RESUMO
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.
Assuntos
Veículos Automotores/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Caminhada/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais , Espanha/epidemiologiaRESUMO
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 64â 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 ≥85â years having a fivefold greater risk than those aged 65-69â years. During the period 2000-2010, incidence increased annually by 1.1% in men and 0.9% in women aged 75-79â 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.
Assuntos
Acidentes/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitalização/tendências , Humanos , Incidência , Escala de Gravidade do Ferimento , Masculino , Alta do Paciente/estatística & dados numéricos , Medição de Risco , Espanha/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
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.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Condução de Veículo/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Espanha/epidemiologia , Adulto JovemRESUMO
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.
Assuntos
Atividade Motora , Viagem/estatística & dados numéricos , Caminhada/estatística & dados numéricos , Adolescente , Adulto , Condução de Veículo , Ciclismo/economia , Ciclismo/estatística & dados numéricos , Estudos Transversais , Europa (Continente) , Exercício Físico , Feminino , Humanos , Masculino , Vigilância da População , Prevalência , Meios de Transporte/estatística & dados numéricos , Caminhada/economia , Adulto JovemRESUMO
Superblocks are currently being introduced in Barcelona to respond to the city's scarcity of green spaces and high levels of air pollution, traffic injuries, and sedentariness. The aim is to calm the streets by reducing the number of square meters dedicated to private vehicles and to reclaim part of this public space for people. Salut als Carrers (Health in the Streets) is a project to evaluate the potential environmental and health effects of the superblock model with an equity perspective in Barcelona. This study aims to explain the various interventions implemented in different neighborhoods in Barcelona and the methods that will be used to evaluate them in a quasi-experimental and health impact assessment (HIA) approaches. Given the complexity of the intervention evaluated, the project employs mixed methodologies. Quantitative methods include: (a) a pre-post health survey of 1200 people randomly selected from the municipal register asked about self-perceived health and quality of life, social support, mental health, mobility, physical activity, neighborhood characteristics, and housing; (b) pre-post environmental measurements, mainly of nitrogen dioxide (NO2), particulate matter of less than 10 µm (PM10), and particulate matter of less than 2.5 µm (PM2.5) and black carbon; (c) pre-post environmental walkability measures using the Microscale Audit of Pedestrian Streetscapes (MAPS) tool; (d) use of public space and physical activity levels using the System for Observing Play and Recreation in Communities (SOPARC), a validated observation tool; (e) pre-post traffic injury measures with a comparison group; and (f) the comparison and integration of pre-post assessment with previous HIAs and the improvement of future HIAs. Qualitative studies will be performed to analyze residents' perception of these effects by using: (a) various focus groups according to different participant characteristics who are more or less likely to use the superblocks; and (b) a guerrilla ethnography, which is a method that combines ethnographic observation and semi-structured interviews. This study, which evaluates the impact of an ambitious urban-renewal program on health, will help to assess the effectiveness of public policy in terms of health and health inequalities.
Assuntos
Poluentes Atmosféricos , Poluição do Ar , Planejamento Ambiental , Qualidade de Vida , Cidades , Saúde Ambiental , Humanos , Veículos Automotores , Material ParticuladoRESUMO
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.
Assuntos
Acidentes de Trânsito , Condução de Veículo , Saúde Pública , Segurança , Acidentes de Trânsito/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Bases de Dados Factuais , Planejamento Ambiental , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Conceitos Meteorológicos , Pessoa de Meia-Idade , Saúde da População Urbana , Adulto JovemRESUMO
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.
Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Veículos Automotores/estatística & dados numéricos , Distribuição de Poisson , Risco , Fatores Sexuais , Espanha , Fatores de Tempo , Índices de Gravidade do Trauma , Adulto JovemRESUMO
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.
Assuntos
Prevenção de Acidentes/métodos , Fraturas do Quadril/epidemiologia , Hospitalização/tendências , Ferimentos e Lesões/epidemiologia , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Feminino , Fraturas Ósseas/epidemiologia , Inquéritos Epidemiológicos , Fraturas do Quadril/prevenção & controle , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Alta do Paciente , Vigilância da População , Distribuição por Sexo , Espanha/epidemiologia , Ferimentos e Lesões/prevenção & controleRESUMO
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.
Assuntos
Acidentes de Trânsito/mortalidade , Alta do Paciente , Terminologia como Assunto , Ferimentos e Lesões/mortalidade , Humanos , Escala de Gravidade do FerimentoRESUMO
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.