Marta Olabarria

Health impact of motorised trips that could be replaced by walking

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.

Work, family and daily mobility: a new approach to the problem through a mobility survey

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.

Measures of exposure to road traffic injury risk

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 peoples mobility should be used in the estimation of road traffic injury risk, instead of vehicles mobility, population census or vehicle fleet.

Improvements in hip fracture incidence counterbalanced by the rise of other fracture types: data from Spain 2000-2010.

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.

Incidence trends of injury among the elderly in Spain, 2000–2010

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 64 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 ≥85 years having a fivefold greater risk than those aged 65–69 years. During the period 2000–2010, incidence increased annually by 1.1% in men and 0.9% in women aged 75–79 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.

Head-on crashes on two-way interurban roads: a public health concern in road safety

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.

Implications of estimating road traffic serious injuries from hospital data

To determine accurately the number of serious injuries at EU level and to compare serious injury rates between different countries it is essential to use a common definition. In January 2013, the High Level Group on Road Safety established the definition of serious injuries as patients with an injury level of MAIS3+(Maximum Abbreviated Injury Scale). Whatever the method used for estimating the number or serious injuries, at some point it is always necessary to use hospital records. The aim of this paper is to understand the implications for (1) in/exclusion criteria applied to case selection and (2) a methodological approach for converting ICD (International Classification of Diseases/Injuries) to MAIS codes, when estimating the number of road traffic serious injuries from hospital data. A descriptive analysis with hospital data from Spain and the Netherlands was carried out to examine the effect of certain choices concerning in- and exclusion criteria based on codes of the ICD9-CM and ICD10. The main parameters explored were: deaths before and after 30 days, readmissions, and external injury causes. Additionally, an analysis was done to explore the impact of using different conversion tools to derive MAIS3 + using data from Austria, Belgium, France, Germany, Netherlands, and Spain. Recommendations are given regarding the in/exclusion criteria and when there is incomplete data to ascertain a road injury, weighting factors could be used to correct data deviations and make more real estimations.

Effect of neighbourhood motorization rates on walking levels

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. β 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 (β = -0.248; P < 0.001 and β = -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. (β = -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.