Author(s): Schwartz, Buliung, Rothman
Little is understood about disability-related inequalities in pedestrian injury risk (including individuals walking, wheeling, and using various mobility devices)-motor vehicle collisions (PMVC). Yet, disabled people may experience increased risk of PMVC, particularly as a result of inaccessible road designs. In order to achieve the goal of road safety for all, it is important to examine inequities in road safety as well as risk factors in different populations who may experience elevated risk on the road.
This research aims to describe the reported risk and risk factors of PMVC for disabled people.
We conducted a scoping review of the literature searching five databases (Medline, Scopus, PsycInfo, Embase, SciTech Premium) for articles examining disability and road injury since 1990 with a focus on quantitative studies. Articles were screened and citations were reviewed for additional relevant articles. All studies that examined the risk of pedestrian-motor vehicle collision, injury, or fatality among disabled people or risk factors for PMVC among people with disabilities were included. Articles were excluded if they examined risk factors in drivers or for differences not related to disability (e.g., age).
The initial search identified 4,754 articles. After screening, 64 studies were included covering a wide range of disciplines including: epidemiology, rehabilitation sciences, urban planning, and neurology. Thirteen studies specifically examined risk of collisions, injury severity, and fatality among disabled people with different impairments or conditions including: all disabilities, users of mobility devices, individuals with sensory impairments, individuals with cognitive impairments, individuals with developmental disabilities, and individuals with epilepsy. Eleven studies demonstrated a significantly higher risk of collisions or fatalities for disabled people, while two lacked large enough samples to evaluate effects. Studies reported difficulties in measuring disability status in motor vehicle injury databases, and therefore, impacts may be underestimated. Fifty-three articles examined risk factors for collisions for disabled people using direct experiments (many in simulated environments), surveys, and observational studies. The largest number of studies (n=20) assessed individual risk factors for collisions, including ability to judge gaps in crossing and slower walking speeds. Other studies examined environmental/social risk factors such as ability to judge crossing gaps at different intersection types (n=17) (e.g., roundabouts, channelized intersection) and driver yielding behaviour (n=2). Six studies examined unsafe environments as reported by disabled people and identified that features such as a lack of sidewalks, short crossing times, and a lack of curb cuts produced greater feelings of risk on the road.
Disability-related inequalities in PMVC are consistently seen in the literature, despite under-reporting of disability in motor vehicle collision databases. Better data is needed to understand this risk. Studies showing individual risk factors indicate that there is a need for road designs to be more inclusive of difference in the way people move and experience the built environment.
More work is needed to assess how inaccessible, ableist or disabling environments are produced in the first place and how they may produce elevated risk of PMVC on the road.