From the School of Occupational and Public Health, Faculty of Community Services, Toronto Metropolitan University, Toronto, Ontario, Canada.
Department of Emergency Medicine, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Epidemiology. 2024 Mar 1;35(2):252-262. doi: 10.1097/EDE.0000000000001696. Epub 2023 Jan 30.
Road traffic injury contributes substantially to morbidity and mortality. Canada stands out among developed countries in not conducting a national household travel survey, leading to a dearth of national transportation mode data and risk calculations that have appropriate denominators. Since traffic injuries are specific to the mode of travel used, these risk calculations should consider travel mode.
Census data on mode of commute is one of the few sources of these data for persons aged 15 and over. This study leveraged a national data linkage cohort, the Canadian Census Health and Environment Cohorts, that connects census sociodemographic and commute mode data with records of deaths and hospitalizations, enabling assessment of road traffic injury associations by indicators of mode of travel (commuter mode). We examined longitudinal (1996-2019) bicyclist, pedestrian, and motor vehicle occupant injury and fatality risk in the Canadian Census Health and Environment Cohorts by commuter mode and sociodemographic characteristics using Cox proportional hazards models within the working adult population.
We estimated positive associations between commute mode and same mode injury and fatality, particularly for bicycle commuters (hazard ratios for bicycling injury was 9.1 and for bicycling fatality was 11). Low-income populations and Indigenous people had increased injury risk across all modes.
This study shows inequities in transportation injury risk in Canada and underscores the importance of adjusting for mode of travel when examining differences between population groups.
道路交通伤害对发病率和死亡率有重大影响。加拿大在发达国家中独树一帜，没有进行全国性的家庭出行调查，导致缺乏全国交通方式数据和有适当分母的风险计算。由于交通事故特定于所使用的交通方式，这些风险计算应考虑交通方式。
通勤模式的人口普查数据是 15 岁及以上人群获取这些数据的少数来源之一。本研究利用了一个全国性的数据链接队列，即加拿大人口普查健康和环境队列，该队列将人口普查社会人口统计学和通勤模式数据与死亡和住院记录相关联，使人们能够通过旅行方式（通勤方式）指标评估道路交通伤害的关联。我们使用工作成年人人群中的 Cox 比例风险模型，根据通勤模式和社会人口统计学特征，检查了加拿大人口普查健康和环境队列中（1996-2019 年）骑自行车者、行人、和汽车乘客的受伤和死亡风险。
我们估计了通勤模式与相同模式伤害和死亡之间的正相关关系，特别是对于骑自行车的通勤者（骑自行车受伤的风险比为 9.1，骑自行车死亡的风险比为 11）。低收入人群和土著居民在所有模式下的受伤风险都增加了。
本研究表明加拿大在交通伤害风险方面存在不平等现象，并强调在检查人群群体之间的差异时，调整交通方式的重要性。
