Why and where pedestrians are injured in Multnomah County, Oregon: A multi-method analysis of the relationship between the pedestrian, the street environment, and traffic safety policy, 1995--2000

Despite significant progress in American motor vehicle safety during the past few decades, traffic-related crash injury remains a leading cause of death and disability. Pedestrians often are described as forgotten or neglected road users. The paradox is that American pedestrians remain second only to motor vehicle occupants in numbers of fatal and nonfatal injuries.; While there are transportation, trauma, and emergency medical services data systems that monitor traffic deaths, many gaps persist in the surveillance of nonfatal motor-vehicle related injuries. The intent of this study is to explore relationships between the pedestrian, the street environment, and traffic safety policy, by conducting a comprehensive study of pedestrian injury in Multnomah County, Oregon. This is a multi-method population incidence study using descriptive and multivariate analyses, complimented by field observation and mapping techniques. Unique to this study is the linking of dispatch, emergency medical services, and trauma registry data. All pedestrians seriously injured during a five-year period in Multnomah County, Oregon comprise the population of interest. Variables of interest include sociodemographic risk factors, key street environment attributes (intersection location, posted design speed, street type), and outcome (injury severity, survival, death).; Adult males predominate within the study population. Of the subgroup of pedestrians with reported positive blood alcohol levels, most experienced high levels of intoxication. Injury severity scores were relatively high, and the New Injury Severity Score measure was the more sensitive predictor of survival and death. Increased age correlated with injury severity and outcome, and substantial disability likely burdens injured pedestrians. For the street environment, intersection location is most highly associated with lower nonfatal and fatal injury incidence.; Linking public health datasets can enrich our knowledge of the pedestrian injury problem at the community level. Despite aggressive traffic calming and safety initiatives, the problem of nonfatal pedestrian injury persists in the area of study. Using the Haddon matrix, education policy outweighs enforcement or regulation and engineering strategies for control and prevention of pedestrian injury. As the pedestrian injury problem has substantial public health consequences, pedestrian safety policy measures should be a priority in Multnomah County, Oregon.