Profiles of active transportation injury survivors: findings from a British Columbia inception cohort

Active transportation (AT) uptake is increasing as a result of its beneficial effects on health and the environment. Active transport injury (ATI) events that do not involve a motor vehicle are common but go unreported in traffic injury databases. This manuscript reports sociodemographic, pre-injury health, and injury-related factors of ATI survivors, as well as circumstances of ATI events. This was a prospective inception cohort study of ATI survivors recruited between January 2022 and December 2023 from four emergency departments (EDs) in British Columbia, Canada. Participants were aged ≥ 16 years and arrived in a participating ED within 48 h of sustaining an ATI. Data were collected from structured interviews and review of medical records. The cohort of 1,932 ATI survivors included 978 pedestrians, 524 cyclists, 168 e-cyclists, 161 e-scooter users, and 100 other micromobility device users. Mean (SD) age was 47.0 (19.3) years; 982 (51%) were female. Over two-thirds of pedestrians were female (70%), compared to a greater proportion of males in other transport modes. Pedestrians and e-cyclists were of older age. Overall pre-injury health was good, with minimal levels of psychological distress, and somatic symptom severity. Pre-existing alcohol, cannabis, and other recreational drug use was highest among other micromobility device users and lowest among pedestrians. The overall cohort had mild injury severity, with e-cyclists sustaining relatively more severe injury, whereas pedestrians and e-scooter users had the lowest injury severity scores. Motor vehicle involvement was reported in one quarter (27%) of incidents. Pedestrians and other micromobility device users were more likely to have been injured via a fall/collision with a stationary object; whereas, cyclists were more likely to have been injured via motor vehicle collision. In a large cohort of ATI survivors, most participants reported good pre-injury health. Injury severity, patterns, and circumstances differed by transport mode; however, across all transport modes, motor vehicle involvement was present in only one quarter of incidents; emphasizing the importance of considering non-motor vehicle incident mechanisms when monitoring ATIs or informing priority areas for ATI prevention.