Factors related to the risk of pedestrian fatality after a crash in Spain, 1993–2013
Introduction
Mortality in pedestrians due to road crashes is an important public health issue worldwide, even in the most developed countries. Among all traffic deaths, pedestrian fatalities account for 27% in Europe (World Health Organization, 2018) and 21% in Spain (Dirección General de Tráfico, 2017). This problem is expected to worsen due to the increase in the number of older people (who are the most likely to die as a consequence of a crash) and to the tendency toward increased walking in urban settings (Niebuhr et al., 2016, Rolison et al., 2012, Shinar, 2012). Consequently, it seems advisable to identify factors that influence the risk of pedestrian death after a vehicle impact, which can be subdivided into four groups: pedestrian-, driver-, vehicle- and environment- (geographic and temporal) related factors.
Many previous studies have assessed the impact of some factors in the aforementioned groups on the severity of crashes involving pedestrians. For example, older pedestrian age is recognized as a marker of higher fatality in most studies (Haleem et al., 2015, Islam and Hossain, 2015, Ma et al., 2017, Mohamed et al., 2013, Niebuhr et al., 2016, Pour-Rouholamin and Zhou, 2016, Vanlaar et al., 2016). Regarding vehicle-related factors, speed is undoubtedly the most relevant predictor of crash severity (Kröyer et al., 2014, Li et al., 2017, Matsui et al., 2016, Oikawa et al., 2016, Olszewski et al., 2015, Verzosa and Miles, 2016, Xu et al., 2016, Zhang et al., 2014). There is also agreement regarding the greater severity related with crashes involving heavier vehicles such as trucks or buses (Aziz et al., 2013, DiMaggio et al., 2006, Jang et al., 2013, Ma et al., 2017, Matsui et al., 2016, Mohamed et al., 2013, Oikawa et al., 2016, Tay et al., 2011, Zajac and Ivan, 2003). Finally, some environment-related characteristics have also consistently been related with severity in most previous studies, such as crashes occurring at night and/or with poor light conditions (Aziz et al., 2013, Coate and Markowitz, 2004, Islam and Hossain, 2015, Jang et al., 2013, Li et al., 2017, Mohamed et al., 2013, Moudon et al., 2011, Olszewski et al., 2015, Pour-Rouholamin and Zhou, 2016, p.; Tay et al., 2011; Verzosa and Miles, 2016; Zhang et al., 2014) and in rural areas compared to urban settings (Islam and Hossain, 2015, Islam and Jones, 2014, Pour-Rouholamin and Zhou, 2016, Tay et al., 2011).
However, few studies have attempted to jointly consider the following aspects of risk in connection with pedestrian fatalities:
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Treating death as the specific outcome. Fortunately, pedestrian death is a rare event after a road crash. Therefore the number of crashes required to obtain precise estimates of the association between this outcome and different risk factors is usually unattainable in datasets available at present.
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Including all types of crashes involving pedestrians, rather than specific subsets of them (based, for example, on characteristics of the pedestrian, the environment or the type of vehicle involved). This limits the external validity of the results.
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Using datasets from a nationwide register of road crashes to cover long sampling periods. Apart of solving the problems of achieving a large sample size and improving external validity, this would also make it possible to estimate the effect of temporal trends on the risk of death. Most published research is restricted to a single city, region or county, and usually comprises a period of only a few years.
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Considering, in the same design, the complete set of factors involved in the risk of pedestrian death – an important issue given that many factors are strongly interrelated. This is especially relevant for factors related with the characteristics of the driver of the vehicle involved in the crash, which are not well addressed in most studies.
All the above limitations are notable even within Spain, where there are no studies of the association between different types of traffic-related factors and the risk of pedestrian fatality after a crash.
In an attempt to overcome these limitations, we designed the present study to determine the adjusted association between pedestrian-, driver-, vehicle-, and environment-related factors and the risk of pedestrian death in the 24 hours after a crash in Spain for the period from 1993 to 2013.
Section snippets
Material and methods
From the Spanish Registry of Road Crashes with Victims (a police-based registry maintained by the Spanish General Traffic Directorate [DGT]), we collected information on all 203,622 traffic crashes in Spain from 1993 to 2013 which involved a pedestrian and a motor vehicle. The registry contains information collected by the Spanish Traffic Police at the scene of all collisions with victims. This information is classified in three categories: crash-related information, vehicle-related
Results
Of the 203,622 pedestrians included in the study, 9119 (4.5%) died within 24 hours after the crash. For each group of independent variables, the CMRR and AMRR are shown in Table 1, Table 2, Table 3, Table 4, Table 5, along with the distribution of their categories in the study population. Table 1 summarizes the estimates for pedestrian-related factors. Higher risk of fatality was associated exponentially with increasing age. This relationship is graphically depicted in Fig. 1 (solid line), in
Discussion
Our results are generally consistent with the findings of earlier studies that investigated some of the same variables. For example, the higher risk of fatality in older pedestrians was described in almost all previous studies (Haleem et al., 2015, Islam and Hossain, 2015, Li et al., 2017, Ma et al., 2017, Mohamed et al., 2013, Moudon et al., 2011, Niebuhr et al., 2016, Oikawa et al., 2016, Olszewski et al., 2015, Olszewski et al., 2016, Pour-Rouholamin and Zhou, 2016, p.; Rolison et al., 2012;
Conclusions
Our study confirms that the patterns of association in Spain between the risk of pedestrian death and some individual-, vehicle- and environment-related factors (i.e., ageing, heavy vehicles and crashes occurring at night) are similar, in many respects, to the patterns reported in previous research from other countries. More importantly, we detected other associations not found in previous studies, such as those for vehicle-related (previous defects, presence of passengers) and driver-related
Acknowledgments
We wish to thank the Spanish General Directorate of Traffic (DGT) for allowing access to their database of traffic accidents with victims, and K. Shashok for improving the use of English in the manuscript.
Conflict of interest
The authors declare that they have no conflicts of interest.
Financial support
This work was supported by the Ministry of Economy and Competitiveness (Instituto de Salud Carlos III) and the European Regional Development Fund (ERDF) under Research Project Reference PI13/01584.
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