Comparative analysis of injury identification using KABCO and ISS in linked North Carolina trauma registry and crash data.

OBJECTIVE: The purpose of this study was to examine differences between police-reported injury severity and trauma registry data among persons with linked records in North Carolina and quantify the degree of alignment. METHODS: We analyzed linked North Carolina trauma registry and motor vehicle crash data from 2018. Injury severity identification was assessed using police-reported 5-point scale KABCO from crash data and Injury Severity Score (ISS) from trauma records. The analysis was stratified by age, sex/gender, race, ethnicity, and road users type to examine differences across groups. We calculated sensitivity, specificity, positive predictive values, and negative predictive values between police-reported injury severity and trauma registry data using ISS as the gold standard. RESULTS: A higher proportion of patients were classified as suspected minor injuries (39.0%) compared to moderate injuries in trauma registry (25.1%). Police-reported crash data underreported injury severity when compared to trauma registry data. Police-reported KABCO had a higher degree of specificity when classifying minor injuries (79.3%) but substantially underestimated seriously injured patients, with a sensitivity of 49.9%. These findings were also consistent when stratified by subpopulations. CONCLUSION: Hospital-based motor vehicle crash data are a main source of injury severity identification for road safety. Police-reported data were relatively accurate for minor injuries but not seriously injured patients. Understanding the characteristics of each data source both separately and linked will be critical for problem identification and program development to move toward a safe transportation system for all road users.

Structural Racism and Pedestrian Safety: Measuring the Association Between Historical Redlining and Contemporary Pedestrian Fatalities Across the United States, 2010‒2019.

Objectives. To examine the association between historical redlining and contemporary pedestrian fatalities across the United States. Methods. We analyzed 2010-2019 traffic fatality data, obtained from the Fatality Analysis Reporting System, for all US pedestrian fatalities linked by location of crash to 1930s Home Owners' Loan Corporation (HOLC) grades and current sociodemographic factors at the census tract level. We applied generalized estimating equation models to assess the relationship between the count of pedestrian fatalities and redlining. Results. In an adjusted multivariable analysis, tracts graded D ("Hazardous") had a 2.60 (95% confidence interval = 2.26, 2.99) incidence rate ratio (per residential population) of pedestrian fatalities compared with tracts graded A ("Best"). We found a significant dose‒response relationship: as grades worsened from A to D, rates of pedestrian fatalities increased. Conclusions. Historical redlining policy, initiated in the 1930s, has an impact on present-day transportation inequities in the United States. Public Health Implications. To reduce transportation inequities, understanding how structurally racist policies, past and present, have an impact on community-level investments in transportation and health is crucial. (Am J Public Health. 2023;113(4):420-428. https://doi.org/10.2105/AJPH.2022.307192).

Mixed method assessment of built environment and policy responses to the COVID-19 pandemic by United States municipalities focusing on walking and bicycling actions.

Introduction: In 2020, the COVID-19 pandemic prompted community officials to initiate local level environmental and policy changes to slow the spread of infection and provide more opportunities for outdoor recreation. Changes in both regards could positively or negatively impact walking and bicycling. Using a mixed methods approach, the purpose of this United States-based study was to systematically describe municipal response to the pandemic at the community level through environmental and policy changes that may have impacted walking and bicycling. Methods: Websites of all United States' municipalities with a residential population of at least 100,000 (n = 314) were searched to identify environmental and policy changes that might impact walking/bicycling as a result of the pandemic. When actions were identified, we systematically abstracted information from the websites. To provide more contextual information, we interviewed representatives from 12 municipalities about changes made at the municipal level as a result of the pandemic that could impact walking and bicycling. Interviews were recorded, transcribed, and coded for themes. Results: For the 314 municipalities, we identified 353 actions resulting from the COVID-19 pandemic that may impact walking and bicycling. Approximately double the number of actions were identified in large-size municipalities (234 actions in 157 municipalities with population≥165,000) compared to mid-size municipalities (119 actions among 157 municipalities with population 100,000 to 164,999). Generally, fewer actions that might suppress walking and bicycling (n = 59) were identified in comparison to actions that would likely facilitate walking and bicycling (n = 294). In-depth interviews provided further context and insight into these results. Conclusion: This mixed-method assessment provides an overview of the environmental and policy changes which may impact walking and bicycling that municipalities implemented in 2020 due to the pandemic. A next step in this line of inquiry is to quantify the impact of these changes on population levels of walking and bicycling and related health and safety outcomes.

Self-reported factors that influence rear seat belt use among adults.

INTRODUCTION: While seat belt use among front seat occupants has significantly increased overtime a substantial usage gap still exists between front and back seat occupants. This study aims to identify factors that predict rear seat belt use among adult back seat passengers. METHODS: We examined data from the 2016 Motor Vehicle Occupant Safety Survey, conducted by the National Highway Traffic Safety Administration, to determine the influence of front seat belt use, support of and belief of rear seat belt use laws, peer perception of seat belt use, nighttime belt use, and demographic factors on self-reported rear seat belt use. Rao-Scott chi-squared tests were used to determine significant associations between self-reported rear belt use and each predictor. Multivariate logistic regression was used to calculate adjusted odds ratios and determine the influence of significant predictors on rear seat belt use. Sampling weights were applied to produce nationally representative estimates; all statistical significance tests accounted for the complex survey design. RESULTS: Among adults who reported riding in the back seat, 63% reported always using a rear seat belt. Front seat belt use, support and belief of state seat belt laws, nighttime seat belt use, age, and education were significantly associated with rear seat belt use. Multivariate regression results showed that adults who supported rear seat belt laws, reported front seat belt use and believed their state has a rear seat belt law were significantly more likely to report full-time use in the back seat. CONCLUSIONS: Seat belt laws and front seat belt use had the strongest association with reporting full-time use in the back seat. Practical Applications: Increasing familiarity with existing laws directed towards rear seat belt use as well as increasing awareness about the benefits of seat belts in all seating positions may help improve rear seat belt use.