Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA; Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA, USA.
Escuela de Gobierno Alberto Lleras Camargo, Universidad de Los Andes, Bogotá, Colombia.
Lancet Planet Health. 2022 Feb;6(2):e122-e131. doi: 10.1016/S2542-5196(21)00323-5.
Road-traffic injuries are a key cause of death and disability in low-income and middle-income countries, but the effect of city characteristics on road-traffic mortality is unknown in these countries. The aim of this study was to determine associations between city-level built environment factors and road-traffic mortality in large Latin American cities.
We selected cities from Argentina, Brazil, Chile, Colombia, Costa Rica, El Salvador, Guatemala, Mexico, Panama, and Peru; cities included in the analysis had a population of at least 100 000 people. We extracted data for road-traffic deaths that occurred between 2010 and 2016 from country vital registries. Deaths were grouped by 5-year age groups and sex. Road-traffic deaths were identified using ICD-10 codes, with adjustments for ill-defined codes and incomplete registration. City-level measures included population, urban development, street design, public transportation, and social environment. Associations were estimated using multilevel negative binomial models with robust variances.
366 cities were included in the analysis. There were 328 408 road-traffic deaths in nearly 3·5 billion person-years across all countries, with an average crude rate of 17·1 deaths per 100 000 person-years. Nearly half of the people who died were younger than 35 years. In multivariable models, road-traffic mortality was higher in cities where urban development was more isolated (rate ratio [RR] 1·05 per 1 SD increase, 95% CI 1·02-1·09), but lower in cities with higher population density (0·94, 0·90-0·98), higher gross domestic product per capita (0·96, 0·94-0·98), and higher intersection density (0·92, 0·89-0·95). Cities with mass transit had lower road mortality rates than did those without (0·92, 0·86-0·99).
Urban development policies that reduce isolated and disconnected urban development and that promote walkable street networks and public transport could be important strategies to reduce road-traffic deaths in Latin America and elsewhere.
Wellcome Trust.
道路交通伤害是低收入和中等收入国家的主要死亡和致残原因，但城市特征对道路交通死亡率的影响在这些国家尚不清楚。本研究旨在确定大型拉丁美洲城市的城市级建成环境因素与道路交通死亡率之间的关联。
我们从阿根廷、巴西、智利、哥伦比亚、哥斯达黎加、萨尔瓦多、危地马拉、墨西哥、巴拿马和秘鲁选择了城市；分析中包含的城市人口至少为 10 万人。我们从国家生命登记处提取了 2010 年至 2016 年期间发生的道路交通死亡数据。根据 ICD-10 编码，将死亡分组为 5 岁年龄组和性别。使用多水平负二项式模型进行关联估计，模型具有稳健方差。
共纳入 366 个城市。在所有国家，近 35 亿人年中发生了 328408 例道路交通死亡事件，粗死亡率平均为每 10 万人年 17.1 例。近一半死亡者年龄小于 35 岁。在多变量模型中，城市发展越孤立，道路交通死亡率越高（每增加 1 个标准差的比率比[RR]为 1.05，95%CI 为 1.02-1.09），而人口密度越高（0.94，0.90-0.98）、人均国内生产总值越高（0.96，0.94-0.98）和交叉口密度越高（0.92，0.89-0.95），道路交通死亡率越低。拥有大众交通的城市的道路交通死亡率低于没有大众交通的城市（0.92，0.86-0.99）。
减少孤立和分散的城市发展并促进适合步行的街道网络和公共交通的城市发展政策，可能是减少拉丁美洲和其他地区道路交通死亡的重要策略。
惠康信托基金会。
