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Halloween and Fatal Pedestrian Crashes in the United States Yip, Candace; Staples, John A 2018-02-16

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Motor vehicle crashes are a major cause of death in the United States.1 Identifying periods of heightened crash risk can highlight opportunities for injury prevention.2,3Halloween is widely celebrated across North America.4 Millions of trick-or-treating children run through the streets at dusk with costumes that limit peripheral vision and visibility to drivers, yet few contemporary studies examine Halloween crash risks.5 We hypothesized that the risk of fatal pedestrian crash was higher on Halloween evening compared to control evenings. We performed a population-based retrospective study using data on all fatal traffic crashes occurring in the United States between 1975 and 2016 (42 years). We compared the number of fatal pedestrian crashes that occurred between 5:00pm and 11:59pm on October 31steach year to the number of fatal pedestrian crashes that occurred during identical time intervals on control days exactly one week earlier and one week later. This design controlled for weekday, season, and year while minimizing bias from changes in vehicle design, roadway engineering, medical care and other possible confounders.2 De-identified crash data was obtained from the US National Highway Traffic Safety Administration’s Fatality Analysis Reporting System (FARS). The primary analysis used exact binomial tests to evaluate deviation from the expected ratio of 1:2. Subgroup analyses evaluated the influence of participant and crash characteristics. Pre-specified analyses examined the variation in risk by clock time and by year. HALLOWEEN AND FATAL PEDESTRIAN CRASHES IN THE UNITED STATESPreliminary ResultsCandace Yip1 (BSc candidate) and John A Staples2,3,4 (MD, MPH)[1] UBC Faculty of Science; [2] UBC Department of Medicine;[3] Centre for Clinical Epidemiology & Evaluation (C2E2); [4] Centre for Health Evaluation & Outcome Sciences (CHÉOS)IntroductionMethodsResults ConclusionReferencesWe examined 42 years of population-based U.S. national data and found a 49% increase in the risk of a fatal pedestrian crash on Halloween evenings compared to control evenings. These risks were particularly dramatic in children: Among pedestrians between 4 and 8 years of age, the risk was increased by 900%. Relative risks have remained stable since 1975 despite diminishing absolute risks. Parents and policymakers may wish to develop strategies to reduce the risk of childhood traffic injury on Halloween. These strategies may include traffic elimination or calming within trick-or-treating neighborhoods, incorporating reflective patches on Halloween costumes, and increased parental supervision.1. Stevenson M, Sleet D, Ferguson R. Preventing child pedestrian injury: a guide for practitioners. Am J Lifestyle Med. 2015;9:442-450.2. Staples JA, Redelmeier DA. The April 20 cannabis celebration and fatal traffic crashes in the United States. JAMA Intern Med. Published online 12 Feb 2018.3. St. Patrick's Day 2018 - Buzzed driving is drunk driving. NHTSA. Accessed 24 January 2018 at https://www.trafficsafetymarketing.gov/get-materials/drunk-driving/saint-patricks-day 4. Facts for features: Halloween: Oct. 31, 2017. (7 Sept 2017) United States Census Bureau. Washington, DC. Release Number: CB17-FF.18. 5. Centers for Disease Control and Prevention (CDC). Childhood pedestrian deaths during Halloween - United States, 1975-1996. MMWR. 1997;46(42):987-990.AcknowledgementsThis study was supported by the Vancouver Coastal Health Research Institute (VCHRI), the Canadian Institutes of Health Research (CIHR) and the UBC Science Undergraduate & Co-op programs. Dr. Staples was the principal investigator and co-op term supervisor.Figure 3. Halloween pedestrian crashes, 1975-2016 Figure 2. Diurnal variation of pedestrian crashesLegend: Scatterplot of the absolute number of fatal pedestrian crashes occurring between 5:00 pm and midnight on October 31st occurring annually between 1975 to 2016. Main findings suggest the absolute number of pedestrians involved in fatal crashes has gradually decreased over time.Legend: Scatterplot of the total number of crashes in the study interval occurring each hour on Halloween (blue) and on control dates (red). The x-axis shows the hour of the day, from 5:00 am on October 31st to 5:00 am on November 1st. Main finding illustrates a substantial increase in crash risk on Halloween evenings and nights.Legend: Forest plot showing relative increase in risk of fatal pedestrian crash on the evening of October 31st compared to control evenings 1 week earlier and later. The x-axis shows odds ratios where values more than 1 denote increased risk on October 31st and values less than 1 denote decreased risk. The center dot indicate point estimate and horizontal lines indicate 95% confidence intervals. The y-axis shows subgroups based on pedestrian and crash characteristics.  Figure 1. Relative risk of fatal pedestrian crashes on Halloween (subgroup analysis)Odds Ratio3 and Under4 to 89 to 1213 to 1718 to 3031 to 4041 to 50>50MaleFemale1975-19841985-19941995-20042005-2016Monday -ThursdayWeekend (Friday -Sunday)RuralUrbanEntire cohortAge(years)SexPeriodDay of WeekLocation2 4 8 160 1 Motor vehicle crashes are a major cause of death in the United States.1 Identifying periods of heightened crash risk can highlight opportunities for injury prevention.2,3Halloween is widely celebrated across North America.4 Millions of trick-or-treating children run through the streets at dusk with costumes that limit peripheral vision and visibility to drivers, yet few contemporary studies examine Halloween crash risks.5 We hypothesized that the risk of fatal pedestrian crash was higher on Halloween evening compared to control evenings. We performed a population-based retrospective study using data on all fatal traffic crashes occurring in the United States between 1975 and 2016 (42 years). We compared the number of fatal pedestrian crashes that occurred between 5:00pm and 11:59pm on October 31steach year to the number of fatal pedestrian crashes that occurred during identical time intervals on control days exactly one week earlier and one week later. This design controlled for weekday, season, and year while minimizing bias from changes in vehicle design, roadway engineering, medical care and other possible confounders.2 De-identified crash data was obtained from the US National Highway Traffic Safety Administration’s Fatality Analysis Reporting System (FARS). The primary analysis used exact binomial tests to evaluate deviation from the expected ratio of 1:2. Subgroup analyses evaluated the influence of participant and crash characteristics. Pre-specified analyses examined the variation in risk by clock time and by year. HALLOWEEN AND FATAL PEDESTRIAN CRASHES IN THE UNITED STATESPreliminary ResultsCandace Yip1 (BSc candidate) and John A Staples2,3,4 (MD, MPH)[1] UBC Faculty of Science; [2] UBC Department of Medicine;[3] Centre for Clinical Epidemiology & Evaluation (C2E2); [4] Centre for Health Evaluation & Outcome Sciences (CHÉOS)IntroductionMethodsResults ConclusionReferencesWe examined 42 years of population-based U.S. national data and found a 49% increase in the risk of a fatal pedestrian crash on Halloween evenings compared to control evenings. These risks were particularly dramatic in children: Among pedestrians between 4 and 8 years of age, the risk was increased by 900%. Relative risks have remained stable since 1975 despite diminishing absolute risks. Parents and policymakers may wish to develop strategies to reduce the risk of childhood traffic injury on Halloween. These strategies may include traffic elimination or calming within trick-or-treating neighborhoods, incorporating reflective patches on Halloween costumes, and increased parental supervision.1. Stevenson M, Sleet D, Ferguson R. Preventing child pedestrian injury: a guide for practitioners. Am J Lifestyle Med. 2015;9:442-450.2. Staples JA, Redelmeier DA. The April 20 cannabis celebration and fatal traffic crashes in the United States. JAMA Intern Med. Published online 12 Feb 2018.3. St. Patrick's Day 2018 - Buzzed driving is drunk driving. NHTSA. Accessed 24 January 2018 at https://www.trafficsafetymarketing.gov/get-materials/drunk-driving/saint-patricks-day 4. Facts for features: Halloween: Oct. 31, 2017. (7 Sept 2017) United States Census Bureau. Washington, DC. Release Number: CB17-FF.18. 5. Centers for Disease Control and Prevention (CDC). Childhood pedestrian deaths during Halloween - United States, 1975-1996. MMWR. 1997;46(42):987-990.AcknowledgementsThis study was supported by the Vancouver Coastal Health Research Institute (VCHRI), the Canadian Institutes of Health Research (CIHR) and the UBC Science Undergraduate & Co-op programs. Dr. Staples was the principal investigator and co-op term supervisor.Figure 3. Halloween pedestrian crashes, 1975-2016 Figure 2. Diurnal variation of pedestrian crashesLegend: Scatterplot of the absolute number of fatal pedestrian crashes occurring between 5:00 pm and midnight on October 31st occurring annually between 1975 to 2016. Main findings suggest the absolute number of pedestrians involved in fatal crashes has gradually decreased over time.Legend: Scatterplot of the total number of crashes in the study interval occurring each hour on Halloween (blue) and on control dates (red). The x-axis shows the hour of the day, from 5:00 am on October 31st to 5:00 am on November 1st. Main finding illustrates a substantial increase in crash risk on Halloween evenings and nights.Legend: Forest plot showing relative increase in risk of fatal pedestrian crash on the evening of October 31st compared to control evenings 1 week earlier and later. The x-axis shows odds ratios where values more than 1 denote increased risk on October 31st and values less than 1 denote decreased risk. The center dot indicate point estimate and horizontal lines indicate 95% confidence intervals. The y-axis shows subgroups based on pedestrian and crash characteristics.  Figure 1. Relative risk of fatal pedestrian crashes on Halloween (subgroup analysis)Odds Ratio3 and Under4 to 89 to 1213 to 1718 to 3031 to 4041 to 50>50MaleFemale1975-19841985-19941995-20042005-2016Monday -ThursdayWeekend (Friday -Sunday)RuralUrbanEntire cohortAge(years)SexPeriodDay of WeekLocation2 4 8 160 1 ABSTRACT   Scary stuff: Halloween and traffic fatalities in the United States  Authors: Candace Yip, John A Staples  Background: Throughout North America, children celebrate Halloween by walking through residential neighborhoods at dusk while wearing costumes that limit peripheral vision and visibility to drivers.i Few studies have considered traffic injury risks on Halloween.ii   Methods: We performed a population-based retrospective study using data on all fatal traffic crashes occurring in the United States between 1975 and 2016. The number of pedestrians involved in fatal crashes between 5:00pm to 11:59pm on October 31st was compared to the number of pedestrians in crashes during identical time intervals on control days one week earlier and one week later.iii Additional analyses examined factors influencing crash risk.  Results: Fatal pedestrian crashes were significantly more likely to occur on Halloween (678 crash-involved pedestrians on Halloween evenings versus 912 crash-involved pedestrians on control evenings; odds ratio, 1.48; 95% confidence interval, 1.36 - 1.64; p-value, < 0.001). Pedestrians aged 4 to 8 years old exhibited the greatest risk increase (odds ratio, 9.00; 95% confidence interval, 5.05 - 16.06; p-value <0.001). Risks were highest from 5:00pm to 7:59pm. Relative risks remained stable over the 42-year study interval despite small decreases in absolute risk.  Conclusions: Parents and policymakers may wish to develop strategies to reduce risk of childhood traffic injury on Halloween. These may include the incorporation of reflective patches on Halloween costumes and the elimination of traffic within trick-or-treating areas.  i Facts for features: Halloween: Oct. 31, 2017. (7 Sept 2017) United States Census Bureau. Washington, DC. Release Number: CB17-FF.18.   ii Centers for Disease Control and Prevention (CDC). Childhood pedestrian deaths during Halloween - United States, 1975-1996. MMWR. 1997;46(42):987-990.  iii Staples JA, Redelmeier DA. The April 20 cannabis celebration and fatal traffic crashes in the United States. JAMA Intern Med. Published online 12 Feb 2018.                                                            

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