Objectives The purpose of this study was to investigate the contribution of neighbourhood disorder around alcohol outlets to pedestrian injury risk.
Methods A spatial analysis was conducted on census block groups in Baltimore City. Data included pedestrian injury EMS records from 1 January 2014 to 15 April 2015 (n=858), off-premise alcohol outlet locations for 2014 (n=693) and neighbourhood disorder indicators and demographics. Negative binomial regression models were used to determine the relationship between alcohol outlet count and pedestrian injuries at the block group level, controlling for other neighbourhood factors. Attributable risk was calculated by comparing the total population count per census block group to the injured pedestrian count.
Results Each one-unit increase in the number of alcohol outlets was associated with a 14.2% (95% CI 1.099 to 1.192, P<0.001) increase in the RR of neighbourhood pedestrian injury, adjusting for traffic volume, pedestrian volume, population density, per cent of vacant lots and median household income. The attributable risk was 10.4% (95% CI 7.7 to 12.7) or 88 extra injuries. Vacant lots was the only significant neighbourhood disorder indicator in the final adjusted model (RR=1.016, 95% CI 1.007 to 1.026, P=0.003). Vacant lots have not been previously investigated as possible risk factors for pedestrian injury.
Conclusions This study identifies modifiable risk factors for pedestrian injury previously unexplored in the literature and may provide evidence for alcohol control strategies (eg, liquor store licencing, zoning and enforcement).
- geographical / spatial analysis
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Contributors All authors have complied with the principles of the ethical practice of public health and contributed substantially to the conception and design or analysis and interpretation of data. Specifically, EDN designed the research questions in collaboration with coauthors, conducted all data analysis, created the first draft of the manuscript, made substantial edits in the subsequent drafts and approved the final submitted draft. KMP and FCC participated in the design of the study, made substantial edits to drafts of the manuscript and approved the final submitted draft. ARK and AJM acquired the data, made substantial contributions to the interpretation of data and results and approved the final submitted draft. AJM, JVB and ACG made substantial contributions to the conceptualisation of the data analytic plan and interpretation of results, reviewed and revised the manuscript critically for important intellectual content and approved the final submitted draft. Each author certifies that he or she has participated sufficiently in the work to believe in its overall validity and take public responsibility for all of its content.
Funding This work was supported by the National Institute on Alcohol Abuse and Alcoholism (Grant Numbers R01-AA015196 and F31AA023716), the Centers for Disease Control and Prevention (Grant Number 1U49CE000728) and the National Institute on Drug Abuse (Grant Number R34DA034314).
Competing interests None declared.
Patient consent Not required.
Ethics approval This research was approved by the Institutional Review Board at the Johns Hopkins Bloomberg School of Public Health and deemed non-human subjects research.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The data that support the findings of this study are available from the Baltimore City Fire Department (BCFD), but restrictions apply to the availability of these data, which were used under licence for the current study and so are not publicly available. Data are however available from the authors upon reasonable request and with permission of BCFD.