Estimating walking and bicycling in Canada and their road collision fatality risks: The need for a national household travel survey

Motor vehicle collision (MVC) emergency department (ED) visits and hospitalisations in Ontario during the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic policy response dramatically changed local transportation patterns. This project investigated the impact of COVID-19 policies on motor vehicle collision (MVC)-related emergency department (ED) visits and hospitalisations in Ontario.

METHODS

Data were collected on MVC-related ED visits and hospitalisations in Ontario between March 2016 and December 2022. Using an interrupted time series design, negative binomial regression models were fitted to the pre-pandemic data, including monthly indicator variables for seasonality and accounting for autocorrelation. Extrapolations simulated expected outcome trajectories during the pandemic, which were compared with actual observed outcome counts using the overall per cent change and mean monthly difference. Data were modelled separately for vehicle occupants, pedestrians and cyclists (MVC and non-MVC injuries).

RESULTS

There was a 31.5% decrease in observed ED visits (95% CI -35.4 to -27.3) and a 6.0% decrease in hospitalisations (95% CI -13.2 to 1.6) among vehicle occupants, relative to expected counts during the pandemic. Results were similar for pedestrians. Among cyclist MVCs, there was an increase in ED visits (12.8%, 95% CI -8.2 to 39.4) and hospitalisations (46.0%, 95% CI 11.6 to 93.6). Among non-MVC cyclists, there was also an increase in ED visits (47.0%, 95% CI 12.5 to 86.8) and hospitalisations (50.1%, 95% CI 8.2 to 101.2).

CONCLUSIONS

We observed fewer vehicle occupant and pedestrian collision injuries than expected during the pandemic. By contrast, we observed more cycling injuries than expected, especially in cycling injuries not involving motor vehicles. These observations may be attributable to changes in transportation patterns during the pandemic and increased uptake of recreational cycling.

Characterizing Older Adults' Travel Behaviour and Unmet Needs: Findings from the Canadian Longitudinal Study on Aging (CLSA)

This study provides researchers, practitioners, and policy makers with a profile of older adults' travel behaviour and the older adult population that reports unmet travel needs. In addition, we quantified associations between reporting an unmet travel need and measures of health and social connectedness. Data came from the second follow-up survey of the Canadian Longitudinal Study on Aging, collected from 2018 to 2021 (n = 14,167). Nine in ten (90.2%) older adults aged 65 years and older indicated that driving is the main way they get around. Older adults with an unmet travel need were more likely to be women, have lower household incomes and education levels, and have a mobility limitation. People with an unmet travel need had 2.7 times the odds of reporting fair or poor general health (OR = 2.66, 95% CI: 2.19, 3.22) and 3.1 times the odds of feeling socially isolated (OR = 3.10, 95% CI: 2.57, 3.72) compared to those without an unmet need.

Ascertainment and description of pedestrian and bicycling injuries and fatalities in Ontario from administrative health records 2003-2017: contributions of non-collision falls and crashes

INTRODUCTION

Pedestrian and bicycling injuries may be less likely to be captured by traffic injury surveillance relying on police reports. Non-collision injuries, including pedestrian falls and single bicycle crashes, may be more likely than motor vehicle collisions to be missed. This study uses healthcare records to expand the ascertainment of active transportation injuries and evaluate their demographic and clinical features.

METHODS

We identified pedestrian and bicyclist injuries in records of deaths, hospitalisations and emergency department visits in Ontario, Canada, between 2002 and 2017. We described the most common types of clinical injury codes among these records and assessed overall counts and proportions of injury types captured by each ascertainment definition. We also ascertained relevant fall injuries where the location was indicated as 'street or highway'.

RESULTS

Pedestrian falls represented over 50% of all pedestrian injuries and affected all age groups, particularly non-fatal falls. Emergency department records indicating in-traffic bicycle injuries not involving a collision with motor vehicles increased from 14% of all bicycling injury records in 2003 to 34% in 2017. The overall number of injuries indicated by these ascertainment methods was substantially higher than official counts derived from police reports.

CONCLUSION

The use of healthcare system records to ascertain bicyclist and pedestrian injuries, particularly to include non-collision falls, can more fully capture the burden of injury associated with these transportation modes.

Building CapaCITY/É for sustainable transportation: protocol for an implementation science research program in healthy cities

INTRODUCTION

Improving sustainable transportation options will help cities tackle growing challenges related to population health, congestion, climate change and inequity. Interventions supporting active transportation face many practical and political hurdles. Implementation science aims to understand how interventions or policies arise, how they can be translated to new contexts or scales and who benefits. Sustainable transportation interventions are complex, and existing implementation science frameworks may not be suitable. To apply and adapt implementation science for healthy cities, we have launched our mixed-methods research programme, CapaCITY/É. We aim to understand how, why and for whom sustainable transportation interventions are successful and when they are not.

METHODS AND ANALYSIS

Across nine Canadian municipalities and the State of Victoria (Australia), our research will focus on two types of sustainable transportation interventions: all ages and abilities bicycle networks and motor vehicle speed management interventions. We will (1) document the implementation process and outcomes of both types of sustainable transportation interventions; (2) examine equity, health and mobility impacts of these interventions; (3) advance implementation science by developing a novel sustainable transportation implementation science framework and (4) develop tools for scaling up and scaling out sustainable transportation interventions. Training activities will develop interdisciplinary scholars and practitioners able to work at the nexus of academia and sustainable cities.

ETHICS AND DISSEMINATION

This study received approval from the Simon Fraser University Office of Ethics Research (H22-03469). A Knowledge Mobilization Hub will coordinate dissemination of findings via a website; presentations to academic, community organisations and practitioner audiences; and through peer-reviewed articles.

Risk Factors and Inequities in Transportation Injury and Mortality in the Canadian Census Health and Environment Cohorts (CanCHECs)

BACKGROUND

Road traffic injury contributes substantially to morbidity and mortality. Canada stands out among developed countries in not conducting a national household travel survey, leading to a dearth of national transportation mode data and risk calculations that have appropriate denominators. Since traffic injuries are specific to the mode of travel used, these risk calculations should consider travel mode.

METHODS

Census data on mode of commute is one of the few sources of these data for persons aged 15 and over. This study leveraged a national data linkage cohort, the Canadian Census Health and Environment Cohorts, that connects census sociodemographic and commute mode data with records of deaths and hospitalizations, enabling assessment of road traffic injury associations by indicators of mode of travel (commuter mode). We examined longitudinal (1996-2019) bicyclist, pedestrian, and motor vehicle occupant injury and fatality risk in the Canadian Census Health and Environment Cohorts by commuter mode and sociodemographic characteristics using Cox proportional hazards models within the working adult population.

RESULTS

We estimated positive associations between commute mode and same mode injury and fatality, particularly for bicycle commuters (hazard ratios for bicycling injury was 9.1 and for bicycling fatality was 11). Low-income populations and Indigenous people had increased injury risk across all modes.

CONCLUSIONS

This study shows inequities in transportation injury risk in Canada and underscores the importance of adjusting for mode of travel when examining differences between population groups.

Effect of transit-oriented design on pedestrian and cyclist safety using bivariate spatial models

INTRODUCTION

Walking and cycling for transportation provide immense benefits (e.g., health, environmental, social). However, pedestrians and bicyclists are the most vulnerable segment of the traveling public due to the lack of protective structure and difference in body mass compared with motorized vehicles. Numerous studies are dedicated to enhancing active transportation modes, but very few studies are devoted to the safety analysis of the transit stops, which serve as the important modal interface for pedestrians and bicyclists.

METHOD

This study bridges the gap by developing joint models based on the multivariate conditional autoregressive (MCAR) priors with distance-oriented neighboring weight matrix. For this purpose, transit-oriented design (TOD) related data in Los Angeles County were used for model development. Feature selection relying on both random forest (RF) and correlation analysis was employed, which leads to different covariates inputs to each of the two joint models, resulting in increased model flexibility. An integrated nested Laplace approximation (INLA) algorithm was adopted due to its fast, yet robust, analysis. For a comprehensive comparison of the predictive accuracy of models, different evaluation criteria were utilized.

RESULTS

The results demonstrate that models with correlation effect perform much better than the models without a correlation of pedestrians and bicyclists. The joint models also aid in the identification of the significant covariates contributing to the safety of each of the two active transportation modes. The findings show that population density, employment density, and bus stop density positively influence bicyclist-involved crashes, suggesting that an increase in population, employment, or the number of bus stops leads to more active modes involved collisions.

PRACTICAL APPLICATIONS

The findings of this study may prove helpful in the development and implementation of the safety management process to improve the roadway environment for the active modes in the long run.

Older Adults' Choice of Patterns of Outdoor Physical Activity Duration: A Mixed Multinomial Logit Model

Outdoor physical activity duration is a key component of outdoor physical activity behavior of older adults, and therefore, an important determinant of their total physical activity levels. In order to develop a successful outdoor physical activity program, it is important to identify any heterogeneity in preferences for outdoor physical activity duration patterns among older adults. In addition, more insight is needed in the influence of environmental characteristics on duration choice for creating supportive neighborhood environments matching individuals’ preferences. To this end, a mixed multinomial logit model is estimated based on one-week data collected among 336 respondents aged 60 or over in 2017 in Dalian, China. The present model formulation accounts for heterogeneity in individuals’ preferences and allows for the analysis of substitution and complementary relationships between the different patterns of outdoor physical activity duration. Results indicate that older adults vary significantly in their preferences for each outdoor physical activity duration pattern. Moreover, short walking duration, short exercise duration and medium exercise duration are substitutes for medium walking duration while short walking duration and short exercise duration are complements for medium exercise duration in terms of individuals’ outdoor physical activity duration preferences. In addition, we find that distance to the nearest park, footpath conditions and neighborhood aesthetics are associated with older adults’ outdoor physical activity duration choice.