Community-level infrastructure risk factors for motor vehicle injuries of car occupants and pedestrians: Results from the PURE study

Shrikant I. Bangdiwala, Department of Health Research Methods, Evidence and Impact, McMaster University, and Population Health Research Institute, Hamilton, Canada.
Scott Lear, Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
Bo Hu, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Chinthanie Ramasundarahettige, Department of Statistics, Population Health Research Institute, Hamilton, Canada.
Khalid F. Alhabib, Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia.
Cristian Ricci, Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa.
Rosnah Ismail, Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Katarzyna Połtyn-Zaradna, Department of Population Health, Division of Population Studies and Prevention of Noncommunicable Diseases, Wroclaw Medical University, Wroclaw, Poland.
Rita Yusuf, BRAC James P. Grant School of Public Health, Dhaka, Bangladesh.
Ravi Prasad Varma, Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, and Health Action by People, Thiruvananthapuram, India.
Hassan Mir, Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada.
Annika Rosengren, Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine, Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden.
Jephat Chifamba, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe.
P V. Lakhsmi, Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Alvaro Avezum, International Research Center, Hospital Alemão Oswaldo Cruz, São Paulo, SP, Brazil.
Indu Mohan, Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India.
Ahmad Bahonar, Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran.
Romaina Iqbal, Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan.
Mukhtar Kulimbet, Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan.
Sumathy Rangarajan, Population Health Research Institute, Hamilton, Canada.
Jose Patricio Lopez Jaramillo, Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia.
Maria Luz Diaz, Estudios Clinicos Latinoamerica, Santa Fe, Argentina.
Rasha Khatib, Advocate Health - MidwestFollow
Pamela Seron, Departamento Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile.
K Burcu Tumerdem Calik, Department of Health Management, Marmara University Faculty of Health Sciences, Maltepe, Turkey.
Karen Yeats, Department of Medicine, Queen's University, Kingston, Canada.
Minghai Yan, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China.
Yingxuan Zhu, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China.
Salim Yusuf, Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, Canada.

Abstract

Disproportionately more of the world's fatalities and injuries on the roads occur in low- and middle-income countries, despite these countries having approximately only 60% of the world's vehicles. Injury rates due to motor-vehicles are related to a complex multidimensional array of risk factors, embedded in the social and economic infrastructure of a country or region. Whether environmental infrastructure factors differ in determining the risk of an injury for motor vehicle occupants compared to pedestrians and other vulnerable road users has not been extensively studied. We explored the role of environmental infrastructure factors on motor-vehicle-related non-fatal injury using the Prospective Urban and Rural Epidemiology (PURE) cohort study of 162,793 adults from 23 high-, middle- and low-income countries. As expected, low-income countries had slightly higher motor vehicle injury rates, with pedestrians tending to have higher injury rates in these countries. There was considerable variation in motor vehicle injury rates within country-income-categories, while there were similarities in motor vehicle injury rates despite large differences in motorization of countries. There was a meaningful community effect on motor vehicle injury rates. We found that community-level infrastructure risk factors for motor vehicle injuries differed for car occupants and for pedestrians, with road quality and alcohol use being the main factors associated with an injury for car occupants, while poor roadside infrastructure (streetlights, sidewalks) and alcohol use were the main risk factors for an injury as a pedestrian.

Active transport, such as walking and bicycling, are being promoted as leading to healthy lifestyle habits and reduced pollution. These require improved walkability for pedestrians, but also separation from motorized vehicles, which leads to recommending that low-and middle-income countries devote more funds for roadway quality and streetlight infrastructure. Policies to reduce motor vehicle injuries should be supported at the national level, but should be specific at the community level, since they must be focused on the specific local infrastructure. Countermeasures for reducing road transport injuries for pedestrians have different risk factors than for reducing injuries for car occupants.

Document Type

Article

PubMed ID

41204631

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