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Seriously injured road users in rural and urban road traffic in a Swedish region - a Vision Zero perspective
Mälardalen University, School of Health, Care and Social Welfare, Health and Welfare.ORCID iD: 0000-0002-1831-1400
2020 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Globally more than 50 million people are injured in road traffic every year. The incidence of road injuries is increasing while that of fatalities is decreasing. Road safety measures are being implemented in many countries to reduce the effects on public health. In highly motorized countries, the process is often managed by quantitative targets. Sweden has a target for 2020 based on Vision Zero: that no-one should be killed or seriously injured in road traffic. In Vision Zero, pedestrians in single crashes are not defined as road users, even when they move in the same areas as road users with vehicles. In this thesis the road space (pavements, tracks and roads) defines the road user.

The aim of the thesis is to study the development of serious injuries in rural and urban areas during a period when Vision Zero was being implemented through government efforts to direct the process in Sweden. The thesis adopts a regional perspective. Three of the four studies in the thesis are cross-sectional studies with data from Region Västmanland during twelve to fifteen years, 2003–2017. Data are also based on analyses of ten regional infrastructure plans in Sweden for the period 2014–2025.

On national roads in the region, the incidence of serious injuries decreased for car occupants, but on regional roads it increased. In urban areas the incidence for unprotected road users doubled on roads and more than doubled on tracks and pavements where the greatest number of unprotected road users are seriously injured. One factor in the increased incidence is the growing number of elderly people in the population caused by the large generation born in the 1940s and a lengthening lifespan. From 2012 the probability of being seriously injured increased for cyclists and pedestrians 80 years and older, and from 2015 for the group 65 years and older.

In urban areas during the period, there was a shift in serious injuries for pedestrians and cyclists from less head injuries to more injuries in lower extremities. The probability of receiving serious injuries to the lower extremities increased fourfold from the age of 50 for both pedestrians and cyclists, but for cyclists the probability increased with age.

For pedestrians, pavements and tracks were associated with decreased probability of all injuries except for head injuries, but for cyclists this decrease is only seen for the most severe injuries. For pedestrians, the probability of getting injuries in more than one bodily region decreased on Vision Zero roads.

Prioritized investments in regional plans are mostly justified by accessibility and increased walking and cycling, and only more sparsely by road safety. This reflects an imbalance in the government’s clarifications of the transport goals.

In directives for regional planning and in support of the objectives of Agenda 2030, the government has argued for more active mobility. There is a need to include pedestrian falls in the category of single crashes in the work with Vision Zero. Increased walking and cycling justifies more road safety measures especially in urban areas in order to achieve the targets of Vision Zero. To achieve Vision Zero it is important that the concerned road authorities and regions are committed to the goals and fulfil their tasks. More active mobility in combination with an increased number of older people is a challenge for municipalities as road authorities in urban areas.

Place, publisher, year, edition, pages
Västerås: Mälardalen University , 2020.
Series
Mälardalen University Press Dissertations, ISSN 1651-4238 ; 312
Keywords [en]
Vision Zero, road injuries, rural, urban, cyclist, pedestrian, policy, management by objectives
National Category
Medical and Health Sciences Health Sciences
Research subject
Public Health Sciences
Identifiers
URN: urn:nbn:se:mdh:diva-47553ISBN: 978-91-7485-464-0 (print)OAI: oai:DiVA.org:mdh-47553DiVA, id: diva2:1425875
Public defence
2020-06-10, Sal Beta, Högskoleplan 1, Västerås, 13:00 (Swedish)
Opponent
Supervisors
Funder
Swedish Transport Administration, TRV 2014/49856Available from: 2020-04-23 Created: 2020-04-22 Last updated: 2020-05-19Bibliographically approved
List of papers
1. Incidence of seriously injured road users in a Swedish region, 2003-2014, from the perspective of a national road safety policy
Open this publication in new window or tab >>Incidence of seriously injured road users in a Swedish region, 2003-2014, from the perspective of a national road safety policy
2019 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 19, no 1, article id 1576Article in journal (Refereed) Published
Abstract [en]

Background: Since 1997 Sweden has a policy for road safety called Vision Zero. Given that Vision Zero is mainly used to reduce fatalities among car occupants, the question has been raised by the research community whether a Vision Zero approach promotes health for all road traffic users. The objective is to measure target fulfilment of the national road safety policy for a Swedish region by examining incidence of serious injury during 2003-2014 in rural and urban road spaces with or without implemented measures. Methods: Data on seriously injured road users, defined as ISS > 8 (Injury Severity Score), were retrieved from STRADA (Swedish Traffic Accident Data Acquisition) together with data from NVDB (National Road Database). These data are used to describe where road users are seriously injured in relation to implemented national policy and using a conceptual model of a road space comprising roads, pavements and tracks for walking and cycling. Seriously injured road users in single and multiple crashes with and without vehicles are included. The development of the incidence is analysed for different road users and places in the road space. Results: Despite implemented road safety measures in the region, the incidence of seriously injured road users per 100,000 inhabitants in rural areas increased from 7.8 in 2003 to 9.3 in 2014 but doubled in urban areas from 8.0 in to 16.3 respectively. In areas not transformed by Vision Zero, only 36% were injured in rural areas while 64% were injured in urban areas. In contrast, in transformed areas 61% of injuries occurred in rural areas, whereas 39% occurred in urban areas. While the incidence decreased for car occupants on transformed national roads in rural areas, the incidence of serious injuries increased among unprotected road users in urban areas, in particular on pavements and tracks for cycling and walking than on the roads where Vision Zero had been implemented. Conclusion: The reduction in the incidence for car occupants in the region may not be adequate to contribute to fulfilling the national target. More needs to be done, especially in the urban areas, where more active mobility is desired. 

Place, publisher, year, edition, pages
BioMed Central Ltd., 2019
Keywords
Incidence, ISS, Policy, Road injury, Rural, STRADA, Urban, Vision Zero
National Category
Other Social Sciences
Identifiers
urn:nbn:se:mdh:diva-46308 (URN)10.1186/s12889-019-7937-0 (DOI)000501793800017 ()31775706 (PubMedID)2-s2.0-85075790945 (Scopus ID)
Available from: 2019-12-12 Created: 2019-12-12 Last updated: 2020-04-22Bibliographically approved
2. Factors related to the increasing number of seriously injured cyclists and pedestrians in a Swedish urban region 2003–17
Open this publication in new window or tab >>Factors related to the increasing number of seriously injured cyclists and pedestrians in a Swedish urban region 2003–17
2019 (English)In: Journal of Public Health, ISSN 1741-3842, E-ISSN 1741-3850, p. 1-7Article in journal (Refereed) Published
Abstract [en]

Background

The number of seriously injured unprotected road users has increased during implementation of a road safety policy Vision Zero. The aim of the study is to identify factors associated with the increase in serious injuries among cyclists and pedestrians (even single pedestrian accidents) that occurred in an urban road space in a Swedish region 2003–17. The urban road space includes roads, pavements and tracks for walking and cycling.

Methods

Data were retrieved from STRADA (Swedish Traffic Accident Data Acquisition) and NVDB (National Road Database). Descriptive statistics and logistic regression with odds ratios for sex, age and part of road space were assessed.

Results

The number of seriously injured cyclists and pedestrians more than doubled from 2003 to 2017, with the greatest increase for pedestrians. Older age increased the probability of serious injury since 2012 for the group ≥ 80 years and since 2015 for the group 65–79 years. No significant effect of sex. Most injuries occur in areas not transformed by Vision Zero.

Conclusions

An increasing number of elderly persons in the generation born in the 1940s and increased life expectancy are important factors. There is a need to increase road safety measures that also promote active mobility.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-46369 (URN)10.1093/pubmed/fdz064 (DOI)31211391 (PubMedID)
Available from: 2019-12-13 Created: 2019-12-13 Last updated: 2020-04-22Bibliographically approved
3. What types of injuries did seriously injured pedestrians and cyclists receive in a Swedish urban region in the time period 2003–2017 when Vision Zero was implemented?
Open this publication in new window or tab >>What types of injuries did seriously injured pedestrians and cyclists receive in a Swedish urban region in the time period 2003–2017 when Vision Zero was implemented?
2020 (English)In: Public Health, ISSN 0033-3506, E-ISSN 1476-5616, Vol. 181, p. 59-64Article in journal (Refereed) Published
Abstract [en]

Objectives

The aim of the study is to examine what types of injuries that seriously injured pedestrians and cyclists received in urban road spaces from 2003 to 2017 in the Swedish region of Västmanland, when the road safety policy Vision Zero was implemented.

Study design

This is a cross-sectional data annually collected over a period of fifteen years.

Methods

Data from health care for 403 seriously injured pedestrians and cyclists were retrieved from the registry STRADA (Swedish Traffic Accident Data Acquisition) and cross-referenced with the National Road Database to see if any Vision Zero measures had previously been implemented at the crash location. The study includes injuries from both single and multiple crashes on roads, pavements, and tracks for walking and cycling (road space). Statistical analysis was performed by descriptive statistics, chi-square tests, and multiple logistic regression analyses.

Results

Pedestrians were seriously injured in lower extremities more than cyclists, whereas more cyclists were seriously injured in the head. During the period, pedestriansꞌ head injuries decreased significantly, but injuries in lower extremities increased significantly. In addition, for cyclists, there was a shift from decreased probability of head injuries to increased probability of injuries in lower extremities related to increased age. For pedestrians, pavements/tracks were associated with a decreased probability of a majority of injury outcomes but for cyclists only for severe injury outcomes.

Conclusions

From 2003 to 2017, there was a shift among seriously injured pedestrians, with head injuries decreasing and injuries in lower extremities increasing. This shift was probably related to an ageing population in the region, given that increased age among both pedestrians and cyclists was associated with a decreased probability of head injuries but increased probability of injuries in lower extremities. On Vision Zero roads, there was a decreased probability of pedestrians receiving serious injury to more than one bodily region. An increased number of older people combined with policies for more active mobility such as walking and cycling are a challenge for road authorities in urban areas.

National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:mdh:diva-46787 (URN)10.1016/j.puhe.2019.11.019 (DOI)2-s2.0-85077913357 (Scopus ID)
Note

©2019 The Authors. Published by Elsevier Ltd on behalf of The Royal Society for Public Health. This is anopen access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Available from: 2020-01-23 Created: 2020-01-23 Last updated: 2020-04-30Bibliographically approved
4. National Road Safety Policy in Sweden as Reflected in Plans for Regional Transport Infrastructure
Open this publication in new window or tab >>National Road Safety Policy in Sweden as Reflected in Plans for Regional Transport Infrastructure
2020 (English)In: Scandinavian Journal of Public Administration, ISSN 2001-7405, E-ISSN 2001-7413, Vol. 24, no 1Article in journal (Refereed) Published
Abstract [en]

In 1997 the Swedish Parliament adopted the Vision Zero road safety policy, which since 2009 is included in a consideration goal (road safety, environment, health) as one of two goals under an overall transport goal. The target of achieving Vision Zero is not specified for different authorities. Investments in infrastructure are a common way of designing a safe system. Plans for regional transport infrastructure are therefore tools to achieve the national target.

The aim of the study is to analyse how Vision Zero has been applied by regional authorities as a term, a goal or a clarification in justifying measures in county plans for regional transport infrastructure in the period 2014–2025 in Sweden. Ten of twenty-one plans were included in the analysis as they selected costs for road safety measures for both state and municipal roads. The plans were analysed using directed and summative content analysis.

The consideration goal is rarely in evidence. Measures are most often justified by accessibility and public transport, walking and cycling, as clarifications of the functional goal (accessibility). It is likely that the imbalance between the functional goal and the consideration goal reflects a lack of governance by the Vision Zero road safety policy.Fulfilling a national road safety target requires well-adapted sub-targets for the organizations concerned.

Keywords
Vision Zero, Policy, Management by objectives, Road safety, Road injury, Plan
National Category
Health Sciences
Identifiers
urn:nbn:se:mdh:diva-47430 (URN)
Available from: 2020-03-27 Created: 2020-03-27 Last updated: 2020-04-22Bibliographically approved

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123453 of 5
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