Exposure-based, 'like-for-like' assessment of road safety by travel mode using routine health data.

BACKGROUND: Official reports on modal risk have not chosen appropriate numerators and denominators to enable like-for-like comparisons. We report age- and sex-specific deaths and injury rates from equivalent incidents in England by travel mode, distance travelled and time spent travelling. METHODS: Hospital admissions and deaths in England 2007-2009 were obtained for relevant ICD-10 external codes for pedestrians, cyclists, and car/van drivers, by age-group and sex. Distance travelled by age-group, sex and mode in England (National Travel Survey 2007-2009 data) was converted to time spent travelling using mean trip speeds. Fatality rates were compared with age-specific Netherlands data. RESULTS: All-age fatalities per million hours' use (f/mhu) varied over the same factor-of-three range for both sexes (0.15-0.45 f/mhu by mode for men, 0.09-0.31 f/mhu for women). Risks were similar for men aged 21-49 y for all three modes and for female pedestrians and drivers aged 21-69 y. Most at risk were: males 17-20 y (1.3 f/mhu (95% CI 1.2-1.4)) for driving; males 70+ (2.2 f/mhu(1.6-3.0)) for cycling; and females 70+ (0.95 f/mhu (0.86-1.1)) for pedestrians. In general, fatality rates were substantially higher among males than females. Risks per hour for male drivers