Risk Of Road Traffic Injuries Research Articles

The effects of ambient temperature on road traffic injuries in Jinan city: a time-stratified case-crossover study based on distributed lag nonlinear model.

The impact of climate change, especially extreme temperatures, on health outcomes has become a global public health concern. Most previous studies focused on the impact of disease incidence or mortality, whereas much less has been done on road traffic injuries (RTIs). This study aimed to explore the effects of ambient temperature, particularly extreme temperature, on road traffic deaths in Jinan city. Daily data on road traffic deaths and meteorological factors were collected among all residents in Jinan city during 2011-2020. We used a time-stratified case-crossover design with distributed lag nonlinear model to evaluate the association between daily mean temperature, especially extreme temperature and road traffic deaths, and its variation in different subgroups of transportation mode, adjusting for meteorological confounders. A total of 9,794 road traffic deaths were collected in our study. The results showed that extreme temperatures were associated with increased risks of deaths from road traffic injuries and four main subtypes of transportation mode, including walking, Bicycle, Motorcycle and Motor vehicle (except motorcycles), with obviously lag effects. Meanwhile, the negative effects of extreme high temperatures were significantly higher than those of extreme low temperatures. Under low-temperature exposure, the highest cumulative lag effect of 1.355 (95% CI, 1.054, 1.742) for pedal cyclists when cumulated over lag 0 to 6 day, and those for pedestrians, motorcycles and motor vehicle occupants all persisted until 14 days, with ORs of 1.227 (95% CI, 1.102, 1.367), 1.453 (95% CI, 1.214, 1.740) and 1.202 (95% CI, 1.005, 1.438), respectively. Under high-temperature exposure, the highest cumulative lag effect of 3.106 (95% CI, 1.646, 5.861) for motorcycle occupants when cumulated over lag 0 to 12 day, and those for pedestrian, pedal cyclists, and motor vehicle accidents all peaked when persisted until 14 days, with OR values of 1.638 (95% CI, 1.281, 2.094), 2.603 (95% CI, 1.695, 3.997) and 1.603 (95% CI, 1.066, 2.411), respectively. This study provides evidence that ambient temperature is significantly associated with the risk of road traffic injuries accompanied by obvious lag effect, and the associations differ by the mode of transportation. Our findings help to promote a more comprehensive understanding of the relationship between temperature and road traffic injuries, which can be used to establish appropriate public health policies and targeted interventions.

Risk of road traffic injury in Norway 1970–2022

This paper describes changes in the risk of road traffic injury in Norway during the period from 1970 to 2022. During this period, the risk of fatal and personal injury declined by more than 70 % for most groups of road users. There are five main potential explanations of a decline in the risk of injury: (1) a reduced probability of accidents that have the potential for causing injury; (2) an improved protection against injury given that an accident has occurred; (3) improved medical care increasing the survival rate, given an injury (this would reduce the number of fatalities, but not the number of injuries); (4) a tendency for the reporting of injuries in official accident statistics to decline over time; (5) uncertain or erroneous estimates of the exposure to the risk of injury. The decline in the risk of road traffic injuries in Norway after 1970 can probably be attributed to a combination of reduced reporting of injuries in official statistics, improved protection against injury in accidents, and (for fatal injuries) improved medical care. Insurance data, available from 1992, do not indicate a reduction in the risk of accidents leading to insurance claims. Incomplete and possibly erroneous data for mopeds and motorcycles make it impossible to identify sources of changes in injury risk over time for these modes of transport.

A novel correction method for modelling parameter-driven autocorrelated time series with count outcome

BackgroundCount time series (e.g., daily deaths) are a very common type of data in environmental health research. The series is generally autocorrelated, while the widely used generalized linear model is based on the assumption of independent outcomes. None of the existing methods for modelling parameter-driven count time series can obtain consistent and reliable standard error of parameter estimates, causing potential inflation of type I error rate.MethodsWe proposed a new maximum significant ρ correction (MSRC) method that utilizes information of significant autocorrelation coefficient ρ estimate within 5 orders by moment estimation. A Monte Carlo simulation was conducted to evaluate and compare the finite sample performance of the MSRC and classical unbiased correction (UB-corrected) method. We demonstrated a real-data analysis for assessing the effect of drunk driving regulations on the incidence of road traffic injuries (RTIs) using MSRC in Shenzhen, China. Moreover, there is no previous paper assessing the time-varying intervention effect and considering autocorrelation based on daily data of RTIs.ResultsBoth methods had a small bias in the regression coefficients. The autocorrelation coefficient estimated by UB-corrected is slightly underestimated at high autocorrelation (≥ 0.6), leading to the inflation of the type I error rate. The new method well controlled the type I error rate when the sample size reached 340. Moreover, the power of MSRC increased with increasing sample size and effect size and decreasing nuisance parameters, and it approached UB-corrected when ρ was small (≤ 0.4), but became more reliable as autocorrelation increased further. The daily data of RTIs exhibited significant autocorrelation after controlling for potential confounding, and therefore the MSRC was preferable to the UB-corrected. The intervention contributed to a decrease in the incidence of RTIs by 8.34% (95% CI, -5.69–20.51%), 45.07% (95% CI, 25.86–59.30%) and 42.94% (95% CI, 9.56–64.00%) at 1, 3 and 5 years after the implementation of the intervention, respectively.ConclusionsThe proposed MSRC method provides a reliable and consistent approach for modelling parameter-driven time series with autocorrelated count data. It offers improved estimation compared to existing methods. The strict drunk driving regulations can reduce the risk of RTIs.

Road traffic injuries and alcohol use in the emergency department in Tanzania: a case-crossover study

Abstract
 Introduction: Alcohol is the leading risk factor for road traffic injury (RTI). Africa has the second-highest rate of alcohol dependence and the highest road traffic fatality rate. We describe the proportion of Tanzanian emergency department (ED) patients presenting with RTIs who are blood alcohol content (BAC) positive and determine the dose-response relationship between drinking and injury risk.Methods: Analysis of data from EDs in Tanzania from 2013 to 2014 was performed. Adults presenting to an ED within 6 hours of injury had BAC testing and were asked whether and how much alcohol was consumed prior to the injury. Data also included self-reported alcohol use during control periods 1 day and 1 week prior to the injury. Case-crossover analysis of injury risk used logistic regression to determine matched-pair odds ratios (ORs) and 95% confidence intervals (CIs).Results: Of 513 injury patients, 375 (73%) suffered RTIs. Overall, 29% of RTI patients were BAC-positive. Approximately 40% of those who reported using alcohol prior to RTI reported drinking more than 5 standard drinks. With any alcohol, drivers of both motorcycles and cars/trucks had increased odds of RTI (4.90 OR (CI 2.5-9.5) and 5.70 OR (CI 2.8-11.6) respectively). While the odds of RTI in car/truck drivers demonstrated a dose-dependent response, that in motorcyclists was highest after 3-4 drinks (5.60 OR, CI 2.22-14.10).Discussion: The RTI burden in Tanzania is high. Any alcohol can increase RTI risk. These findings should guide drunk-driving legislation.

Sober up: Time from last drink to a road traffic injury

PurposeThere is no intervention that quickly reduces a person's blood alcohol content (BAC). “Sober up before you drive” may prevent road traffic injury (RTI) caused by alcohol consumption. The aim of this study was to analyze the risk of RTI on an hourly basis (1–6 h) after the last drink and the determinants of this risk. MethodsThis was a case-crossover study of alcohol consumption among 430 patients who suffered an RTI and arrived at an emergency department in a large hospital in Mexico City from January to April 2022. ResultsOf the 430 patients studied, 46 reported drinking within 1 h before the RTI, for a risk ratio (RR) of 7.7 (95% CI [5.6, 10.4]). This RR decreased to 2.2 (95% CI [1.3, 3.7]) for the 12 patients drinking in the second hour before the RTI and was null for those drinking earlier (p ≤ 0.001 for the trend). The induction time was 3 h among those with higher BAC and intoxication levels. The RR for an RTI decreases 71% from the first to second hour from the last drink and 32% from the second to third hour. This decrease was similar among those intoxicated and those with increased BACs. In multiple regression models, higher levels of intoxication and higher BACs remained associated with higher RRs. DiscussionPeople should avoid driving after drinking. Waiting to drive, walking, or riding after drinking reduces the risk of an RTI, especially for people with higher BAC and intoxication levels.

Associations and mediators between types of motorcycle ownership and road traffic injuries among motorcycle taxi drivers in Dar es Salaam, Tanzania

BackgroundRapid growth in the use of motorcycle taxis in low-and-middle-income countries has been associated with an increased risk of road traffic injuries (RTIs). This study aimed to examine the association between types of motorcycle ownership, such as self-ownership, rental or shared ownership, and the risk of RTIs among Tanzanian motorcycle taxi drivers. Furthermore, we investigated whether the risky driving behaviours, number of working hours and motorcycle conditions mediate the association between types of motorcycle ownership and risk of RTIs. The study included 164 cases of motorcycle taxi drivers with RTIs resulting in hospitalisation and 400 controls of motorcycle taxi drivers randomly selected from parking stages. The results show that motorcycle taxi drivers who co-own or rent their motorcycles were two to three times more likely to have RTIs than those who self-own their motorcycles after adjusting for age, education, marital status and the number of dependents. Mediation analysis shows that risky driving behaviours have a greater indirect effect on the risk of RTIs among motorcycle taxi drivers who rent their motorcycles, while the number of working hours had a significantly higher mediation effect on the risk of RTIs among motorcycle taxi drivers who co-own their motorcycles. This study shows that co-ownership or rental of motorcycles is associated with a higher risk of RTIs. Risky driving behaviours and the number of working hours are found to be important mediators. Further research on tailored approaches to improve and promote the safety of motorcycle taxi drivers’ working conditions is needed.

Applying the Consolidated Framework for Implementation Research (CFIR) to examine barriers and facilitators to built environment change in five Canadian municipalities: Lessons from road safety and injury prevention professionals

IntroductionRoad traffic injury and death continue to be a concern in Canada. The built environment (BE) is a contributing factor affecting the health of road users, yet there are significant challenges to making injury-reducing BE changes. This research increases our knowledge of these challenges by investigating the opinions of injury prevention and road safety professionals working in Canada about the barriers and facilitators to BE change. MethodsSemi-structured interviews and virtual focus groups (VFG) were conducted with 80 key informants (KIs) working in transport and injury prevention sectors in five Canadian cities: Vancouver, Calgary, Peel Region, Toronto, and Montréal. The Consolidated Framework for Implementation Research (CFIR) informed the interview guides. Thematic analysis was used to systematically analyze the data, a process that involved developing codes aligning with the research question, what are the barriers and facilitators to BE change? Themes were cross-referenced with the CFIR domains and constructs to illustrate how barriers and facilitators influence implementation of BE changes. ResultsThe prioritization of motor vehicles, lack of funding and resources, lack of political will, and sectoral silos were described as the most significant barriers to BE change. Cross-sectoral collaboration, data sharing, and champions and advocates were the most significant facilitators. ConclusionsCross-referencing themes with the CFIR situated our findings within the scope of implementation science, which demonstrated how barriers and facilitators influence BE change project implementation. The prioritization of motor vehicles results in disproportionate injury and health risks for VRUs. Collaboration across sectors, with the support of champions and advocates, can facilitate sharing of resources, data, and expertise, which results in more opportunities to enact BE change. Knowledge of these barriers and facilitators, contextualized by the CFIR, makes a case for policy/decision-makers in Canada to approve BE projects that reduce risk of road traffic injury and death.

Road traffic injury risk from alcohol and cannabis use among emergency department patients in Argentina.

ABSTRACTObjective.To report the risk from alcohol, cannabis, and their combined use for non-fatal road traffic injuries for drivers, passengers, and pedestrians.Methods.Risk was estimated using the case-crossover method. Participants (N= 306) were injured patients from an emergency department in Mar del Plata, Argentina.Results.Alcohol use (OR= 6.78, CI 95% 3.75-12.25) as well as combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.73) significantly increased the risk of a road traffic injuries. Alcohol use increased the risk in both, women (OR= 8.87, CI 95% 2.69-29.21) and men (OR= 6.16, CI 95% 3.10-12.23); in those >30 years old (OR= 6.01, CI 95% 2.09-17.24) and those <30 years old (OR= 7.15, CI 95% 3.49-14.65). This last group also had an increased risk after combined alcohol and cannabis use (OR= 7.05, CI 95% 1.16-42.75). Both drivers (OR= 6.40, CI 95% 3.23-12.69) and passengers (OR= 13.83, CI 95% 2.87-66.42) had an increased risk after alcohol consumption.Conclusions.To our knowledge, these are the first estimates of the risk of having a road traffic injury after alcohol and cannabis consumption in one of the countries of the Southern Cone (Argentina, Chile, and Uruguay). These results highlight the urgent need to implement and enforce comprehensive alcohol control measures. Furthermore, given the global trend towards legalizing cannabis for recreational use, our results could also inform policymakers to enact or amend impaired driving laws.

Promoting the independent mobility of young people with SEND: The lived experience of young people with autism, ADHD, and learning disabilities

IntroductionYoung people with special educational needs and disabilities (SEND) are at heightened risk of road traffic injury and their caregivers are often concerned about independent mobility and the safety risks it poses. This qualitative research aimed to increase understanding of the facilitators and barriers to independent mobility for 7–10 and 11-13 year-olds with SEND. MethodThirteen young people (11 male and two female, six children 7-10 years-old and seven children 11-13 years-old) diagnosed with autism, attention deficit hyperactivity disorder (ADHD), or learning disabilities video recorded three journeys they regularly undertook and then participated in a semi-structured interview with their caregiver. A thematic analysis of travel films and interview transcripts was conducted. ResultsYounger children were typically not travelling independently, but both older and younger children were anxious about independent mobility. Younger and older children with SEND demonstrated unsafe behaviours in the road, had limited awareness at times of road safety, could become overwhelmed, and required longer to process information. ConclusionsThe findings informed recommendations for how to effectively support the independent mobility of young people with SEND. Children are often diagnosed with multiple conditions, and it is the profile rather than the specific diagnosis that impacts their road safety. Targeting specific behaviours rather than specific disorders may therefore be a more effective approach. Road safety was a central concern for caregivers, but it was one aspect of independent mobility and a broad focus on teaching independent mobility was preferable. Support with independent mobility and road safety should be provided by a range of people who come into contact with the young person and education may need repeating at key transition points.

Trends of Road Traffic Injury in Ethiopia, 2015 to 2017: National eHMI data analysis.

Background: Road traffic injury (RTI) is one of the leading causes of mortality and morbidity globally. It accounts for more than 1.35 million deaths per year. Low and middle-income countries are affected severely, thus, Ethiopia is among the most affected countries. This paper aims to analyze three years of Electronic Health Management Information System (eHMIS) surveillance data of Road traffic injuries in Ethiopia. Methods: eHMIS Road traffic injury data were reviewed for three years period ( 2015 to 2017) and Analysis was done by Microsoft Excel and SPSS. Result: The trend of injury in Ethiopia increased from 69882 to 100,628 from 2015 to 2017, which was more than a 30 % increase in three years, and inpatient death increased from 125 to 265. Males were affected more than females. Means of monthly reported injuries were computed for each year and one-way ANOVA was employed to test the difference of means of injuries, and all three means were significantly different with P &lt; 0.05 at 95% CI. Linear regression was used to evaluate the trend per a year; the slope of the trend was estimated to be B = 22033, with 95% CI (17536 -26529), P&lt; 0.05, which indicated a significant increase of the trend. Conclusion: This analysis revealed that in Ethiopia the burden of Road Traffic Injury (RTI) was increasing. Being male has a greater risk of RTI. High-level political commitment and actions are needed to halt the problem.

A systematic review and meta-analysis of the impact of curbs on crash outcomes

Introduction Road traffic crashes involving vertical curbs are commonly reported to occur on highways and expressways in India. We found a gap in terms of systematically assessing the evidence of the impact of curbs on road safety outcomes in the real world. Method We conducted a systematic review and meta-analysis of the impact of curbs on the risk of road traffic injuries. We used keywords in a database of records prepared by an earlier evidence gap map (EGM). The EGM used a comprehensive search strategy including 6 academic database, 17 organizational websites, hand searching, contacting experts and back referencing. Results We found 4 studies that evaluated impact of a curbed median or a curbed shoulder. We found that the presence of a curb on a median increases the risk for all crashes, all single-vehicle crashes, all median-related crashes and median-related injury crashes. The data also indicate that the severity of accidents reduces for curbs on median while it increases for curbs on shoulder, though the latter effect is not statistically significant. All the epidemiological studies were conducted on rural highways and did not report effects for different traffic speeds or vehicle types. However, our review of crash tests and simulation studies indicates that the impact of a curb design may be highly sensitive to speed and vehicle types. Conclusions The safety impacts of a curb depend on the context of the road. In an urban road, a curb should ensure safety of pedestrians from an errant vehicle. On high-speed rural roads, curbs should be avoided and treatments should facilitate safe departure of the vehicle from the roadway.

Needs for International Benchmarking of Road Safety Management Based on Mobility Exposure Measures and Risk Patterns.

Each year, 1.35 million people worldwide die due to Road Traffic Injuries (RTI), highlighting the need for further research. The risk of RTI is usually estimated as the number of casualties divided by the level of exposure in a population. Identifying the most appropriate exposure measures is one of the most important current challenges in this field. This paper presents an analysis of exposure measures used in empirical studies on road accidents. The results show a large variability in the exposure measures used, ranging from more general measures (such as population figures or vehicle fleet) to more specific measures related to mobility (such as number of trips, distances or travel time). A comparison of the risk patterns found shows that there is a partial consensus on the profiles with the highest risk of road traffic injuries. In conclusion, there is a need for the international standardization of criteria and data to be recorded, at least injury severity and measures of exposure to mobility, as the travel time disaggregated by socio-demographic variables and mode of transport. Such data would provide higher-quality results on risk profiles and facilitate the implementation of more effective, knowledge-based road safety policies.

Prenatal cannabis use disorder and future risk of road traffic injuries in Canadian children

The extent to which child traffic injuries may be attributed to parents who use cannabis before driving is unknown. We investigated whether prenatal cannabis use disorders may predict future road traffic injuries in children. We conducted a cohort study of 792,082 children in Quebec, Canada with 6,280,663 years of follow-up between 2006 and 2019. The main exposure measure was maternal cannabis use disorder before or during pregnancy. The main outcome measure was future hospitalizations for transport-related injuries in children after birth. Using Cox proportional hazards regression models adjusted for potential confounders, we estimated hazard ratios and 95% confidence intervals (CI) for the association of prenatal cannabis use disorders with transport-related injuries in children. Maternal cannabis use disorders before birth were associated with 5.64 times the risk of hospitalization for future motor vehicle crash injuries in children (95% CI 2.61–12.21). The risk increased with the child's age. Prenatal cocaine, opioid, and other drug use disorders were not associated with pediatric transport-related injuries. Maternal cannabis use disorders before birth may be an early predictor of childhood injuries from motor vehicle crashes.

Traffic Injury Risk Based on Mobility Patterns by Gender, Age, Mode of Transport and Type of Road

The role of gender and age in the risk of Road Traffic Injury (RTI) has not been fully explored and there are still significant gaps with regard to how environmental factors, such as road type, affect this relationship, including mobility as a measure of exposure. The aim of this research is to investigate the influence of the environmental factor road type taking into account different mobility patterns. For this purpose, a cross-sectional study was carried out combining two large databases on mobility and traffic accidents in Andalusia (Spain). The risk of RTI and their severity were estimated by gender and age, transport mode and road type, including travel time as a measure of exposure. Significant differences were found according to road type. The analysis of the rate ratio (Ratemen/Ratewomen), regardless of age, shows that men always have a higher risk of serious and fatal injuries in all modes of transport and road types. Analysis of victim rates by gender and age groups allows us to identify the most vulnerable groups. The results highlight the need to include not only gender and age but also road type as a significant environmental factor in RTI risk analysis for the development of effective mobility and road safety strategies.

Identification of Road Traffic Injury Risk Prone Area Using Environmental Factors by Machine Learning Classification in Nonthaburi, Thailand

Road traffic injuries are a major cause of morbidity and mortality worldwide and currently rank ninth globally among the leading causes of disease burden regarding disability-adjusted life years lost. Nonthaburi and Pathum Thani are parts of the greater Bangkok metropolitan area, and the road traffic injury rate is very high in these areas. This study aimed to identify the environmental factors affecting road traffic injury risk prone areas and classify road traffic injuries from an environmental factor dataset using machine learning algorithms. Road traffic injury risk prone areas were set as the dependent variables for the analysis, with other factors that influence road traffic injury risk prone areas being set as independent variables. A total of 20 environmental factors were selected from the spatial datasets. Then, machine learning algorithms were applied using a grid search. The first experiment from 2017 in Nonthaburi and Pathum Thani was used for training the model, and then, 2018 data from Nonthaburi and Pathum Thani were used for validation. The second experiment used 2018 Nonthaburi data for the training, and 2018 Pathum Thani data were used for the validation. The important factors were grocery stores, convenience stores, electronics stores, drugstores, schools, gas stations, restaurants, supermarkets, and road geometrics, with length being the most critical factor that influenced the road traffic injury risk prone model. The first and second experiments in a random forest model provided the best model environmental factors affecting road traffic injury risk prone areas, and machine learning can classify such road traffic injuries.

Road traffic injuries and substance use among emergency department patients in the Dominican Republic and Peru.

ABSTRACTObjective.To report demographic and substance use characteristics and risk of road traffic injury (RTI) from alcohol use, cannabis use, and combined use in a sample of emergency department patients from two countries in Latin America and the Caribbean.Methods.A cross-sectional study in which patients 18 years and older admitted within six hours of suffering an RTI to one emergency department in Santa Domingo, Dominican Republic (n = 501) and in Lima, Peru (n = 431) were interviewed. Case-crossover analysis, based on self-reported use prior to the RTI, was used to analyze risk from alcohol, cannabis, and co-use.Results.Overall, 15.3% reported alcohol use prior to the event and 2.5% cannabis use. Drivers using alcohol only were over twice as likely to have an RTI (OR = 2.46, p < 0.001), and nearly eight times more likely if using both alcohol and cannabis (OR = 6.89, p < 0.01), but risk was not elevated for cannabis alone. Significant differences were not found for passengers or pedestrians.Conclusions.Risk of RTI for drivers in these two samples is significantly elevated from alcohol use, and more so for co-use with cannabis. Differences between the two countries underscore the need for similar data from the region to determine risk of RTI from substance use, including risk for passengers and pedestrians. Data suggest that alcohol contributes significantly to the burden of RTI, which calls for more stringent enforcement of alcohol control policy related to drink driving in the region.

Increased risk of road traffic injuries in individuals with insomnia

IntroductionFew studies have clinically assessed road traffic injuries in individuals with insomnia. This study examined the epidemiological characteristics of road traffic injuries in individuals with insomnia and identified relevant factors. MethodsIn this retrospective cohort study, we used administrative data (National Health Insurance Research Database) to identify a cohort from people admitted to hospital with insomnia and matched controls from other admitted patients. All the included data were used to determine the incidence rate of having road traffic injuries in hospital admission in individuals aged 18 and older with insomnia. A control group of individuals without insomnia with a 4:1 ratio was matched by gender, age, and index year. Cox regression models were used to evaluate the effects of insomnia on the risk of road traffic injuries (Hazard ratio, HR). The link between insomnia and repeated road traffic injury was also explored. ResultsFrom 2000 to 2015, 1,936,512 people aged 18 and older were hospitalized in Taiwan (194,035 with insomnia and 776,140 without insomnia). After other factors were controlled, the risk of road traffic injuries in individuals with insomnia was 1.23 times that of individuals without insomnia. In the 25 to 44 age group, the risk in individuals with insomnia was 1.80 times that of those without insomnia. Additionally, the risk of road traffic injuries in automobile drivers and motorcycle riders with insomnia was 1.46 and 1.29 times that of those without insomnia, respectively. The risk of repeated road traffic injuries with insomnia was 2.06 times that of those without insomnia. ConclusionsTo reduce the probability of road traffic injury, high-risk groups should seek early medical assistance to resolve insomnia.

Risk of road traffic injuries and their prevention in Nepal

Risk of road traffic injuries and their prevention in Nepal

Determinants of road traffic injuries in Iranian children; results from a National Representative Demographic- Health Survey 2010

BackgroundRoad Traffic Injuries (RTIs) are a leading cause of disabilities and mortalities in Iran. The occurrence of RTIs among children is increasing. This study aims are to assess RTIs among Iranian children and to determine the main socio-economics determinants.MethodsThe National Institute of Health Research (NIHR) in collaboration with the Iran Ministry of Health (MoH) conducted a nationwide survey: The Multiple Indicator Demographic and Health Survey 2010 (IrMIDHS 2010). The Survey was undertaken by Medical Universities in Iran. Based on multistage clustered randomized sampling, 30,960 households were included in the survey. We performed a multivariate logistic regression to determine the main socio-economic factors associated with RTIs among children.ResultsApproximately 0.9% of the children received RTIs in 2010. Main socio-economics contributors to RTIs involving Iranian children included household size (Adjusted OR: 1.06 (CI 95% 1.01, 1.14), sex (Adjusted ORfemale: 0.38 (CI 95% 0.29, 0.50), living with both parents (Adjusted OR: 0.55 (CI 95% 0.13, 0.95), being in the 2nd (Adjusted OR: 0.81 (CI 95%: 0.60, 0.90) or 4th income quartile (Adjusted OR: 0.13 (CI 95%: 0.02, 0.92) rather than the 1st income quartile, being aged five to nine (Adjusted OR: 1.39 (CI 95%: 1.10, 2.10), or aged 15 to 18 (Adjusted OR: 2.94 (CI 95%: 2.07, 4.97), and residency in a non- owned or non-tenancy house (Adjusted OR: 0.42 (CI 95%: 0.23 0.74).ConclusionsChildren need safe places for playing and doing their daily activities. Policy and regulation development aimed at protecting children from road traffic injuries needs to take into consideration the socio-economic factors associated with risk of road traffic injury among children.

Social and environmental risk factors for road traffic injuries among children under five in rural China.

Background:Road traffic injuries (RTIs) have become a considerable issue for children. In China, RTIs are among the top 3 contributors to injury-related mortality and disability-adjusted life years. The present study aimed to evaluate social and environmental factors that may contribute to RTIs among children under 5 in rural areas of China.Methods:The study was based on 1 year of data (October 1, 2015 to September 30, 2016) from the National Maternal and Child Health Surveillance System (NMCHSS) from all districts in 334 National Maternal and Child Health Surveillance Districts in 30 Chinese provinces, autonomous regions, and municipalities. Data were analyzed to identify environmental, social, and primary caregiver factors related to RTIs among children under 5.Results:Based on data for the 279 children registered in the NMCHSS during the study period, incidence of RTIs increased with increasing age and was higher for boys than girls. Risk of RTIs depended on distances from the child's home to roads and playgrounds. Enrollment in kindergarten and characteristics of primary caregivers affected risky road behaviors by children. Most primary caregivers (67.4%) reported never using child car seats, and 70.6% reported never using a child helmet. Among primary caregivers without a driver's license, 24.8% reported having driven motor vehicles or motorcycles.Conclusions:The living environment and behaviors of primary caregivers can affect risk of RTIs in children younger than 5 years in rural China. Road safety awareness should be strengthened at the community and kindergarten levels.