Volume 10

TREND 10.4 Injury Inequity Among NV Pedestrians

Nevada Traffic Research & Education Newsletter
SEPTEMBER 2021 // VOL. 10, ISSUE 04

Venn Diagram of Nevada Crash Data and Nevada Trauma Data

TREND In Focus: Injury Inequity Among Nevada Pedestrians

Understanding the Burden of Pedestrian Injuries Using Measurements of Community Need

By Emily Strickler, MPH, Ana Reyes, MS, Emily Carter, Merika Charupoom, Laura K. Gryder-Culver, MA, and Deborah A. Kuhls, MD

Active transportation facilitates opportunities for individuals to exercise while accomplishing their daily tasks such as commuting to work, running errands, and participating in social activities. [1] Unfortunately, modes of active transportation such as walking are not without risk. Many pedestrians each year are involved in auto-pedestrian crashes which result in severe injuries and in many cases death; in 2020 there were 83 pedestrian deaths on Nevada roads, accounting for 26.4% of all road user deaths that year. [2] Oppressed communities, the elderly, and low-income individuals are more likely to use walking, biking, or public transportation as a primary means of transportation due to vehicle expenses. In Southern Nevada, 8.5% of residents lack a vehicle. [3] Pedestrian crash rates are disparate among communities of color and low income areas. Pedestrian fatality data from the National Highway Traffic Safety Administration (NHTSA) found that nationwide (years 2010-2019) the pedestrian fatality rate was 1.65/100,000, but for census tracts with a median household income under $41,000 the pedestrian fatality rate was over 2.5/100,000. [4] This TREND in Focus analysis investigates patterns of equity among pedestrians involved in a crash and admitted to a trauma center in Nevada (N=772) for years 2015-2017.

Results

Demographics

From 2015-2017 there were 772 pedestrian patients admitted to a Nevada trauma center following a crash in which law enforcement responded. The majority of trauma patients were male (63.1%) and white (61.7%). Median age was 38 years, however the bimodal distribution indicates two distinct groups of roughly 15-30, and 50-70 years of age (Fig. 1).

Measurements of Need

Information for the following data sets are derived from patient home ZIP codes. The median household income in Nevada from 2015-2019 was $60,365. 950 Fig. 2 depicts Median Household Income Ratio, separating Nevada pedestrian patients as living in areas below (73%) and above the median household income (27%). Community Needs Index (CNI) represents a community’s unmet healthcare needs; higher CNI score indicate greater community health needs. One research study concluded patients with CNI scores of ≥4 (as indicated in red on Fig. 3) are twice as likely to be readmitted to an Emergency Department as those who live in lower CNI (<4) communities. [6] Sixty-five percent (65%) of Nevada pedestrian patients live in high CNI and 35% live in lower CNI areas.

Injury Outcomes

Nearly one in three pedestrians (28.1%) were severely injured (Injury Severity Score > 15). Almost 12% of patients died in the hospital, and one in five (21.1%) were discharged to nursing or rehabilitation facilities. The median cost of hospital charges was $61K (IQR $31K – $140K). One third of patients were on medicaid (34.5%), 7.2% had Medicare, and 15.3% had no insurance at all. For pedestrians that survive, the burden of these injuries is extreme, both physically and financially. Pedestrians are our most vulnerable of road users, and this analysis indicates they are also disadvantaged economically. We must do more to ensure the safety of all Nevadans.

Histogram of the number of Nevada Pedestrian Trauma Patients based on age.
Figure 1. NV Pedestrian Trauma Patient Age
Hisogram of the number of Nevada Pedestrian Trauma Patients based on median household income ratio.
Figure 2. NV Median Household Income Ratio
Histogram of the number of Nevada Pedestrian Trauma Patients based on community needs index.
Figure 3. NV Pedestrian Community Needs Index

TREND in Focus: References

  1. Active Transportation. US Department of Transportation.
    https://www.transportation.gov/mission/health/active-transportation
  2. FATALITIES BY COUNTY, PERSON TYPE, DAY, MONTH, YEAR AND PERCENT CHANGE. THE OFFICE OF TRAFFIC SAFETY, STATE FATAL DATA. January 2021.
  3. Regional Bicycle & Pedestrian Plan for Southern Nevada. Regional Transportation Commission of Southern Nevada. https://assets.rtcsnv.com/wp-content/uploads/sites/4/2020/10/20135858/Appendix-O-Regional-Bicycle-Pedestrian-Plan.pdf
  4. Dangerous by Design 2021. Smart Growth America. https://smartgrowthamerica.org/dangerous-by-design/
  5. Quick Facts Nevada. United States Census Bureau. Accessed Sept 24, 2021. https://www.census.gov/quickfacts/NV
  6. Huang DD, Shehada MZ, Chapple KM, et al. Community Need Index (CNI): a simple tool to predict emergency department utilization after hospital discharge from the trauma service. Trauma Surg Acute Care Open. 2019;4(1):e000239. Published 2019 Jan 12. doi:10.1136/tsaco-2018-000239
  7. Akers M. First 7 months of 2021 the deadliest in 10 years on Nevada roads. Journal. https://www.reviewjournal.com/news/news-columns/road-warrior/first-7-months-of-2021-the-deadliest-in-10-years-on-nevada-roads-2421325/. Published August 16, 2021. Accessed September 29, 2021.

Spotlight

Traffic Safety Research Team Published in Journal of Trauma and Acute Care Surgery

By Emily Strickler, MPH

Traffic Safety Research staff past and present, Samantha- Slinkard-Barnum, MPH (University of South Carolina College of Nursing), Laura K. Gryder-Culver, MA, Kavita Batra, PhD, MPH, BDS, Paul Chestovich, MD, and Deborah A. Kuhls, MD were recently published in the Journal of Trauma and Acute Care Surgery. The study “Skilled Maneuvering: Evaluation of a Young Driver Advanced Training Program” was funded by the Nevada Department of Public Safety, Office of Traffic Safety.

Young drivers (16-20) made up nearly 9% of all U.S. traffic- related fatalities in 2018. The focus of this evaluation was a Nevada Advanced Driver Training (ADT) program composed of four modules and taught by professional drivers. The program aims to reduce young driver traffic injuries. Nevada ADT utilizes both classroom lessons and hands-on driving exercises as educational environments.

Using data from training events (which occurred over three weekends from December 2018 to March 2019) a mixed methods outcome evaluation was conducted. The purpose of this study was to determine if the Nevada ADT program achieved its objective of increasing safe driving knowledge and behaviors. Pre- and post- test and pre-event questionnaires on student driving history were used for analysis using descriptive statistics, dependent samples t- test, Pearson’s r correlation coefficient, and Chi-square test.

There were 646 student participant responses provided for analysis. Mean safe driving behavior knowledge scores increased from 43.9% (pre-test) to 74.9% (post-test). The program was successful in achieving its intended outcomes among young drivers.

Findings serve as baseline data to evaluate prospective Advanced Driver Training programs in Nevada and beyond.

Logo of The American Association- For the Surgery of Trauma
Image of the Journal of Trauma and Acute Care Surgery

Shifting Gears: Virtual and In-Person Community Outreach

National Summer Transportation Institute: Calculating Statistics of Traffic Safety

By Emily Carter and Merika Charupoom

Screenshot of what words students thought of when they hear the word "statistics."

Our traffic safety research team hosted a Calculating Statistics of Traffic Safety class during the National Summer Transportation Institute (NSTI) held by the UNLV College of Engineering in July. NSTI is a free two week summer camp for high school students interested in STEM (Science, Technology, Engineering and Mathematics) disciplines, especially related to the transportation industry. The purpose of the program is to broaden student interest in the transportation industry.

Screenshot of real traffic safety data variables student used and Screenshot of students calculating different statistical measures using data and created graphs or visualizations with them.

Students learned about descriptive statistics and best practices for visualizing data. As a hands on activity, students were able to work with real traffic safety data, specifically 2019 Clark County pedestrian self-reported citation data from over 800 individuals. Each student was able to identify variables of interest, form a hypothesis, manipulate the data to examine relationships, and then present their results to the class.

Back to School Fair at the Boulevard Mall

Photo of Mathew, Erin, Emily C. (left to right).

Our team members Emily C., Mathew and Erin attended the Back to School Fair at the Boulevard Mall where children and families were provided traffic safety materials including: children’s pedestrian safety and car seat safety coloring pages, reflective slap bands, and our RoadWise and TREND Newsletter infographics reporting on Nevada traffic safety statistical trends and laws.

Photo of traffic safety materials handed out to children and their families.

As children have gone back to in-person school since the onset of the COVID-19 pandemic, traffic safety has become increasingly important. During this event, our hope was to provide parents and children with traffic safety information to prevent injuries and fatalities. Our team members educated many parents on helmet use for their child using our infographics.

Staff Feature
Emily Strickler, BA, MPH

Image of Emily Strickler, BA, MPH.

Emily Strickler is a Research Assistant in the Department of Surgery at Kirk Kerkorian School of Medicine (KSOM) at UNLV. In her current position, E. Strickler is part of the evaluation readiness assessment pilot team, conducts literature reviews, writes reports, and cleans data related to research projects conducted by the Traffic Safety Research team with the KSOM at UNLV.

E. Strickler received her BA in Human Biology in 2016 from Stanford University and is almost a graduate of the Master’s of Public Health program at the UNLV School of Public Health (focus on environmental and occupational health). This fall she will finish her thesis examining the relationship between neighborhood social media apps and social cohesion, and perceived safety among adults in Southern Nevada. E. Strickler’s research interests are centered on the built environment, social determinants of health, and health equity. At the KSOM at UNLV she’s working with traffic safety prevention and intervention programs to increase evaluation skills and capacity, mentoring medical students on individual research projects, and conducting research on DUI records from Nevada law enforcement agencies. She is excited to work to address how road users of all modes can be educated and motivated to make safer decisions, ultimately resulting in better outcomes for all.

Infographics

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Funding Statement

Funding for this project comes from the Nevada Department of Public Safety‐Office of Traffic Safety.
Grants:
#TS-2019-UNLV-00089
#TS-2019-UNLV-00149

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