Effectiveness of a Road Traffic Injury Prevention Intervention in Reducing Pedestrian Injuries, Barcelona, Spain, 2002-2019.

This study aimed to evaluate the effectiveness of the Safe Routes to School (SRTS) intervention in Barcelona, Spain, at reducing the number of road traffic collisions and injuries in the school environment. It was a pre-post, quasi-experimental evaluation with a matched comparison group. Road traffic injuries were significantly reduced in the intervention schools-especially among school-age pedestrians-but not in the comparison schools. The SRTS program significantly improved road safety among children. (Am J Public Health. 2023;113(5):495-499. https://doi.org/10.2105/AJPH.2022.307216).

Methods to evaluate the effectiveness of advanced stop lines for motorcycles in improving road safety.

In Barcelona, Advanced Stop Lines (ASL) for motorcycles, were implemented since 2009. This paper aims to describe the process followed in determining the best statistical model to analyse the effectiveness of ASL in preventing road traffic injury collisions. A quasi-experimental design of an evaluation study of an intervention with comparison group was performed.•The starting model is the Poisson regression model, including type of area (ASL, comparison zone), period (pre and post-intervention), linear trend of the number of collisions, period and type of area interaction, as explanatory variables.•Various models are tested to correct existing overdispersion in the starting model: Poisson -Lognormal, Poisson- Gamma, Zero-Inflated Poisson, Zero-Inflated Negative Binomial, Hurdle model with Poisson distribution and with Negative Binomial distribution. To select the best model the Akaike Information Criterion is used. The final model is the Poisson-lognormal, adding the area as random factor (for each area repeated measures for different years are available).•The coefficients of the model parameters are interpreted in terms of relatives risks (RR), and the percentage change in the number of collisions is estimated in the post regards the pre-intervention period, from the RRs (- (1-RR)), to quantify the impact of ASL. The interaction allows assessment of whether the effect of the intervention differed between ASL and comparison zones.

Head-on crashes on two-way interurban roads: a public health concern in road safety.

OBJECTIVE: To describe the magnitude and characteristics of crashes and drivers involved in head-on crashes on two-way interurban roads in Spain between 2007 and 2012, and to identify the factors associated with the likelihood of head-on crashes on these roads compared with other types of crash. METHODS: A cross-sectional study was conducted using the National Crash Register. The dependent variables were head-on crashes with injury (yes/no) and drivers involved in head-on crashes (yes/no). Factors associated with head-on crashes and with being a driver involved in a head-on crash versus other types of crash were studied using a multivariate robust Poisson regression model to estimate proportion ratios (PR) and confidence intervals (95% CI). RESULTS: There were 9,192 head-on crashes on two-way Spanish interurban roads. A total of 15,412 men and 3,862 women drivers were involved. Compared with other types of crash, head-on collisions were more likely on roads 7 m or more wide, on road sections with curves, narrowings or drop changes, on wet or snowy surfaces, and in twilight conditions. Transgressions committed by drivers involved in head-on crashes were driving in the opposite direction and incorrectly overtaking another vehicle. Factors associated with a lower probability of head-on crashes were the existence of medians (PR=0.57; 95%CI: 0.48-0.68) and a paved shoulder of less than 1.5 meters (PR=0.81; 95%CI: 0.77-0.86) or from 1.5 to 2.45 meters (PR=0.90; 95%CI: 0.84-0.96). CONCLUSIONS: This study allowed the characterization of crashes and drivers involved in head-on crashes on two-way interurban roads. The lower probability observed on roads with median strips point to these measures as an effective way to reduce these collisions.

Head-on crashes on two-way interurban roads: a public health concern in road safety / Colisiones frontales en vías interurbanas de doble sentido: un problema de salud pública en seguridad vial

Objective: To describe the magnitude and characteristics of crashes and drivers involved in head-on crashes on two-way interurban roads in Spain between 2007 and 2012, and to identify the factors associated with the likelihood of head-on crashes on these roads compared with other types of crash. Methods: A cross-sectional study was conducted using the National Crash Register. The dependent variables were head-on crashes with injury (yes/no) and drivers involved in head-on crashes (yes/no). Factors associated with head-on crashes and with being a driver involved in a head-on crash versus other types of crash were studied using a multivariate robust Poisson regression model to estimate proportion ratios (PR) and confidence intervals (95% CI). Results: There were 9,192 head-on crashes on two-way Spanish interurban roads. A total of 15,412 men and 3,862 women drivers were involved. Compared with other types of crash, head-on collisions were more likely on roads 7 m or more wide, on road sections with curves, narrowings or drop changes, on wet or snowy surfaces, and in twilight conditions. Transgressions committed by drivers involved in head-on crashes were driving in the opposite direction and incorrectly overtaking another vehicle. Factors associated with a lower probability of head-on crashes were the existence of medians (PR=0.57; 95%CI: 0.48-0.68) and a paved shoulder of less than 1.5 meters (PR=0.81; 95%CI: 0.77-0.86) or from 1.5 to 2.45 meters (PR=0.90; 95%CI: 0.84-0.96). Conclusions: This study allowed the characterization of crashes and drivers involved in head-on crashes on two-way interurban roads. The lower probability observed on roads with median strips point to these measures as an effective way to reduce these collisions (AU)

Objetivo: Describir la magnitud y las características de las colisiones y de los conductores/as implicados/as en colisiones frontales en carretera convencional, e identificar los factores asociados a la probabilidad de colisión frontal respecto a otro tipo de colisiones, en España, en 2007-2012. Métodos: Estudio de diseño transversal utilizando el Registro de víctimas y accidentes. Las variables dependientes fueron la colisión frontal con víctimas (sí/no) y ser un conductor implicado en colisión frontal (sí/no). Se estudiaron los factores asociados a colisión o a ser un conductor implicado en colisión frontal respecto a los otros tipos de colisión, mediante un modelo multivariado de regresión de Poisson robusta, estimando razones de proporción (RP) y sus intervalos de confianza del 95% (IC95%). Resultados: Ocurrieron 9192 colisiones frontales en carretera convencional, con 15.412 hombres y 3862 mujeres involucrados/as. Hubo una mayor probabilidad de colisión frontal respecto a otro tipo de colisión en carreteras con 7 m o más de calzada, en curvas, estrechamiento de calzada o cambios de rasante, con superficie húmeda o nevada, y durante el crepúsculo. Conducir en dirección contraria y realizar un adelantamiento indebido se asocian a colisión frontal en conductores/as. La existencia de mediana (RP=0,57; IC95%: 0,48-0,68) o de arcén de menos de 1,5m (PR=0,81; IC95%: 0,77-0,86) o de 1,5m a 2,45m (PR=0,90; IC95%: 0,84-0,96) se asocian a menor probabilidad de colisión frontal. Conclusiones: Este estudio ha permitido caracterizar las colisiones y los conductores/as implicados en colisiones frontales en carretera convencional. La menor probabilidad de colisión frontal cuando existen medianas hace recomendable su implementación como medida efectiva para disminuir este tipo de colisiones (AU)

Effect of neighbourhood motorization rates on walking levels.

BACKGROUND: Motorized traffic may discourage people walking. This study analyses the influence of motorization on pedestrian mobility in the neighbourhoods of a European city, controlling for environmental, sociodemographic, mobility and road safety characteristics of the neighbourhood in which each trip was made. METHODS: Cross-sectional ecological study using the 38 neighbourhoods of Barcelona as the unit of analysis. Mobility information was obtained from the 2006 Daily Mobility Survey. Walking rates were calculated for 32.343 men and women who made walking trips, per 1000 men and women who made trips in the 38 neighbourhoods. Data were aggregated to calculate the total number of motorized trips made in each neighbourhood. ß coefficients and their confidence intervals were calculated using Poisson regression, in order to study the relationship between walking and motorization, in the different tertiles of motorization and adjusting for contextual factors and their corresponding interactions with motorization. RESULTS: Levels of motorization in the neighbourhood negatively influence walking, even when environmental variables of the neighbourhood are considered. In men we observe a gradient whereby walking rates fall as motorization rises (ß = -0.248; P < 0.001 and ß = -0.363; P < 0.001 in the second and third quartiles of motorization, respectively). In the case of women we find that only high levels of motorization have a negative influence on the rates of women who walk. (ß = -0.256; P < 0.001). CONCLUSION: Motorized traffic discourages people walking. Motorization is a modifiable environment-related factor which should be taken into account when designing policies to promote safe active travel.

Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010.

BACKGROUND: In recent years, the incidence of injury in older people has increased. The aim of this study is to address the hypothesis that this increase is due to an increase in the incidence of some injuries that, while less common than hip fractures, are sufficient jointly to counteract the decrease or stabilisation in hip fracture rates observed in most countries. METHODS: We performed a descriptive study of trends using data from the National Hospital Discharge Register. We included individuals 65 years and older who were discharged from a Spanish hospital during the period 2000-2010 with at least one injury diagnosis in the primary diagnosis field on the discharge form. The dependent variables were the following injury groups, classified using the Barell Matrix: hip fracture, shoulder and upper arm fractures, forearm and elbow fractures, thoracic fractures, lower leg and ankle fractures, and TBI type 1 internal injury. Incidence rates were calculated per 100,000 inhabitants (data from National Statistics Institute) and stratified by sex and age group. Trends, in terms of Annual Percent Change (APC), were assessed using Poisson Regression with discharge year as the independent variable. RESULTS: Hip fracture continues to be the most important injury type in older people. Thoracic fractures and TBI internal injuries are more common in men, while fractures in the upper extremities are more common in women. All injuries increased in frequency with age, except lower leg and ankle fractures, which decreased. While a secular decreasing trend in hip fracture was noted, the incidences of fractures of the shoulder and upper arm, forearm and elbow, and lower leg and ankle, as well as of TBI type 1 internal injuries have increased steadily. CONCLUSIONS: Although hip fracture continue to be the most common type of injury in older people, this study has allowed identifying other types of injury that are becoming increasingly common. These trends are driving paradigm changes in the burden of injuries requiring treatment within the hospital system, and must be taken into account in the design of preventative programs and actions.

Latent risk and trend models for the evolution of annual fatality numbers in 30 European countries.

In this paper a unified methodology is presented for the modelling of the evolution of road safety in 30 European countries. For each country, annual data of the best available exposure indicator and of the number of fatalities were simultaneously analysed with the bivariate latent risk time series model. This model is based on the assumption that the amount of exposure and the number of fatalities are intrinsically related. It captures the dynamic evolution in the fatalities as the product of the dynamic evolution in two latent trends: the trend in the fatality risk and the trend in the exposure to that risk. Before applying the latent risk model to the different countries it was first investigated and tested whether the exposure indicator at hand and the fatalities in each country were in fact related at all. If they were, the latent risk model was applied to that country; if not, a univariate local linear trend model was applied to the fatalities series only, unless the latent risk time series model was found to yield better forecasts than the univariate local linear trend model. In either case, the temporal structure of the unobserved components of the optimal model was established, and structural breaks in the trends related to external events were identified and captured by adding intervention variables to the appropriate components of the model. As a final step, for each country the optimally modelled developments were projected into the future, thus yielding forecasts for the number of fatalities up to and including 2020.

Incidence trends of injury among the elderly in Spain, 2000-2010.

BACKGROUND: The significant growth in the elderly population expected in the coming years demands a thorough and up-to-date understanding of the incidence of injuries in this group for purposes of prevention polices and their evaluation. The aim of this study was to describe the incidence of injuries in hospital inpatients over 64 years of age in Spain, stratified by sex, age group, and the severity and mechanism of injury, and to analyse trends in incidence during the period 2000-2010. METHODS: Descriptive trends study using data from the National Hospital Discharge Register. The dependent variable was the number of hospital discharges with injury. Stratified incidence rates were calculated per 100,000 inhabitants. Trends, in terms of annual per cent change, were assessed using Poisson regression with discharge year as the independent variable. RESULTS: Rates of injury were higher among women than men, increased with age in both sexes, with individuals aged ≥85 years having a fivefold greater risk than those aged 65-69 years. During the period 2000-2010, incidence increased annually by 1.1% in men and 0.9% in women aged 75-79 years, 2.3% and 1.6% in 80-84-year-olds and 3.3% and 2.4% in ≥85-year-olds, respectively. The incidence of all levels of injury severity and all mechanisms of injury increased during the study period, except for traffic injuries, which decreased. CONCLUSIONS: Incidence of injury in the elderly is rising, particularly in older individuals, indicating that the increase in the number of hospitalisations is not a consequence of population aging only.

Gender differences in road traffic injury rate using time travelled as a measure of exposure.

There is no consensus on whether the risk of road traffic injury is higher among men or among women. Comparison between studies is difficult mainly due to the different exposure measures used to estimate the risk. The measures of exposure to the risk of road traffic injury should be people's mobility measures, but frequently authors use other measures such population or vehicles mobility. We compare road traffic injury risk in men and women, by age, mode of transport and severity, using the time people spend travelling as the exposure measure, in Catalonia for the period 2004-2008. This is a cross-sectional study including all residents aged over 3 years. The road traffic injury rate was calculated using the number of people injured, from the Register of Accidents and Victims of the National Traffic Authority as numerator, and the person-hours travelled, from the 2006 Daily Mobility Survey carried out by the Catalan regional government, as denominator. Sex and age specific rates by mode of transport and severity were calculated, and Poisson regression models were fitted. Among child pedestrians and young drivers, males present higher risk of slight and severe injury, and in the oldest groups women present higher risk. The death rate is always higher in men. There exists interaction between sex and age in road traffic injury risk. Therefore, injury risk is higher among men in some age groups, and among women in other groups, but these age groups vary depending on mode of transport and severity.

[Definition of hospital discharge, serious injury and death from traffic injuries]. / Definición de alta hospitalaria, lesión grave y muerte por lesiones por tráfico.

Road traffic injury surveillance involves methodological difficulties due, among other reasons, to the lack of consensus criteria for case definition. Police records have usually been the main source of information for monitoring traffic injuries, while health system data has hardly been used. Police records usually include comprehensive information on the characteristics of the crash, but often underreport injury cases and do not collect reliable information on the severity of injuries. However, statistics on severe traffic injuries have been based almost exclusively on police data. The aim of this paper is to propose criteria based on medical records to define: a) "Hospital discharge for traffic injuries", b) "Person with severe traffic injury", and c) "Death from traffic injuries" in order to homogenize the use of these sources.

Birth defects in medically assisted reproduction pregnancies in the city of Barcelona.

OBJECTIVE: To assess the association between the use of medically assisted reproduction (MAR) and birth defects (BD) in newborns and terminations of pregnancy in pregnant women registered in Barcelona in the period 1992 to 2007. METHODS: We studied 1905 cases and 2722 controls in a retrospective population-based case-control study. Cases comprised any newborn presenting at least one major BD, as well as any pregnancy terminated because of BD. Controls were newborns without BD. Exposure was MAR. Adjusted odds ratios (aOR) with 95% confidence intervals (CI) were calculated by means of logistic regression to assess the association. RESULTS: The MAR was demonstrated to be associated with BD, after adjusting for probable confounders (aOR = 1.8; 95% CI = 1.4 to 2.5). Regarding MAR modalities, this association was statistically significant only for assisted reproduction techniques (ART) (aOR = 2.7; 95% CI = 1.8 to 4.1). In the stratified analysis by structural BD categories, frequencies for all categories were increased after ART with the exception of head-face-neck-eye defects, none after artificial insemination, and digestive-abdominal wall defects in ovulation induction. CONCLUSIONS: This study demonstrated a strong association between ART and BD, with an almost threefold increased risk for overall BD after ART, as compared with natural conception. Increased associations were also observed for almost all structural BD categories.

Work, family and daily mobility: a new approach to the problem through a mobility survey

Objectives: To analyze gender inequalities in socioeconomic factors affecting the amount of time spent travelling for work-related and home-related reasons among working individuals aged between 30 and 44 years old during a weekday in Catalonia (Spain). Methods: A cross-sectional study was conducted. Data were obtained from employed individuals aged between 30 and 44 years of age who reported travelling on the day prior to the interview in the Catalan Mobility Survey 2006 (N = 23,424). Multivariate logistic regression models were adjusted to determine the factors associated with longer time spent travelling according to the reason for travelling (work- or home-related journeys). Odds ratios and 95% confidence intervals are presented. Results: A higher proportion of men travelled and spent more time travelling for work-related reasons, while a higher proportion of women travelled and spend more time travelling for home-related reasons. A higher educational level was associated with greater time spent travelling for work-related reasons in both men and women but was related to an increase in travelling time for home-related reasons only in men. In women, a larger household was associated with greater travel time for home-related reasons and with less travel time for work-related reasons. Conclusion: This study confirms the different mobility patterns in men and women, related to their distinct positions in the occupational, family and domestic spheres. Gender inequalities in mobility within the working population are largely determined by the greater responsibility of women in the domestic and family sphere. This finding should be taken into account in the design of future transport policies (AU)

Objetivo: Analizar cómo los factores socioeconómicos afectan de manera desigual al tiempo invertido en desplazamiento por motivos relacionados con el trabajo y con el hogar en un día laboral, entre hombres y mujeres de 30 a 44 años de edad en Cataluña. Métodos: Estudio transversal. Los datos provienen de individuos ocupados de 30 a 44 años de edad que declararon haber realizado algún desplazamiento el día anterior a la entrevista en la Encuesta de Movilidad de Cataluña 2006 (N = 23.424). Se ajustaron modelos de regresión logística multivariados para determinar los factores asociados a desplazarse más tiempo por motivos relacionados con el trabajo y con el hogar. Se presentan las odds ratio y sus correspondientes intervalos de confianza del 95%. Resultados: Los hombres se desplazan en mayor proporción e invierten más tiempo en desplazamientos por trabajo, mientras que las mujeres lo hacen por desplazamientos relacionados con el hogar. Un nivel de estudios elevado se asocia a mayor tiempo en desplazamientos por trabajo en ambos sexos, pero sólo en los hombres se asocia con mayor tiempo en desplazamientos por hogar. Sólo en las mujeres, un mayor número de personas en el hogar está asociado a mayor tiempo en desplazamientos por hogar, y menor tiempo invertido en desplazamientos por trabajo. Conclusión: Este estudio confirma los diferentes patrones de movilidad entre hombres y mujeres, derivados de su diferente posición en el ámbito laboral y familiar. Las desigualdades en movilidad entre la población trabajadora están determinadas por la mayor responsabilidad de las mujeres en la esfera doméstica. Este hecho debería ser considerado a la hora de diseñar futuras políticas de transporte (AU)

Measures of exposure to road traffic injury risk.

OBJECTIVE: To compare the risk of road traffic injury calculated using an exposure measure based on people's mobility, person-hours travelled (person-hours), with the risk obtained using population census, vehicle fleet and vehicle-kilometres travelled. METHODS: The rate of road traffic injury on a working day in Catalonia in 2006 was calculated using the number of people injured from the Register of Accidents and Victims of the National Traffic Authority and as denominator: person-hours travelled, from the 2006 Daily Mobility Survey of Catalonia; population census and vehicle fleet, from the National Statistics Institute; and vehicle-kilometres, from the Ministry of Public Works. RESULTS: Compared with person-hours travelled: population census may underestimate the risk in groups with low mobility; vehicle-kilometres may underestimate the risk in regions with high level of non-motorised mobility and high use of public transport; vehicle fleet may underestimate the risk for collective forms of transport such as buses and for motorcyclists who make many trips but of short duration. CONCLUSIONS: Measures of exposure involving people's mobility should be used in the estimation of road traffic injury risk, instead of vehicle's mobility, population census or vehicle fleet.

Health impact of motorised trips that could be replaced by walking.

BACKGROUND: We aimed to quantify the number of women and men, in Catalonia, among those not achieving physical activity recommendations, making short motorized trips which could have been made on foot, and to estimate the annual economic benefit due to reducing mortality as a result of replacing one short, daily, motorized journey with walking. METHODS: Cross-sectional study. Mobility data came from individuals >17 years who reported, in the 2006 Daily Mobility Survey, having travelled on the referred working day (N = 80,552). The health economic assessment tool for walking (HEAT) from the World Health Organization (WHO) Regional Office for Europe was used to calculate the economic benefit. RESULTS: Of those not meeting recommendations, 15.6% of men (95% CI 15.2-16.1) and 13.9% of women (95% CI 13.5-14.4) would go on to meet them if they were to replace at least one short motorized trip per day by walking. If applied to the entire population of Catalonia, this change would increase up to 326,557 men (95% CI 313 373-339,740) and up to 252,509 women (95% CI 240,855-264,163) who would achieve recommendations through walking rather than driving. According to HEAT estimations, this would suppose a saving of €124,216,000 (95% CI 120,182,000-128,250,000) in men and €84,927,000 (95% CI 81,774,000-88,079,000) in women, derived from the reduction in mortality gained from walking accumulated over one year. CONCLUSION: This study demonstrates the potential of trips on foot as a source of physical activity. It also points out that both benefits for the health of the population and a huge economic benefit could have been gained through active transportation interventions.

Work, family and daily mobility: a new approach to the problem through a mobility survey.

OBJECTIVES: To analyze gender inequalities in socioeconomic factors affecting the amount of time spent travelling for work-related and home-related reasons among working individuals aged between 30 and 44 years old during a weekday in Catalonia (Spain). METHODS: A cross-sectional study was conducted. Data were obtained from employed individuals aged between 30 and 44 years of age who reported travelling on the day prior to the interview in the Catalan Mobility Survey 2006 (N = 23,424). Multivariate logistic regression models were adjusted to determine the factors associated with longer time spent travelling according to the reason for travelling (work- or home-related journeys). Odds ratios and 95% confidence intervals are presented. RESULTS: A higher proportion of men travelled and spent more time travelling for work-related reasons, while a higher proportion of women travelled and spend more time travelling for home-related reasons. A higher educational level was associated with greater time spent travelling for work-related reasons in both men and women but was related to an increase in travelling time for home-related reasons only in men. In women, a larger household was associated with greater travel time for home-related reasons and with less travel time for work-related reasons. CONCLUSION: This study confirms the different mobility patterns in men and women, related to their distinct positions in the occupational, family and domestic spheres. Gender inequalities in mobility within the working population are largely determined by the greater responsibility of women in the domestic and family sphere. This finding should be taken into account in the design of future transport policies.

Spinal cord injury and traumatic brain injury: a cost-of-illness study.

BACKGROUND: Among traumatic injuries, spinal cord injuries (SCI) and traumatic brain injuries (TBI) are of major importance because of their epidemiological and economic impact on society. The overall objective of this study was to estimate the economic cost associated with people with SCI and TBI in Spain in 2007. METHODS: A cost-of-illness analysis was performed, considering the perspective of society, using a 1-year time horizon. Medical costs, adaptation costs, material costs, administrative costs, and costs of police, firefighters and roadside assistance, productivity losses due to institutionalization and sick leave, as well as an estimate of productivity losses of carers, and productivity losses due to death were included. RESULTS: The economic cost associated with people with SCI is between EUR 92,087,080.97 and 212,496,196.41 (USD 131 million and 302 million) according to the injury mechanism, and between EUR 1,079,223,688.66 and 3,833,752,692.78 (USD 1,536 million and 5,458 million) for people with TBI. CONCLUSIONS: There is an urgent need to develop effective interventions known to prevent SCI and TBI, and to evaluate their effectiveness and efficiency.

Incidence trends of traumatic spinal cord injury and traumatic brain injury in Spain, 2000-2009.

AIMS: The aim of the present study was to estimate the incidence of hospital discharges for traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) in Spain by injury circumstances (traffic crashes and others), injury severity, gender and age group and to describe its trends over the period 2000-2009. METHODS: It is a study of trends that includes hospital discharges with a primary diagnosis of TSCI or TBI. Crude and age-standardised rates were calculated per million inhabitants. Changes in rates between 2000 and 2009 were assessed through calculation of the relative risk adjusted for age, using Poisson regression. RESULTS: Between 2000 and 2009 in Spain, 10,274 patients were admitted for traumatic TSCI, and 206,503 for TBI. The annual incidence rate for TSCI was 23.5 per million, that for TBI was 472.6 per million. The overall incidence rate for TSCI fell significantly between 2000 and 2009 by 24.2% (traffic-related 40.9%, other 12.9%), as did that for TBI (23.8% overall, 60.2% traffic-related, with no change for other circumstances). Among people aged 65 years and over, no change was observed for TSCI, incidence of TBI fell significantly when due to traffic crashes, but there was a dramatic increase of 87% in men and 89.3% in women when due to other circumstances. CONCLUSIONS: Over the last decade the incidence of these types of injury has fallen significantly when the injury resulted from traffic crashes, and to a lesser extent when from other circumstances. However TBI incidence among people aged 65 and over injured in non-traffic-related circumstances has risen dramatically.

Effect on road traffic injuries of criminalizing road traffic offences: a time-series study.

OBJECTIVE: To determine the effect of criminalizing some traffic behaviours, after the reform of the Spanish penal code in 2007, on the number of drivers involved in injury collisions and of people injured in traffic collisions in Spain. METHODS: This study followed an interrupted times-series design in which the number of drivers involved in injury collisions and of people injured in traffic collisions in Spain before and after the criminalization of offences were compared. The data on road traffic injuries in 2000-2009 were obtained from the road traffic collision database of the General Traffic Directorate. The dependent variables were stratified by sex, age, injury severity, type of road user, road type and time of collision. Quasi-Poisson regression models were fitted with adjustments for time trend, seasonality, previous interventions and national fuel consumption. FINDINGS: The overall number of male drivers involved in injury collisions dropped (relative risk, RR: 0.93; 95% confidence interval, CI: 0.89-0.97) after the reform of the penal code, but among women no change was observed (RR: 0.99; 95% CI: 0.95-1.03). In addition, 13 891 men (P < 0.01) were prevented from being injured. Larger reductions were observed among young male drivers and among male motorcycle or moped riders than among the drivers of other vehicles. CONCLUSION: The findings suggest that criminalizing certain traffic behaviours can improve road safety by reducing both the number of drivers involved in injury collisions and the number of people injured in such collisions.

Road safety in the political agenda: the impact on road traffic injuries.

BACKGROUND: This paper aims at assessing the effectiveness of the package of road safety measures implemented after road safety was included in the political agenda in the year 2004 on the number of road traffic-injured people in Spain. METHODS: An evaluation study was performed using an interrupted time-series design. The study population was people injured in road traffic crashes in Spain between 1 January 2000 and 31 December 2006. The road traffic crashes database of the General Directorate for Traffic was used. The dependent variable was the monthly number of people injured, stratified by sex, age, severity and type of road user. The explanatory variable (intervention) compared the post-intervention period (2004-6) with the pre-intervention period (2000-3). Quasi-Poisson regression models were adjusted, controlling for time trend and for seasonality. RESULTS: Results show a reduction in the risk of being injured for both men (RR 0.91; 95% CI 0.87 to 0.95) and women (RR 0.89; 95% CI 0.85 to 0.94). Risk reductions were observed across all age groups and all road users, except for pedestrians. CONCLUSIONS: The present study suggests that prioritising road safety reduces the number of people injured in road traffic collisions.