Deprived neighborhoods and risk of road trauma (incidence and severity) among under 25year-olds in the Rhône Département (France).

INTRODUCTION: Previous research has shown that there are inequalities with regard to traffic accident risk between different social categories. This study describes the influence of the type of residential municipality (with or without deprived urban areas, "ZUS, zones urbaines sensibles"), used as an indicator of contextual deprivation, on the incidence and severity of road trauma involving people of under 25years of age in the Rhône. METHOD: Injury data were taken from The Rhône Road Trauma Registry. The study covers the 2004-2007 period, with 13,589 young casualties. The incidence of traffic injury of all severities were computed according to the type of municipality and the age, gender, and type of road user. The ratios of the incidences of deprived municipalities, compared with others were calculated. Subsequently the severity factors and incidences according to the severity level (ISS 1-8, ISS 9+) were studied. RESULTS: For the main types of road users except motorized two-wheeler users, the incidences were higher in the deprived municipalities: the greatest difference was for pedestrians, where the incidences were almost twice those of other municipalities. This excess risk, constituting a health inequality topic rarely considered, was even greater in municipalities with two or three ZUSs. It was essentially observed for minor injuries among motorists, cyclists, and pedestrians. CONCLUSIONS: While the incidence increased among people less than 25years of age, the severity of road injuries was lower in deprived neighborhoods, contrary to what is suggested by other studies. This lower severity disappeared when taking into account the crash characteristics. IMPACT ON INDUSTRY: The incidence of injuries as a pedestrian, cyclist or motorist is higher among young people living in deprived municipalities. These areas should therefore be the targets of dedicated education programs, as well as further investigations about urban planning.

Contextual deprivation, daily travel and road traffic injuries among the young in the Rhône Département (France).

This study investigated the effect of the socioeconomic level of the municipality of residence on personal injury road traffic accident risk among young persons of 10-24 years of age in the Rhône Département. This effect was assessed by comparing incidences of injuries (n=2792 casualties) on the basis of three denominators: the resident population of young people, the number of users of each mode and the distances covered by each mode. The results are presented for each type of road users (pedestrians, car passengers, car drivers, motorised two-wheeler riders, cyclists, public transport users). Young persons from deprived municipalities use motorised-two wheelers, bicycles and the car (as passengers and drivers) less frequently, they walk more and take public transports more often than those from other municipalities. When considering injury risk, motorised two wheeler injuries among adolescent males, for example, are significantly less frequent in deprived municipalities. But the motorised two-wheeler riders as well as car passengers from deprived municipalities are characterized by an excess injury risk, whether the selected denominator is the number of users or the kilometres travelled by this mode. For the first time in France, this study has enabled a comparison of the effects of a contextual socioeconomic indicator (the type of municipality of residence, deprived, or not) on daily travel practices and injury incidences among the population, among the users of each mode and per km of travel.

Severe outcome of children following trauma resulting from road accidents.

OBJECTIVE: The aim of the study was to determine the risk factors of a severe outcome for children severely injured [killed or with an Injury Severity Score (ISS)>or=16] in a road accident. MATERIALS AND METHODS: Casualties that occurred between 1996 and 2001 which involved children under 14 years of age were assessed in a population-based study based on data included in a French road trauma Registry. A severe traumatic brain injury (TBI) was defined as a head injury with an Abbreviated Injury Scale (AIS) severity score>or=3. A multivariate logistic regression was performed to quantify the risk of a "severe outcome" defined as death or an expected serious impairment 1 year later. RESULTS: The annual incidence of an ISS of 16+ was 7.7 per 100,000 children. Among the 126 severely injured children included in this study, 40 died (including 16 immediate deaths), and a severe outcome was expected for 54 of the 86 survivors. Children with an "isolated severe TBI" and those with "multiple injuries including TBI" were more likely to have a severe outcome than those who had an "isolated severe injury without TBI" (OR: 7.91; 95%CI: 1.43-43.77 and OR: 8.37; 95%CI: 1.52-46.13, respectively). Age was inversely linked to a severe outcome. The unprotected motor vehicle occupants (MVO) had an odds ratio of 7.56 (95%CI: 1.07-53.56) compared to the protected MVO. Only 30% of children who survived a severe TBI were admitted to rehabilitation. CONCLUSION: The mechanism of the injury, an injury pattern involving the head and a young age were associated with a severe outcome following a road accident. A majority of children severely injured were not referred to inpatient rehabilitation.