Community-level infrastructure risk factors for motor vehicle injuries of car occupants and pedestrians: results from the PURE study

Bangdiwala S.I. Lear S. Hu B. Ramasundarahettige C. Alhabib K.F. Ricci C. Ismail R. Połtyn-Zaradna K. Yusuf R. Prasad Varma R. Mir H. Rosengren A. Chifamba J. Lakhsmi P.V.M. Avezum A. Mohan I. Bahonar A. Iqbal R. Kulimbet M. Rangarajan S. Lopez Jaramillo J.P. Diaz M.L. Khatib R. Seron P. Tumerdem Calik K.B. Yeats K. Yan M. Zhu Y. Yusuf S.
2025 Taylor and Francis Ltd.

International Journal of Injury Control and Safety Promotion
2025

Disproportionately more of the world’s fatalities and injuries on the roads occur in low- and middle-income countries, despite these countries having approximately only 60% of the world’s vehicles. Injury rates due to motor-vehicles are related to a complex multidimensional array of risk factors, embedded in the social and economic infrastructure of a country or region. Whether environmental infrastructure factors differ in determining the risk of an injury for motor vehicle occupants compared to pedestrians and other vulnerable road users has not been extensively studied. We explored the role of environmental infrastructure factors on motor-vehicle-related non-fatal injury using the Prospective Urban and Rural Epidemiology (PURE) cohort study of 162,793 adults from 23 high-, middle- and low-income countries. As expected, low-income countries had slightly higher motor vehicle injury rates, with pedestrians tending to have higher injury rates in these countries. There was considerable variation in motor vehicle injury rates within country-income-categories, while there were similarities in motor vehicle injury rates despite large differences in motorization of countries. There was a meaningful community effect on motor vehicle injury rates. We found that community-level infrastructure risk factors for motor vehicle injuries differed for car occupants and for pedestrians, with road quality and alcohol use being the main factors associated with an injury for car occupants, while poor roadside infrastructure (streetlights, sidewalks) and alcohol use were the main risk factors for an injury as a pedestrian. Active transport, such as walking and bicycling, are being promoted as leading to healthy lifestyle habits and reduced pollution. These require improved walkability for pedestrians, but also separation from motorized vehicles, which leads to recommending that low-and middle-income countries devote more funds for roadway quality and streetlight infrastructure. Policies to reduce motor vehicle injuries should be supported at the national level, but should be specific at the community level, since they must be focused on the specific local infrastructure. Countermeasures for reducing road transport injuries for pedestrians have different risk factors than for reducing injuries for car occupants.

motor vehicle occupant , Road traffic accidents , roadway infrastructure , vulnerable road user

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Department of Health Research Methods, Evidence and Impact, McMaster University, and Population Health Research Institute, Hamilton, Canada
Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College and Chinese Academy of Medical Sciences, Beijing, China
Department of Statistics, Population Health Research Institute, Hamilton, Canada
Department of Cardiac Sciences, King Fahad Cardiac Center, College of Medicine, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
Africa Unit for Transdisciplinary Health Research, Faculty of Health Sciences, North-West University, Potchefstroom, South Africa
Department of Public Health Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
Department of Population Health, Division of Population Studies and Prevention of Noncommunicable Diseases, Wroclaw Medical University, Wroclaw, Poland
BRAC James P. Grant School of Public Health, Dhaka, Bangladesh
Sree Chitra Tirunal Institute for Medical Sciences and Technology, Trivandrum, and Health Action by People, Thiruvananthapuram, India
Department of Medicine, University of Ottawa Heart Institute, University of Ottawa, Ottawa, Canada
Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Sahlgrenska University Hospital, Department of Medicine, Geriatrics and Emergency Medicine/Östra, Gothenburg, Sweden
Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
Department of Community Medicine and School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, India
International Research Center, Hospital Alemão Oswaldo Cruz, SP, São Paulo, Brazil
Mahatma Gandhi University of Medical Sciences and Technology, Jaipur, India
Isfahan Cardiovascular Research Center, Cardiovascular Research Institute, Isfahan University of Medical Sciences, Isfahan, Iran
Department of Community Health Sciences, Aga Khan University, Karachi, Pakistan
Asfendiyarov Kazakh National Medical University, Almaty, Kazakhstan
Population Health Research Institute, Hamilton, Canada
Masira Research Institute, Medical School, Universidad de Santander, Bucaramanga, Colombia
Estudios Clinicos Latinoamerica, Santa Fe, Argentina
Advocate Aurora Research Institute, Milwaukee, WI, United States
Institute of Community and Public Health, Birzeit University, Birzeit, Palestine
Departamento Ciencias de la Rehabilitación, Facultad de Medicina, Universidad de La Frontera, Temuco, Chile
Department of Health Management, Marmara University Faculty of Health Sciences, Maltepe, Turkey
Department of Medicine, Queen’s University, Kingston, Canada
Medical Research and Biometrics Center, National Center for Cardiovascular Diseases, Fuwai Hospital, Peking Union Medical College & Chinese Academy of Medical Sciences, Beijing, China
Department of Medicine, McMaster University, and Population Health Research Institute, Hamilton, Canada

Department of Health Research Methods
Faculty of Health Sciences
Medical Research and Biometrics Center
Department of Statistics
Department of Cardiac Sciences
Africa Unit for Transdisciplinary Health Research
Department of Public Health Medicine
Department of Population Health
BRAC James P. Grant School of Public Health
Sree Chitra Tirunal Institute for Medical Sciences and Technology
Department of Medicine
Department of Molecular and Clinical Medicine
Department of Biomedical Sciences
Department of Community Medicine and School of Public Health
International Research Center
Mahatma Gandhi University of Medical Sciences and Technology
Isfahan Cardiovascular Research Center
Department of Community Health Sciences
Asfendiyarov Kazakh National Medical University
Population Health Research Institute
Masira Research Institute
Estudios Clinicos Latinoamerica
Advocate Aurora Research Institute
Institute of Community and Public Health
Departamento Ciencias de la Rehabilitación
Department of Health Management
Department of Medicine
Medical Research and Biometrics Center
Department of Medicine

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