Trends in children and youth KSI Collisions (2000-2019) by neighbourhood deprivation in Toronto, Canada

Author(s): Schwartz, Rothman, Macarthur,

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In Canada, road injury is a leading cause of death in children and youth. Low socioeconomic status is often associated with higher risk of injury. Despite trends in Ontario towards declining pedestrian road injury, this decline may not be equal across the population by deprivation status.


The aim of this study was to examine trends in rates of child and youth pedestrians killed or seriously injured (KSI) because of a collision with a motor vehicle from 2000 to 2019 by neighbourhood deprivation in Toronto, Canada.


Police-reported child and youth (age 1-19 years) pedestrian KSI collisions from 2000 to 2019 were mapped onto Toronto’s 140 neighbourhoods to estimate population rates of child and youth KSI. The 2016 Ontario Marginalization Index (On-Marg), a multifactor score based on Canadian census measures (e.g., lone-parent families, population below the low-income cut-off), was used to determine neighbourhood deprivation tertile (low, medium, highly deprived). Five-year time intervals (2000-2004, 2005-2009, 2010-2014, 2015-2019) were used because of small numbers of KSI collisions per year. A Poisson regression analysis examined child and youth KSI rates by deprivation and time interval. Models controlled for location (urban core versus inner suburbs) as there are higher pedestrian volumes in the urban core. An interaction term was included for deprivation and time interval to estimate whether trends over time differed based on neighbourhood deprivation.


Between 2000-2019, 523 child and youth pedestrian KSI collisions occurred in Toronto. The rate of child and youth KSI decreased by 55%, from 37.1 per 100,000 population in 2000-2004 to 16.6 per 100,000 in 2015-2019. This decrease mostly occurred from 2000 to 2010. A decrease by at least 50% was seen across all neighbourhood deprivation levels. In multivariate models, significantly lower KSI rates were associated with increasing time interval (Incidence Rate Ratio (IRR): 0.73, 95% Confidence Interval (CI): 0.68-0.79). Higher KSI rates were associated with medium deprivation (IRR:1.32, 95% CI: 0.94-1.85) and high deprivation neighbourhoods (IRR: 1.30, 95% CI: 0.91-1.86), compared to the least deprived neighbourhoods, though differences were not significant. The urban core was significantly associated with higher KSI (IRR:1.44, 95% CI: 1.05-1.98) compared to the suburbs. Interaction terms for time interval and deprivation were not significant, indicating that trends by neighbourhood deprivation did not differ significantly.


Toronto child and youth pedestrian KSI greatly decreased from 2000 to 2019 and these declines were observed uniformly across deprivation levels. It must be noted that declines have slowed from 2010-2019. Decreases in child and youth pedestrian KSI rates may be, in part, attributed to changes in policy such as traffic-calming and reduced city-wide speed limits introduced in the early 2000s. Although not statistically significant, KSI rates were higher in more deprived neighbourhoods while significantly more KSI were observed in the urban core.


It is important to understand and learn from early successes in the first decade of the 2000s that led to a reduction in KSI collisions and ensure that road safety interventions are applied equitably across areas by deprivation and location in the future.