RESUMO
Nine in 10 road traffic deaths occur in low- and middle-income countries (LMICs). Despite this disproportionate burden, few studies have examined built environment correlates of road traffic injury in these settings, including in Latin America. We examined road traffic collisions in Bogotá, Colombia, occurring between 2015 and 2019, and assessed the association between neighborhood-level built environment features and pedestrian injury and death. We used descriptive statistics to characterize all police-reported road traffic collisions that occurred in Bogotá between 2015 and 2019. Cluster detection was used to identify spatial clustering of pedestrian collisions. Adjusted multivariate Poisson regression models were fit to examine associations between several neighborhood-built environment features and rate of pedestrian road traffic injury and death. A total of 173,443 police-reported traffic collisions occurred in Bogotá between 2015 and 2019. Pedestrians made up about 25% of road traffic injuries and 50% of road traffic deaths in Bogotá between 2015 and 2019. Pedestrian collisions were spatially clustered in the southwestern region of Bogotá. Neighborhoods with more street trees (RR, 0.90; 95% CI, 0.82-0.98), traffic signals (0.89, 0.81-0.99), and bus stops (0.89, 0.82-0.97) were associated with lower pedestrian road traffic deaths. Neighborhoods with greater density of large roads were associated with higher pedestrian injury. Our findings highlight the potential for pedestrian-friendly infrastructure to promote safer interactions between pedestrians and motorists in Bogotá and in similar urban contexts globally.
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Acidentes de Trânsito , Ambiente Construído , Pedestres , Características de Residência , Ferimentos e Lesões , Humanos , Colômbia/epidemiologia , Acidentes de Trânsito/estatística & dados numéricos , Acidentes de Trânsito/mortalidade , Estudos Transversais , Adulto , Masculino , Feminino , Pedestres/estatística & dados numéricos , Adulto Jovem , Pessoa de Meia-Idade , Ferimentos e Lesões/epidemiologia , Adolescente , Características de Residência/estatística & dados numéricos , Criança , Pré-Escolar , Idoso , Planejamento AmbientalRESUMO
BACKGROUND: Mexico City approved new road safety policies in 2015, which included lower speed limits and higher fines for traffic offences. In 2019, economic fines were replaced by a point penalty system among other changes. This study evaluates these policies on road traffic collisions, injuries and deaths. METHODS: Collisions data came from insurance collision claims (January 2015 to December 2019) and road traffic deaths from vital registrations (January 2013 to December 2019). We conducted an interrupted time series analysis for each outcome using negative binomial regression models with an offset of insured vehicles (collisions) or total population (deaths). Then, we classified the 16 municipalities in the city into enforcement and no-enforcement groups based on presence or absence of automated traffic enforcement devices and conducted a controlled interrupted time series analysis. RESULTS: The 2015 road safety policies had no effect on total collisions and collisions resulting in injury but were associated with a 0.2% (95% CI -0.3 to 0.0) decline in the mortality trend. The 2019 policies had no effect on total collisions but were associated with a 1.5% increase in the trend of collisions resulting in injuries and with a 2.7% (95% CI 1.0 to 4.5) increase in the mortality trend. Postpolicy trends in enforcement versus no-enforcement municipalities were not significantly different. CONCLUSION: Policies that included high economic penalties for speeding and dangerous behaviours were effective in decreasing traffic mortality while removing economic penalties and replacing them with a point penalty system were associated with an increase in collisions, resulting in injury and mortality.
Assuntos
Acidentes de Trânsito , Ferimentos e Lesões , Humanos , Cidades/epidemiologia , Análise de Séries Temporais Interrompida , México/epidemiologia , Acidentes de Trânsito/prevenção & controle , Políticas , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
BACKGROUND: Mexico City implemented the Pasos Seguros programme to prevent pedestrian injuries and deaths at dangerous road intersections, which included street-level design changes, such as visible pedestrian crossings, sidewalk widening, refuge islands, lane reductions, pedestrian signals and adjustment of traffic light timing at these intersections. Few studies in low and middle-income countries (LMICs) have evaluated the effect of such interventions on pedestrian safety. AIM: Assess the effectiveness of the Pasos Seguros programme at reducing total, injury and fatal pedestrian-motor vehicle crashes. METHODS: Two-group quasi-experimental design. Monthly pedestrian crashes were obtained from the road incident database from Mexico City's Citizen Contact Center. The programme's effectiveness was evaluated by comparing 12 months preintervention to 12 months postintervention implementation using a negative binomial regression with random intercept with a difference-in-difference estimation. A qualitative comparative analysis was used to find the configuration of intersection characteristics and programme components associated with a decrease in pedestrian crashes. RESULTS: Total pedestrian crashes were reduced by 21% (RR 0.79; 95% CI 0.62 to 0.99) after implementation of Pasos Seguros programme. This reduction was observed for pedestrian injury crashes (RR 0.79; 95% CI 0.62 to 1.00) and for fatal crashes (RR 0.61; 95% CI 0.13 to 2.92) although not statistically significant for the latter. A decrease in pedestrian crashes was found at the most complex intersections where more of the programme components was implemented. CONCLUSION: The Pasos Seguros programme successfully decreased total and injury pedestrian crashes. Similar interventions may improve walking safety in other LMIC cities.
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Pedestres , Ferimentos e Lesões , Humanos , Acidentes de Trânsito/prevenção & controle , Cidades , México/epidemiologia , Caminhada , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
This paper introduces a novel benchmark to study the impact and relationship of built environment elements on pedestrian collision prediction, intending to enhance environmental awareness in autonomous driving systems to prevent pedestrian injuries actively. We introduce a built environment detection task in large-scale panoramic images and a detection-based pedestrian collision frequency prediction task. We propose a baseline method that incorporates a collision prediction module into a state-of-the-art detection model to tackle both tasks simultaneously. Our experiments demonstrate a significant correlation between object detection of built environment elements and pedestrian collision frequency prediction. Our results are a stepping stone towards understanding the interdependencies between built environment conditions and pedestrian safety.
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BACKGROUND: Up to a third of global road traffic deaths, and one in five in Mexico, are attributable to alcohol. In 2013, Mexico launched a national sobriety checkpoints program designed to reduce drink-driving in municipalities with high rates of alcohol-related collisions. Our study measured the association between the sobriety checkpoints program and road traffic mortality rates in 106 urban municipalities. METHODS: We leveraged data from the Salud Urbana en America Latina (SALURBAL), which compiles health and environmental data from cities with over 100,000 residents. Death data from 2005 to 2019 (i.e., outcome) were from official vital statistics. Among 106 Mexican municipalities defined as priority areas for intervention, 54 adopted the program (i.e., treatment) in 2013, 16 municipalities did so in 2014, 16 in 2015, 10 in 2016, 7 in 2017, and 2 in 2019. We used a difference-in-difference approach with inverse probability weighting adapted to a context where program adoption is staggered over time. RESULTS: There was a 12.3% reduction in road traffic fatalities per 10,000 passenger vehicles in the post-treatment period compared to the pre-treatment period (95% Confidence Interval, - 17.8; - 6,5). There was a clear trend of decline in mortality in municipalities that adopted the program (vs. comparison) particularly after year 2 of the program. CONCLUSIONS: In this study of 106 municipalities in Mexico, we found a 12.3% reduction in traffic fatalities associated with the adoption of sobriety checkpoints. There was a clear trend indicating that this association increased over time, which is consistent with sustained changes in drink-driving behavior. These findings provide support and insight for efforts to implement and evaluate the impact of sobriety checkpoint policies across Latin America.
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BACKGROUND: Road-traffic injuries are a key cause of death and disability in low-income and middle-income countries, but the effect of city characteristics on road-traffic mortality is unknown in these countries. The aim of this study was to determine associations between city-level built environment factors and road-traffic mortality in large Latin American cities. METHODS: We selected cities from Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Panama, and Peru; cities included in the analysis had a population of at least 100â000 people. We extracted data for road-traffic deaths that occurred between 2010 and 2016 from country vital registries. Deaths were grouped by 5-year age groups and sex. Road-traffic deaths were identified using ICD-10 codes, with adjustments for ill-defined codes and incomplete registration. City-level measures included population, urban development, street design, public transportation, and social environment. Associations were estimated using multilevel negative binomial models with robust variances. FINDINGS: 366 cities were included in the analysis. There were 328â408 road-traffic deaths in nearly 3·5 billion person-years across all countries, with an average crude rate of 17·1 deaths per 100â000 person-years. Nearly half of the people who died were younger than 35 years. In multivariable models, road-traffic mortality was higher in cities where urban development was more isolated (rate ratio [RR] 1·05 per 1 SD increase, 95% CI 1·02-1·09), but lower in cities with higher population density (0·94, 0·90-0·98), higher gross domestic product per capita (0·96, 0·94-0·98), and higher intersection density (0·92, 0·89-0·95). Cities with mass transit had lower road mortality rates than did those without (0·92, 0·86-0·99). INTERPRETATION: Urban development policies that reduce isolated and disconnected urban development and that promote walkable street networks and public transport could be important strategies to reduce road-traffic deaths in Latin America and elsewhere. FUNDING: Wellcome Trust.
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Ambiente Construído , Pobreza , Cidades , Humanos , América Latina/epidemiologia , MéxicoRESUMO
OBJECTIVES: To evaluate variability in life expectancy at birth in small areas, describe the spatial pattern of life expectancy, and examine associations between small-area socioeconomic characteristics and life expectancy in a mid-sized city of a middle-income country. DESIGN: Cross-sectional, using data from death registries (2015-2018) and socioeconomic characteristics data from the 2010 national population census. PARTICIPANTS/SETTING: 40 898 death records in 99 small areas of the city of Córdoba, Argentina. We summarised variability in life expectancy at birth by using the difference between the 90th and 10th percentile of the distribution of life expectancy across small areas (P90-P10 gap) and evaluated associations with small-area socioeconomic characteristics by calculating a Slope Index of Inequality in linear regression. PRIMARY OUTCOME: Life expectancy at birth. RESULTS: The median life expectancy at birth was 80.3 years in women (P90-P10 gap=3.2 years) and 75.1 years in men (P90-P10 gap=4.6 years). We found higher life expectancies in the core and northwest parts of the city, especially among women. We found positive associations between life expectancy and better small-area socioeconomic characteristics, especially among men. Mean differences in life expectancy between the highest versus the lowest decile of area characteristics in men (women) were 3.03 (2.58), 3.52 (2.56) and 2.97 (2.31) years for % adults with high school education or above, % persons aged 15-17 attending school, and % households with water inside the dwelling, respectively. Lower values of % overcrowded households and unemployment rate were associated with longer life expectancy: mean differences comparing the lowest versus the highest decile were 3.03 and 2.73 in men and 2.57 and 2.34 years in women, respectively. CONCLUSION: Life expectancy is substantially heterogeneous and patterned by socioeconomic characteristics in a mid-sized city of a middle-income country, suggesting that small-area inequities in life expectancy are not limited to large cities or high-income countries.
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Disparidades nos Níveis de Saúde , Expectativa de Vida , Adulto , Masculino , Recém-Nascido , Humanos , Feminino , Cidades , Estudos Transversais , Argentina , Fatores SocioeconômicosRESUMO
The built environment of cities is complex and influences social and environmental determinants of health. In this study we, 1) identified city profiles based on the built landscape and street design characteristics of cities in Latin America and 2) evaluated the associations of city profiles with social determinants of health and air pollution. Landscape and street design profiles of 370 cities were identified using finite mixture modeling. For landscape, we measured fragmentation, isolation, and shape. For street design, we measured street connectivity, street length, and directness. We fitted a two-level linear mixed model to assess the association of social and environmental determinants of health with the profiles. We identified four profiles for landscape and four for the street design domain. The most common landscape profile was the "proximate stones" characterized by moderate fragmentation, isolation and patch size, and irregular shape. The most common street design profile was the "semi-hyperbolic grid" characterized by moderate connectivity, street length, and directness. The "semi-hyperbolic grid", "spiderweb" and "hyperbolic grid" profiles were positively associated with higher access to piped water and less overcrowding. The "semi-hyperbolic grid" and "spiderweb" profiles were associated with higher air pollution. The "proximate stones" and "proximate inkblots" profiles were associated with higher congestion. In conclusion, there is substantial heterogeneity in the urban landscape and street design profiles of Latin American cities. While we did not find a specific built environment profile that was consistently associated with lower air pollution and better social conditions, the different configurations of the built environments of cities should be considered when planning healthy and sustainable cities in Latin America.
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Ambiente Construído , Poluição do Ar/análise , Cidades , Planejamento Ambiental , Nível de Saúde , Humanos , América Latina , Fatores SocioeconômicosRESUMO
Road safety research in low- and middle-income countries is limited, even though ninety percent of global road traffic fatalities are concentrated in these locations. In Colombia, road traffic injuries are the second leading source of mortality by external causes and constitute a significant public health concern in the city of Bogotá. Bogotá is among the top 10 most bike-friendly cities in the world. However, bicyclists are one of the most vulnerable road-users in the city. Therefore, assessing the pattern of mortality and understanding the variables affecting the outcome of bicyclists' collisions in Bogotá is crucial to guide policies aimed at improving safety conditions. This study aims to determine the spatiotemporal trends in fatal and nonfatal collision rates and to identify the individual and contextual factors associated with fatal outcomes. We use confidence intervals, geo-statistics, and generalized additive mixed models (GAMM) corrected for spatial correlation. The collisions' records were taken from Bogotá's Secretariat of Mobility, complemented with records provided by non-governmental organizations (NGO). Our findings indicate that from 2011 to 2017, the fatal bicycling collision rates per bicyclists' population have remained constant for females while decreasing 53 % for males. Additionally, we identified high-risk areas located in the west, southwest, and southeast of the city, where the rate of occurrence of fatal events is higher than what occurs in other parts of the city. Finally, our results show associated risk factors that differ by sex. Overall, we find that fatal collisions are positively associated with factors including collisions with large vehicles, the absence of dedicated infrastructure, steep terrain, and nighttime occurrence. Our findings support policy-making and planning efforts to monitor, prioritize, and implement targeted interventions aimed at improving bicycling safety conditions while accounting for gender differences.
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Acidentes de Trânsito/estatística & dados numéricos , Ciclismo/lesões , Acidentes de Trânsito/mortalidade , Ambiente Construído , Cidades , Colômbia , Feminino , Humanos , Masculino , Fatores de Risco , Análise EspacialRESUMO
Objectives. To quantify the impact of a citywide bicycle share program on rates of motor vehicle collisions involving a bicycle.Methods. We conducted an interrupted time series analysis, using crash records from the Pennsylvania Department of Transportation for Philadelphia County from 2010 through 2018. We also calculated summary statistics to illustrate annual and monthly trends in rates of motor vehicle crashes involving a bicycle.Results. The baseline rate of bike events was 106% greater (95% confidence interval [CI] = 1.25, 3.38) at the time bicycle share was implemented compared with January 2010. Before bicycle share implementation, the rate of bicycle events decreased 1% (95% CI = 0.95, 1.03) annually. After the bicycle share program started, the rate of bicycle events decreased 13% (95% CI = 0.82, 0.94) annually.Conclusions. In the long term, programs that increase the number of bicycles on the road, such as bike share, may reduce rates of motor vehicle crashes involving a bicycle.