of life and impairment associated with injuries sustained in road crashes, highlighting the need for continuing care post-discharge to facilitate a rapid return to optimal health.     

Incidence of injury in children and adolescents with intellectual and developmental disability

Introduction: Children and adolescents living with intellectual and developmental disability (IDD) have a higher risk of experiencing morbidities and premature death when compared to children and adolescents living without IDD. Childhood injuries are a leading cause of morbidity and death, yet there are limited studies that explore the prevalence of childhood injuries for individuals living with IDD. The purpose of this study was to analyze Ontario health administrative data to identify and compare rates of injury resulting in hospitalization in children and adolescents living with and without IDD. Methods: This is a cross-sectional study of all Ontarians aged 0–19 years with and without IDD. The outcome of interest was the rate of injury resulting in hospitalization. Results: This study found that children and adolescents with IDD had 1.79 (CI 1.66, 1.92) times higher rates of both intentional and unintentional injuries that resulted in hospitalization when compared to children and adolescents without IDD. Hospitalizations for self-harm related injuries were 3.16 (CI 3.09, 3.23) times higher in the IDD group. Conclusion: Children and adolescents with IDD have a higher risk of sustaining serious injuries, particularly injuries resulting from self-harm. Practical Applications: This study provides evidence of increased injury related hospitalizations for children and adolescents with IDD when compared to their peers without IDD.     

Self-reported falls and fall-related injuries among persons aged>or=65 years--United States, 2006

PROBLEM: In 2005, 15,802 persons aged>or=65 years died from fall injuries. How many older adults seek outpatient treatment for minor or moderate fall injuries is unknown. METHOD: To estimate the percentage of older adults who fell during the preceding three months, the Centers for Disease Control and Prevention (CDC) analyzed data from two questions about falls included in the 2006 Behavioral Risk Factor Surveillance System (BRFSS) survey. RESULTS: Approximately 5.8 million (15.9%) persons aged>or=65 years reported falling at least once during the preceding three months, and 1.8 million (31.3%) of those who fell sustained an injury that resulted in a doctor visit or restricted activity for at least one day. DISCUSSION: This report presents the first national estimates of the number and proportion of persons reporting fall-related injuries associated with either doctor visits or restricted activity. SUMMARY: The prevalence of falls reinforces the need for broader use of scientifically proven fall-prevention interventions. IMPACT ON INDUSTRY: Falls and fall-related injuries represent an enormous burden to individuals, society, and to our health care system. Because the U.S. population is aging, this problem will increase unless we take preventive action by broadly implementing evidence-based fall prevention programs. Such programs could appreciably decrease the incidence and health care costs of fall injuries, as well as greatly improve the quality of life for older adults.     

The effects of primary prevention policies on mortality from motor-vehicle crashes among children in the United States

Introduction: Every year, 4500 children die in motor-vehicle crashes in the United States, with estimated costs of more than $40,000 and $240 billion in productivity losses. The majority of deaths and injuries are associated with improper use of restraint devices, alcohol, high speeds, and built environments. Methodology: This is a retrospective study using U.S. panel data from 1997 through 2005. Data sources included the Fatality Analysis Reporting System, the Insurance Institute for Highway Safety, the U.S. Census Bureau, the Atlas of Presidential Elections, and the U.S. Bureau of Labor Statistics. This study used conditional fixed effects negative binomial regression to analyze the effect of the covariates on mortality by state and year. Results: A total of 32,893 children died in motor-vehicle crashes (MVCs). States that allowed fines greater than $50 for lack of restraint use experienced significant reductions in mortality as well as states with laws allowing the use of red light cameras. Graduate licensing programs requiring a minimum age of 16 for the intermediate-level experienced mortality reductions as much as 90% compared with a minimum age of 14. Higher posted speeds were associated with higher mortality rates, particularly on local roads. Conclusion: This research focuses on the effects injury prevention laws have on mortality, but not on how effectively these laws are implemented and/or enforced. Results may be useful to policy-makers and public health practitioners involved in injury prevention and public health. Practical applications: Design appropriate education and training programs in road safety, implement effective road safety interventions and improve traffic safety legislation.     

Implications of Functional Capacity Loss and Fatality for Vehicle Safety Prioritization

Objective: We investigate the use of the Functional Capacity Index (FCI) as a tool for establishing vehicle safety priorities by comparing the life year burden of injuries to the burden of fatality in frontal and side automotive crashes. We demonstrate FCI’s utility by investigating in detail the resulting disabling injuries and their life year costs.

Methods: We selected occupants in the 2000–2013 NASS-CDS database involved in frontal and side crashes, merged their injuries with FCI, and then used the merged data to estimate each occupant’s overall functional loss. Lifetime functional loss was assessed by combining this measure of impairment with the occupants’ expected future life spans, estimated from the Social Security Administration’s Actuarial Life Table.

Results: Frontal crashes produce a large number of disabling injuries, particularly to the lower extremities. In our population, these crashes are estimated to account for approximately 400,000 life years lost to disability in comparison with 500,000 life years lost to fatality. Victims of side crashes experienced a higher rate of fatality but a significantly lower rate of disabling injury (0.3 vs. 1.0%), resulting in approximately 370,000 life years lost to fatality versus 50,000 life years lost to disability.

Conclusions: The burden of disabling injuries to car crash survivors should be considered when setting vehicle safety design priorities. In frontal crashes this burden in life years is similar to the burden attributable to fatality.     

Mandatory child restraint laws: Impact on childhood injuries due to traffic crashes

Research has indicated that laws requiring use of restraint devices for young children traveling in automobiles have had significant effects in increasing restraint use and reducing crash-related childhood injuries. This study examined dimensions along which the effectiveness of Michigan's April 1982 mandatory child restraint law varied. All children involved in motor vehicle crashes in Michigan from January 1978 through December 1982 were analyzed using multivariate intervention analysis methods. Research revealed that the effectiveness of the law in reducing childhood injuries was primarily due to reductions in less severe injuries occurring in crashed vehicles experiencing low to moderate levels of damage. Furthermore, the mechanism for the law's effects was not simply an increase in restraint use. In addition, the number of children riding in the more dangerous front-seat and cargo-area positions apparently decreased following implementation of the law, with children increasingly riding in the safer rear-seat position.     

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.     

Winter storm-related injuries in Oklahoma, January 2007

Introduction

A January 2007 ice storm occurred in Oklahoma, causing power outages and hazardous travel conditions. The objective of this investigation was to describe the nature of winter storm-related injuries among Oklahoma residents, to determine populations at risk, and to inform prevention-planning personnel.

Methods

Winter storm-related injuries were a temporarily reportable condition; all acute-care hospitals and the state medical examiner logged storm-related injuries and deaths during January 12 − 30, 2007. Medical records were retrospectively abstracted.Risk of injury was described by demographic group, injury type, and mechanism.

Results

Among 6,047 persons experiencing winter storm-related injuries, 74% were injured in falls, 13% in motor-vehicle collisions (MVCs), 8% while sledding, 1% by unintentional carbon monoxide poisoning, 1% in cleanup activities, and 3% by other mechanisms. Median age of injured persons was 39 years. Persons aged ≥ 40 years were 1.4 times more likely to experience falls as the cause of injury than those aged < 40 years, and falls were twice as likely as other mechanisms to cause fractures among persons aged ≥ 40 years. Injured persons aged < 40 years were 2.2 times more likely to experience MVC-related injuries, and 19 times more likely to experience sledding-related injuries than persons aged ≥ 40 years.

Conclusions

Younger persons were more likely injured in MVCs and sledding incidents, whereas older persons were more likely to experience falls and fractures.

Impact on industry

Prevention messages for winter storm-related injuries should target winter-driving safety tips to younger adults and precautions regarding falls to older adults.     

Fatal occupational injuries in Jordan during the period 1980 through 1993

All fatal occupational injuries compensated by the Social Security Corporation (SSC) in Jordan during the period 1980–1993 were studied. Variables considered in the analysis included gender, age, nationality, occupation, salary, cause of injury, body part injured and cause of death. The overall fatality rate, of the 705 cases reviewed, was 25.5/100,000/year. The majority (98%) of fatalities were males. The risk of fatal injuries increased with age. Workers over 55 years, had the highest annual fatality rate (37.8). Immigrant workers had a higher fatality rate (32.26) than Jordanians (23.95). Unskilled workers constituted 58.3% of decedents and professionals had the highest fatality rate (52.9). Transportation sector had the highest fatality rate (122.4) followed by construction (50.6). Over the study period, fatality rates tended to decrease significantly in manufacturing, construction and trade economic sectors while no such trend was established by transportation, agriculture and services sectors. The leading causes of fatal injuries were motor-vehicle related accidents (63.0%) and fall of persons (11.1%). Head was the body part most injured and was involved in 46.6% of all deaths. Haemorrhage was the main reported cause of death (24.5%). It is concluded that intervention measures targeting specific occupations (transportation and construction) and causes of fatalities such as motor-vehicle incidents are needed.     

Child passenger restraint use and emergency department--reported injuries: a special study using the National Electronic Injury Surveillance System-All Injury Program, 2004

INTRODUCTION: In 2004, more than 180,000 child passengers aged 相似文献   

Investigating traffic fatality trends and restraint use among rear-seat passengers in the United States, 2000–2016

Introduction: Motor-vehicle crash is one of the leading causes of unintentional injury death in the United States. Previous studies focused on fatalities among drivers and front-seat passengers, with a limited number of studies examining rear-seat passenger fatalities. The objectives of this study were to assess trends in rear-seat passenger motor-vehicle fatalities in the United States from 2000 to 2016 and to identify demographic factors associated with being unrestrained among fatally injured rear-seat passengers. Methods: Rear-seat passenger fatality data were obtained from the Fatality Analysis Reporting System (FARS) database. The fatality rate ratios for overall rear-seat passengers and for different age and sex groups were determined by comparing fatality rates in 2000 and 2016 using random effects models. Risk ratios of being unrestrained for age and sex groups were obtained using general estimating equations. Results: Compared to 2000, the overall rear-seat passenger fatality rate in 2016 decreased by 44% (95% confidence interval [CI]: 39–49%). In particular, the fatality rate among rear-seat passengers decreased more in males than females, and passengers aged 14–19 years experienced a larger decline than all other age groups. Fatally injured male rear-seat passengers had a higher risk of being unrestrained (adjusted risk ratio: 1.06, 95% CI: 1.04–1.07) than their female counterparts, and both youngest (≤13 years) and oldest (65–85 years) passengers were less likely to be unrestrained than those aged 20–64 years. Conclusions: Overall, fatality rates among rear-seat passengers have declined, with differential degrees of improvement by age and sex. Practical Applications: Continued restraint use enforcement campaigns targeted at teenagers and males would further preserve them from fatal injuries and improve traffic safety for the overall population.     

Coverage of motor vehicle crashes with injuries in U.S. newspapers, 1999-2002

Problem

The aims of the study were to evaluate information on motor-vehicle crashes with injuries provided in newspaper reports and to assess the frequency of thematic and episodic reporting of motor-vehicle crashes.

Method

The study used Fatal Analysis Reporting System (FARS) derived variables to code a nationally representative sample of U.S. newspaper reports of motor-vehicle crashes from 1999-2002. A total of 473 newspaper reports of motor-vehicle crashes with injuries were included. Information on the crash event, people involved, and vehicles was extracted. The reports were coded for episodic and thematic news framing.

Results

A majority of newspaper reports used episodic framing. The majority of reports included information on the type of crash, but characteristics about people and vehicles were rarely reported.

Discussion

Lack of information in newspapers makes them an incomplete source from which to influence public perceptions and attitudes.

Impact on industry

This provides an opportunity for news print media to improve public health content.

Impact on industry

Newspapers represent an important source of public information; they are, however, an incomplete source [Voight, B., Lapidus, G., Zavoski, R., & Banco, L. (1998). Injury reporting in Connecticut newspapers. Injury Prevention, 4, 292-294.; Baullinger, J., Quan, L., Bennett, E., Cummings, P., & Williams, K. (2001). Use of Washington state newspaper for submersion injury surveillance. Injury Prevention, 7, 339-342]. To increase the accuracy of information provided to the public through media sources, there is a need for increased communication between public health professionals and reporters.The results of this study raise concerns about the contents of motor-vehicle crash information provided in newspapers and suggest that newspapers do not provide information to allow public perception to be in accord with the importance of motor-vehicle crash injuries and health promoting actions to reduce risk of injury. More balanced and detailed information in newspapers would provide an opportunity for news print media to improve public health programs and public perception about the impact of motor-vehicle crashes on safety for all.     

Unintentional injury deaths in children and youth, 2010–2019

Background: Unintentional injuries are the leading cause of death for children and youth aged 1–19 in the United States. The purpose of this report is to describe how unintentional injury death rates among children and youth aged 0–19 years have changed during 2010–2019. Method: CDC analyzed 2010–2019 data from the National Vital Statistics System (NVSS) to determine two-year average annual number and rate of unintentional injury deaths for children and youth aged 0–19 years by sex, age group, race/ethnicity, mechanism, county urbanization level, and state. Results: From 2010–2011 to 2018–2019, unintentional injury death rates decreased 11% overall—representing over 1,100 fewer annual deaths. However, rates increased among some groups—including an increase in deaths due to suffocation among infants (20%) and increases in motor-vehicle traffic deaths among Black children (9%) and poisoning deaths among Black (37%) and Hispanic (50%) children. In 2018–2019, rates were higher for males than females (11.3 vs. 6.6 per 100,000 population), children aged < 1 and 15–19 years (31.9 and 16.8 per 100,000) than other age groups, among American Indian or Alaska Native (AIAN) and Blacks than Whites (19.4 and 12.4 vs. 9.0 per 100,000), motor-vehicle traffic (MVT) than other causes of injury (4.0 per 100,000), and rates increased as rurality increased (6.8 most urban [large central metro] vs. 17.8 most rural [non-core/non-metro] per 100,000). From 2010–2011 to 2018–2019, 49 states plus DC had stable or decreasing unintentional injury death rates; death rates increased only in California (8%)—driven by poisoning deaths. Conclusion and Practical Application: While the overall injury death rates improved, certain subgroups and their caregivers can benefit from focused prevention strategies, including infants and Black, Hispanic, and AIAN children. Focusing effective strategies to reduce suffocation, MVT, and poisoning deaths among those at disproportionate risk could further reduce unintentional injury deaths among children and youth in the next decade.     

The impact of a standard enforcement safety belt law on fatalities and hospital charges in Ohio

Introduction

The purpose of this study was to analyze linked crash and hospital data to determine the effect that enactment of a standard enforcement safety belt law in Ohio would have on hospital charges and direct medical costs due to motor-vehicle crashes, focusing on the impact to the state's Medicaid system.

Method

The linkage and analysis was conducted as part of the Ohio Crash Outcome Data Evaluation System (CODES) program. Current safety belt usage in Ohio stands at 82% with its secondary enforcement safety belt law.

Results

Assuming an increase in usage to 92% through standard enforcement, over $15.3 million in medical costs to Medicaid for injuries that occur in a single year could be prevented over a 10-year period. Cumulative savings could reach more than $91.2 million during the 10-year period. In addition, 161 fatalities could have been prevented in one year had all unbelted occupants who sustained a fatal injury instead chosen to wear their safety belt.

Summary and Impact on Industry

Clearly, substantial progress can be made in reducing the number of deaths and injuries, as well as medical costs associated with motor-vehicle crashes, by strengthening safety belt laws and increasing safety belt usage in Ohio.     

Risky behaviors and helmet use among young adolescent motorcyclists in Southern Thailand

Background: In Thailand, road traffic injuries are the leading cause of death for youth ages 15–19 years, with 80% of the injuries and deaths from motorcycle accidents. Objectives: To determine the prevalence of child and young adolescent motorcyclists in Hat Yai municipality and their risk behaviors. Method: A cross-sectional study was conducted between June 2011 and March 2012 in which 2,471 students, ages 8 to 18 years, were recruited from 9 primary and secondary schools in Hat Yai municipality. The questionnaire included questions on being a motorcycle rider or passenger, risky behaviors, and helmet use while riding. Results: Of the total, 1,573 (63.7%) were riders and 898 (36.3%) were pillion passengers. The majority of the riders younger than 15 years rode their motorcycle mainly only in narrow streets for a short trip. Only 30% of the riders wore a helmet every time they rode a motorcycle. About 10% of the participants riding or a passenger on a motorcycle had consumed alcohol at least once before riding their motorcycle. Multiple logistic regression analysis found that motorcycle injuries were significantly associated with speeds greater than 60 km/h, not wearing a helmet while riding, and alcohol consumption before riding (odds ratios 1.63, 1.59, and 3.09, respectively). Conclusion: Nearly two thirds of young adolescents in Hat Yai municipality were motorcycle riders. These young adolescents were at risk of traffic injuries because more than 50% of them had ridden at high speed or not worn a helmet while riding, and some of them had consumed alcohol before riding.     

Older Adults at Increased Risk as Pedestrians in Victoria,Australia: An Examination of Crash Characteristics and Injury Outcomes

Objectives: Engaging in active transport modes (especially walking) is a healthy and environmentally friendly alternative to driving and may be particularly beneficial for older adults. However, older adults are a vulnerable group: they are at higher risk of injury compared with younger adults, mainly due to frailty and may be at increased risk of collision due to the effects of age on sensory, cognitive, and motor abilities. Moreover, our population is aging, and there is a trend for the current cohort of older adults to maintain mobility later in life compared with previous cohorts. Though these trends have serious implications for transport policy and safety, little is known about the contributing factors and injury outcomes of pedestrian collision. Further, previous research generally considers the older population as a homogeneous group and rarely considers the increased risks associated with continued ageing.

Method: Collision characteristics and injury outcomes for 2 subgroups of older pedestrians (65–74 years and 75+ years) were examined by extracting data from the state police–reported crash dataset and hospital admission/emergency department presentation data over the 10-year period between 2003 and 2012. Variables identified for analysis included pedestrian characteristics (age, gender, activity, etc.), crash location and type, injury characteristics and severity, and duration of hospital stay. A spatial analysis of crash locations was also undertaken to identify collision clusters and the contribution of environmental features on collision and injury risk.

Results: Adults over 65 years were involved in 21% of all pedestrian collisions. A high fatality rate was found among older adults, particularly for those aged 75 years and older: this group had 3.2 deaths per 100,000 population, compared to a rate of 1.3 for 65- to 74-year-olds and 0.7 for adults below 65 years of age. Older pedestrian injuries were most likely to occur while crossing the carriageway; they were also more likely to be injured in parking lots, at driveway intersections, and on sidewalks compared to younger cohorts. Spatial analyses revealed older pedestrian crash clusters on arterial roads in urban shopping precincts. Significantly higher rates of hospital admissions were found for pedestrians over the age of 75 years and for abdominal, head, and neck injuries; conversely, older adults were underrepresented in emergency department presentations (mainly lower and upper extremity injuries), suggesting an increased severity associated with older pedestrian injuries. Average length of hospital stay also increased with increasing age.

Conclusion: This analysis revealed age differences in collision risk and injury outcomes among older adults and that aggregate analysis of older pedestrians can distort the significance of risk factors associated with older pedestrian injuries. These findings have implications that extend to the development of engineering, behavioral, and enforcement countermeasures to address the problems faced by the oldest pedestrians and reduce collision risk and improve injury outcomes.     

Health burden of serious road injuries in the Netherlands

Background: The consequences of injuries in terms of disabilities and health burden are relevant for policy making. This article provides an overview of the current knowledge on this topic and discusses the health burden of serious road injuries in The Netherlands.

Methods: The overview of current knowledge on disabilities following a road crash is based on a literature review. The health burden of serious road injuries is quantified in terms of years lived with disability (YLD), by combining incidence data from the Dutch hospital discharge register with information about temporary and lifelong disability.

Results: Literature shows that road traffic injuries can have a major impact on victims' physical and psychological well-being and functioning. Reported proportions of people with disability vary between 11 and 80% depending on the type of casualties, time elapsed since the crash, and the health impacts considered. Together, all casualties involving serious injuries in The Netherlands in 2009 account for about 38,000 YLD, compared to 25,000 years of life lost (YLL) of fatalities. Ninety percent of the burden of injury is due to lifelong consequences that are experienced by 20% of all those seriously injured in road accidents. Lower leg injuries and head injuries represent a high share in the total burden of injury as have cyclists that are injured in a crash without a motorized vehicle. Pedestrians and powered 2-wheeler users show the highest burden of injury per casualty.

Conclusion: Given their major impacts and contribution to health burden, road policy making should also be aimed at reducing the number of serious road injuries and limiting the resulting health impacts.