Pedestrian Deaths During the COVID-19 Pandemic

Using a Safe System Framework to Examine the Roadway Mortality Increase Pre-COVID-19 and in the COVID-19 Era in New York State

Roadway mortality increased during COVID-19, reversing a multi-decade downward trend. The Fatality Analysis Reporting System (FARS) was used to examine contributing factors pre-COVID-19 and in the COVID-19 era using the five pillars of the Safe System framework: (1) road users; (2) vehicles; (3) roadways; (4) speed; and (5) post-crash care. Two study time periods were matched to control for seasonality differences pre-COVID-19 (n = 1725, 1 April 2018-31 December 2019) and in the COVID-19 era (n = 2010, 1 April 2020-31 December 2021) with a three-month buffer period between the two time frames excluded. Four of the five pillars of the safe system had road safety indicators that worsened during the pandemic. Mortality was 19.7% higher for motor vehicle occupants and 45.1% higher for riders of motorized two-wheeled vehicles. In adjusted analyses, failure to use safety equipment (safety belts/helmets) was associated with 44% higher mortality. Two road user groups, non-motorized bicyclists and pedestrians, did not contribute significantly to higher mortality. Urban roadway crashes were higher compared to rural crashes. Additional scientific inquiry into factors associated with COVID-19-era mortality using the Safe System framework yielded important scientific insights to inform prevention efforts. Motorized two-wheeled vehicles contribute disproportionately to pandemic-era higher mortality and constitute an emerging road safety issue that deserves further attention.

Vulnerable road user injury trends following the COVID-19 pandemic in Toronto, Canada: An interrupted time series analysis

BACKGROUND

The COVID-19 pandemic altered traffic patterns worldwide, potentially impacting pedestrian and bicyclists safety in urban areas. In Toronto, Canada, work from home policies, bicycle network expansion, and quiet streets were implemented to support walking and cycling. We examined pedestrian and bicyclist injury trends from 2012 to 2022, utilizing police-reported killed or severely injured (KSI), emergency department (ED) visits and hospitalization data.

METHODS

We used an interrupted time series design, with injury counts aggregated quarterly. We fit a negative binomial regression using a Bayesian modeling approach to data prior to the pandemic that included a secular time trend, quarterly seasonal indicator variables, and autoregressive terms. The differences between observed and expected injury counts based on pre-pandemic trends with 95% credible intervals (CIs) were computed.

RESULTS

There were 38% fewer pedestrian KSI (95%CI: 19%, 52%), 35% fewer ED visits (95%CI: 28%, 42%), and 19% fewer hospitalizations (95%CI: 2%, 32%) since the beginning of the COVID-19 pandemic. A reduction of 35% (95%CI: 7%, 54%) in KSI bicyclist injuries was observed, but However, ED visits and hospitalizations from bicycle-motor vehicle collisions were compatible with pre-pandemic trends. In contrast, for bicycle injuries not involving motor vehicles, large increases were observed for both ED visits, 73% (95% CI: 49%, 103%) and for hospitalization 108% (95% CI: 38%, 208%).

CONCLUSION

New road safety interventions during the pandemic may have improved road safety for vulnerable road users with respect to collisions with motor vehicles; however, further investigation into the risk factors for bicycle injuries not involving motor vehicles is required.

Racial and ethnic disparities in motor vehicle crash-related outcomes in North Carolina surrounding the COVID-19 pandemic

Long-term impacts of the COVID-19 pandemic on racial and ethnic disparities in motor vehicle crash (MVC) injuries and death are poorly understood. This study aimed to characterize trends and investigate the heterogeneity of MVC-related disparities in North Carolina across several data sources. Crash reports, emergency department visit records, and death certificates from 2018 to 2021 were used to calculate monthly population-rates of MVC-related public health outcomes. We estimated trendlines using joinpoint regression and compared outcomes across racial and ethnic classifications. MVC and MVC-related injury rates declined in conjunction with NC's stay-at-home order, while rates of severe outcomes remained unimpacted. By December 2021 rates of MVC-related outcomes met or exceeded pre-pandemic levels, with the highest rates observed among non-Hispanic Black individuals. Racial and ethnic disparities in MVC-related outcomes remained prevalent throughout the COVID-19 pandemic. These results highlight the importance of a holistic approach to traffic injury surveillance when assessing the impact of MVCs.

The effect of the COVID-19 pandemic on the trends and characteristics of natural and unnatural deaths in an urban Sri Lankan cohort viewed through retrospective analysis of forensic death investigations from 2019 to 2022

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has had a severe impact on global health. Apart from the disease itself, the strict restrictions and lockdowns enforced to minimize its spread have also substantially disrupted personal and public health.

METHODS

An analysis of forensic autopsy investigations was conducted between 2019 and 2022 on a selected urban population in Colombo, Sri Lanka, assessing the effects of the COVID-19 pandemic on mortality within these communities.

RESULTS

During the COVID-19 restrictions, there was a 2.5-fold increase in the total number of deaths, with a significantly higher percentage of female deaths than before. The majority of these deaths were due to cardiovascular causes, while COVID-19-related deaths ranked third overall. The highest proportion of COVID-19 deaths occurred among unvaccinated females. The monthly frequency of deaths from traffic accidents, poisoning, and asphyxiation decreased, while deaths from blunt trauma, sharp trauma, burns, and immersion increased. There was also a rise in blunt homicides and a greater number of femicides during the COVID-19 restrictions than in the pre-pandemic period. A significantly higher percentage of males who received the COVID-19 vaccine died from cardiovascular causes compared to those in the unvaccinated group.

CONCLUSION

The significant changes in mortality demographics and causes of death within this community during the COVID-19 restrictions underscore the disruption in healthcare, healthseeking behavior, and social interactions during this period. The vulnerability of individuals residing in highly urbanized areas with lower socioeconomic status, particularly women, is brought into sharp focus.

COVID Vaccine Hesitancy and Risk of a Traffic Crash

BACKGROUND

Coronavirus disease (COVID) vaccine hesitancy is a reflection of psychology that might also contribute to traffic safety. We tested whether COVID vaccination was associated with the risks of a traffic crash.

METHODS

We conducted a population-based longitudinal cohort analysis of adults and determined COVID vaccination status through linkages to individual electronic medical records. Traffic crashes requiring emergency medical care were subsequently identified by multicenter outcome ascertainment of all hospitals in the region over a 1-month follow-up interval (178 separate centers).

RESULTS

A total of 11,270,763 individuals were included, of whom 16% had not received a COVID vaccine and 84% had received a COVID vaccine. The cohort accounted for 6682 traffic crashes during follow-up. Unvaccinated individuals accounted for 1682 traffic crashes (25%), equal to a 72% increased relative risk compared with those vaccinated (95% confidence interval, 63-82; P < 0.001). The increased traffic risks among unvaccinated individuals extended to diverse subgroups, was similar to the relative risk associated with sleep apnea, and was equal to a 48% increase after adjustment for age, sex, home location, socioeconomic status, and medical diagnoses (95% confidence interval, 40-57; P < 0.001). The increased risks extended across the spectrum of crash severity, appeared similar for Pfizer, Moderna, or other vaccines, and were validated in supplementary analyses of crossover cases, propensity scores, and additional controls.

CONCLUSIONS

These data suggest that COVID vaccine hesitancy is associated with significant increased risks of a traffic crash. An awareness of these risks might help to encourage more COVID vaccination.

The Apple Mobility Trends Data in Human Mobility Patterns during Restrictions and Prediction of COVID-19: A Systematic Review and Meta-Analysis

The objective of this systematic review with PRISMA guidelines is to discover how population movement information has epidemiological implications for the spread of COVID-19. In November 2022, the Web of Science and Scopus databases were searched for relevant reports for the review. The inclusion criteria are: (1) the study uses data from Apple Mobility Trends Reports, (2) the context of the study is about COVID-19 mobility patterns, and (3) the report is published in a peer-reviewed venue in the form of an article or conference paper in English. The review included 35 studies in the period of 2020-2022. The main strategy used for data extraction in this review is a matrix proposal to present each study from a perspective of research objective and outcome, study context, country, time span, and conducted research method. We conclude by pointing out that these data are not often used in studies and it is better to study a single country instead of doing multiple-country research. We propose topic classifications for the context of the studies as transmission rate, transport policy, air quality, re-increased activities, economic activities, and financial markets.