The association between tree canopy cover over streets and elderly pedestrian falls: A health disparity study in urban areas

Lee, Sung-Min; Ye, Xinyue; Nam, Ji Won; Zhang, Kai

doi:10.1016/j.socscimed.2022.115169

Cited by 9 publications

(5 citation statements)

References 55 publications

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“…A study among individuals at high risk of falling found that higher temperatures were associated with significantly higher odds of a fall being injurious, as opposed to non-injurious (Vongsachang et al 2021 ). An ecologic study of Census blocks in Marin County CA found that a higher extent of tree canopy cover over streets was associated with lower rates of pedestrian falls among adults age 65 and older (Lee et al 2022 ). Because this association was only found during periods when leaves were on the trees (leaf on months), the authors suggest that shade-related lowering of local ambient temperatures may explain the reduction in fall injuries (Lee et al 2022 ).…”

Section: Discussionmentioning

confidence: 99%

“…An ecologic study of Census blocks in Marin County CA found that a higher extent of tree canopy cover over streets was associated with lower rates of pedestrian falls among adults age 65 and older (Lee et al 2022 ). Because this association was only found during periods when leaves were on the trees (leaf on months), the authors suggest that shade-related lowering of local ambient temperatures may explain the reduction in fall injuries (Lee et al 2022 ). As syncope and heat illness are related to high temperatures, lower ambient temperatures may also reduce outdoor fall injuries occurring secondary to syncope and heat illness (Heo et al 2021 ; Horváthová et al 2021 ; Kilbourne et al 1982 ).…”

Section: Discussionmentioning

confidence: 99%

“…Unlike indoor falls, which are more likely influenced by an individual's risk factors and health status, outdoor falls are often associated with health-promoting activities (e.g., walking, running, gardening) instead of poor health and are, in particular, substantially influenced by environmental factors, climate (e.g., winter weather, rain and extreme heat) and the physical aspects of the environment such as poorly maintained paving (Chippendale et al Kelsey et al 2012a , 2012b ; Li et al 2006 ; Satariano et al 20172017 ). While icy conditions are a known cause of outdoor falls, there is emerging evidence that injurious outdoor falls are also associated with higher temperatures (Lee et al 2022 ; Vongsachang et al 2021 ).…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

A methodology for the public health surveillance and epidemiologic analysis of outdoor falls that require an emergency medical services response

Rundle

Crowe²,

Wang

et al. 2023

Inj. Epidemiol.

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Background Falls are a common cause of injury with significantly associated medical costs yet public health surveillance of injuries from falls is underdeveloped. In addition, the epidemiologic understanding of outdoor falls, which have been reported to account for 47% of all injurious falls, is scant. Here we present methods to use emergency medical services (EMS) data as a public health surveillance tool for fall injuries, including those that occur secondary to syncope and heat illness, with a focus on the scope and epidemiology of outdoor fall injuries. Methods Using the 2019 National Emergency Medical Services Information System (NEMSIS) data, we developed an approach to identify EMS encounters for fall injuries, syncope and heat illness. NEMSIS variables used in our algorithm included the EMS respondent’s impression of the encounter, the reported major symptoms and the cause of injury. With these data we identified injuries from falls and, using the NEMSIS data on the location of the encounter, we identified fall injuries as occurring indoors or outdoors. We present the descriptive epidemiology of the identified patients. Results There were 1,854,909 injuries from falls that required an EMS response identified in the NEMSIS data, with 4% of those injuries secondary to episodes of syncope (n = 73,126) and heat illness. Sufficient data were available from 94% of injurious falls that they could be assigned to indoor or outdoor locations, with 9% of these fall injuries occurring outdoors. Among fall injuries identified as occurring outdoors, 85% occurred on streets and sidewalks. Patient age was the primary sociodemographic characteristic that varied by location of the injurious fall. Sixty-six percent of fall injuries that occurred indoors were among those age 65 years or older, while this figure was 34% for fall injuries occurring outdoors on a street or sidewalk. Conclusion The occurrence of outdoor fall injuries identified in the NEMSIS data were substantially lower than reported in other data sets. However, numerically fall injuries occurring outdoors represent a substantial public health burden. The strengths and weaknesses of using this approach for routine public health surveillance of injuries from falls, syncope and heat illness are discussed.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A methodology for the public health surveillance and epidemiologic analysis of outdoor falls that require an emergency medical services response

Rundle

Crowe²,

Wang

et al. 2023

Inj. Epidemiol.

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show abstract

“…The shade they provide reduces ambient temperatures on streets and two recent studies suggest that lower outdoor temperatures are associated with lower risk for pedestrian falls among older adults. 34,35 However, the roots of poorly chosen, inappropriately placed or poorly maintained trees can disrupt pavements, and fallen leaves or branches can create trip hazards that increase the risk of falls. 36 An appropriate policy response is further complicated by the disjointed responsibility for road and sidewalk maintenance.…”

Section: Discussionmentioning

confidence: 99%

A National Study on the Comparative Burden of Pedestrian Injuries from Falls Relative to Pedestrian Injuries from Motor Vehicle Collisions

Rundle,

Crowe,

Wang

et al. 2024

J Urban Health

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Pedestrian injuries from falls are an understudied cause of morbidity. Here we compare the burden of pedestrian injuries from falls occurring on streets and sidewalks with that from motor vehicle collisions.Data on injurious falls on streets and sidewalks, and pedestrian-motor vehicle collisions, to which Emergency Medical Services responded, along with pedestrian and incident characteristics, were identi ed in the 2019 National Emergency Medical Services Information System database.In total, 129,343 injurious falls and 33,910 pedestrians-motor vehicle collisions were identi ed, with 89% of the incidents occurring in urban areas. Thirty two percent of pedestrians struck by motor vehicles were coded as Emergent or Critical by Emergency Medical Services, while 20% of pedestrians injured by falls were similarly coded. However, the number of pedestrians whose acuity was coded as Emergent or Critical was 2.33 times as high for injurious falls as compared with pedestrians-motor vehicle collisions. This ratio was nearly double at 4.3 for individuals 50 years and older, and almost triple at 6.5 for those 65 years and older.In conclusion, there has been substantial and appropriate policy attention given to preventing pedestrian injuries from motor vehicles, but disproportionately little to pedestrian falls. However, the population burden of injurious pedestrian falls is signi cantly greater and justi es an increased focus on outdoor falls prevention, in addition to urban design, policy and built environment interventions to reduce injurious falls on streets and sidewalks, than currently exists across the U.S.

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“…The shade they provide reduces ambient temperatures on streets and two recent studies suggest that lower outdoor temperatures are associated with lower risk for pedestrian falls among older adults. 34 , 35 However, the roots of poorly chosen, inappropriately placed or poorly maintained trees can disrupt pavements, and fallen leaves or branches can create trip hazards that increase the risk of falls. 36 An appropriate policy response is further complicated by the disjointed responsibility for road and sidewalk maintenance.…”

Section: Discussionmentioning

confidence: 99%

A National Study on the Comparative Burden of Pedestrian Injuries from Falls Relative to Pedestrian Injuries from Motor Vehicle Collisions

Rundle

Crowe²,

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

Pedestrian injuries from falls are an understudied cause of morbidity. Here we compare the burden of pedestrian injuries from falls occurring on streets and sidewalks with that from motor vehicle collisions. Data on injurious falls on streets and sidewalks, and pedestrian-motor vehicle collisions, to which Emergency Medical Services responded, along with pedestrian and incident characteristics, were identified in the 2019 National Emergency Medical Services Information System database. In total, 129,343 injurious falls and 33,910 pedestrians-motor vehicle collisions were identified, with 89% of the incidents occurring in urban areas. Thirty two percent of pedestrians struck by motor vehicles were coded as Emergent or Critical by Emergency Medical Services, while 20% of pedestrians injured by falls were similarly coded. However, the number of pedestrians whose acuity was coded as Emergent or Critical was 2.33 times as high for injurious falls as compared with pedestrians-motor vehicle collisions. This ratio was nearly double at 4.3 for individuals 50 years and older, and almost triple at 6.5 for those 65 years and older. In conclusion, there has been substantial and appropriate policy attention given to preventing pedestrian injuries from motor vehicles, but disproportionately little to pedestrian falls. However, the population burden of injurious pedestrian falls is significantly greater and justifies an increased focus on outdoor falls prevention, in addition to urban design, policy and built environment interventions to reduce injurious falls on streets and sidewalks, than currently exists across the U.S.

show abstract

The association between tree canopy cover over streets and elderly pedestrian falls: A health disparity study in urban areas

Cited by 9 publications

References 55 publications

A methodology for the public health surveillance and epidemiologic analysis of outdoor falls that require an emergency medical services response

A methodology for the public health surveillance and epidemiologic analysis of outdoor falls that require an emergency medical services response

A National Study on the Comparative Burden of Pedestrian Injuries from Falls Relative to Pedestrian Injuries from Motor Vehicle Collisions

A National Study on the Comparative Burden of Pedestrian Injuries from Falls Relative to Pedestrian Injuries from Motor Vehicle Collisions

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