Presenter Profile
Joyce C. Pressley, PhD, MPH
Health Policy and Management at CUMC
Director, Outreach Core, CCISP
Columbia University in the City of New York
New York, NY 10032
Phone (cell): 646-644-3036
Dr. Joyce Pressley is Faculty in the Departments of Epidemiology and Health Policy and Management at Columbia University where she teaches and directs the Outreach Core for the Columbia Center for Injury Science and Prevention (CCISP). Dr. Pressley's experience in research, teaching and injury prevention is multidisciplinary--crossing the disciplinary boundaries of public health policy, epidemiology, emergency medicine, critical care, economics and health care management. She has authored studies and mentored students doing research in occupant protection across the age span covering issues such as substance use, child endangerment, vehicle and crash characteristics and outcomes across the age span, the impact of policies and laws on MV occupant safety and the economic burden of MV injury. She is active with the Transportation Research Board (TRB) at the National Academies where she has chaired the Occupant Protection Committee and is a member of the Impairment in Transportation Committee. She is a former chair of APHA’s Injury Control and Emergency Health Services (ICEHS) Section and SAVIR’s Council of Centers, and a recipient of the SAVIR President’s Award. Her PhD degree (1996) is from Duke University.
Presentations
Using the Safe System Framework to Examine Pediatric Mortality on U.S. Roadways Pre-Covid-19 and in Covid-19 Era
Joyce Pressley, PhD, MPH
Zarah Aziz, MS
Barbara Barlow, MD
Riya Virani, BS
The U.S. experienced a significant increase in all age motor vehicle mortality during the Covid-19 pandemic that has not returned to pre-Covid-19 levels. A better scientific understanding of the Covid-19 impact on motor vehicle mortality in the pediatric population could aid in designing and conducting more effective prevention efforts.
A census database of all U.S. roadway deaths, the Fatality Analysis Reporting System (FARS), was employed to investigate pandemic changes in motor vehicle mortality in the U.S. pediatric population aged 0-19 years. The pre-pandemic era was defined from 04/01/2017 to 12/31/2019 (n=9,566) and the Covid-19 era from 04/01/2020 to 12/31/2022 (n=10,692). FARS variables were mapped to the Safe System five pillar framework and compared across the two timeframes for: 1) road users; 2) roadways; 3) vehicles; 4) speeds; and 5) post-crash care. To control for seasonal differences, the two time periods were exact matched by month and length of study time. Deaths occurring during a buffer period from 01/01/2020 to 03/31/2020 were excluded. In this ongoing study, statistical analyses will include Chi Sq for bivariate analyses and multivariable logistic regression for unadjusted and adjusted odds with 95% CI.
The pandemic period was associated with more than 1,100 excess pediatric motor vehicle deaths compared to an identical length period in the pre-Covid timeframe. Mortality increased by 11.8% in ages 0-19 years during the pandemic, but this varied significantly by age. Percent increase in mortality was highest in ages 10-14 (18.1%) and second highest in 15-19 years (13.8%) than other age groups (p=0.005). Mortality increased by approximately 10% in drivers with a full or a GDL license, but by 52.5% in drivers without a driver’s license (p<0.0001). There was a 40.5% increase in failure to use safety equipment (p<0.0001) and a 37.8% increase in underaged alcohol-impaired drivers (p=0.002). Urban roadway mortality increased more than rural roadways (21.2% vs. 2.4%, p<0.0001). Mortality decreased during inclement weather, but increased significantly in clear conditions (p<0.0001) and at night (p=0.0001). Mortality increased by approximately 11.8 to 14.8% for trucks, cars, and SUVs, but by 20.3% for motorized 2 and 3 wheelers and 43.2% for nearly 1,000 “other” vehicle types (p<0.001). Vehicle ejections were up by 27.5% p<0.0001). Speed related crashes increased by 32.2% (p<0.0001). Post crash care had a 17.9% increase in died on the scene and not transported for emergency care during the Covid era (p=0.004).
The U.S. pediatric population experienced an increase in pandemic mortality despite stay-at-home orders, entertainment shuttering, and school closures. Use of the five pillar Safe System framework was valuable in identifying pandemic-associated road user behavior, roadway, vehicle, speed, and post-crash factors contributing to the pediatric pandemic mortality increase.
Attendees of this session will be able to:
1) Explain concepts of the safe system approach and cite an example of its use to expand our scientific knowledge of pediatric motor vehicle fatal injury pre-Covid-19 and in the Covid-19 era;
2) Identify emerging issues and trends in the pediatric population experiencing fatal roadway injury;
3) Discuss how these scientific findings can be used to focus and inform prevention efforts.