Health services use for transport injuries among children and youth in Ontario from 2015–2022: a population-based study
DOI:
https://doi.org/10.55329/hjsh7438Keywords:
bicycling, child and youth, COVID-19, Ontario, pedestrians, transportation injury, trends, Northern AmericaAbstract
Transportation-related injuries remain one of the leading causes of mortality among children and youth in Canada. Factors such as age, sex, marginalization, and the COVID-19 pandemic may influence children’s interactions with their environment and their mobility patterns. The objectives of this study were to describe: (1) the incidence of transport-related emergency department (ED) visits and hospitalizations in Ontario by type (motor vehicle, pedestrian, cycling) and by age and sex; and (2) the temporal trends in transport-related health service utilization by type and level of marginalization over time, including during the COVID-19 pandemic. Data for all traffic and non-traffic motor vehicle and vulnerable road user injuries (VRU, pedestrians and cyclists) were obtained for ED visits and hospitalizations in Ontario from January 2015 to March 2022. Descriptive analyses were completed by age group, sex, and marginalization across the study period. A simulation approach using Bayesian Poisson regression was employed to examine how the pandemic affected temporal trends. During the study period, the rate per 10 000 children and youth with motor vehicle-related injuries was 328 (95% CI: 325–331), and for VRU-related injuries was 275 (95% CI: 272.4–277). Sixty-one percent of cyclist ED visits and hospitalizations were non-traffic related. Males, children and youth aged 10–19 and more marginalized children generally had higher rates of both ED visits and hospitalizations than females, children aged 0–9 and those less marginalized. At the onset of the pandemic, ED visits for traffic-related motor vehicle and all pedestrians were lower than expected, and non-traffic motor vehicle and all cyclists were higher than expected. The greatest differences from expected in ED visits were in the least marginalized children; for example, there was a 107% increase in cyclist non-traffic in the least marginalized versus 11% increase in the most marginalized quintile. The findings of this study reinforce the ongoing need to focus on cycling safety, particularly non-traffic-related, for children and youth. These findings can also inform future equitable injury preventive efforts in light of significant population-level events, such as pandemics, that might change children’s mobility patterns.
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Author Biographies
Linda Rothman, Toronto Metropolitan University, Canada | University of Toronto, Canada
Linda Rothman is an Associate Professor in the School of Occupational and Public Health at the Toronto Metropolitan University and an Assistant Professor (status only) at Dalla Lana, School of Public Health, University of Toronto. She is an epidemiologist, and her area of expertise is in vulnerable road user injuries in urban environments as a public health issue. Her research projects involve multi-disciplinary collaborators from academia, hospitals, not-for-profit organizations, the private sector, school boards, and all levels of the government. She holds several Canadian Institutes of Health Research grants related to the evaluation of new road design modifications such as cycle tracks, reduced speed limits, and automated speed enforcement. She is also an investigator on the Healthy Cities CapaCITY/É implementation science team grant involving researchers working together with municipalities across Canada and Australia to examine the implementation and evaluation of interventions focused on speed reduction and All Ages and Abilities Bicycle Networks.
CRediT contribution: Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Visualization, Writing – original draft.
Ian Pike, British Columbia Children's Hospital Research Institute, Canada
Ian Pike is Professor Emeritus of Pediatrics at UBC, and Investigator Emeritus at the BC Injury Research and Prevention Unit (BCIRPU), BC Children's Hospital Research Institute. He served as Director of the BCIRPU for 20 years during which time the many research initiatives highlighted the importance of injury prevention as a public health concern, and lead to several important policy and practice changes in BC and across Canada. He continues to serve as co-Executive Director and Spokesperson for The Community Against Preventable Injuries (www.preventable.ca), a social marketing organization and campaign focused on changing attitudes and behaviours to prevent serious injuries and deaths.
CRediT contribution: Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Validation, Writing – review & editing.
Adrian Sammy, Toronto Metropolitan University, Canada
Adrian Sammy was a Research Assistant at the School of Occupational and Public Health, Toronto Metropolitan University, and an MPH student at the Dalla School of Public Health, University of Toronto at the time this study was being conducted. During his MPH, he conducted research in areas including injury prevention, clinical trial design, and infectious disease surveillance, gaining broad experience in epidemiological research and biostatistical methods. He later worked as an Epidemiologist at The Regional Municipality of York and is currently a second-year MD student at the Schulich School of Medicine & Dentistry, Western University.
CRediT contribution: Data curation, Formal analysis, Investigation, Methodology, Project administration, Software, Visualization, Writing – review & editing.
Saroar Zubair, SickKids Research Institute, Canada
Saroar Zubair is a Clinical Research Coordinator within the Child Health Evaluative Sciences division at The Hospital for Sick Children. He coordinates studies related to road safety, traffic collisions and child injury. In addition to road safety projects, he provides technical and organizational support for multicenter randomized controlled trials at SickKids. Saroar holds a master’s degree from the University of British Columbia in Human Nutrition with an emphasis on population and public health. Drawing from a diverse professional background encompassing clinical research, education, and the non-profit sector, Saroar is passionate about making a meaningful impact in his field through data-driven practical projects.
CRediT contribution: Data curation, Formal analysis, Investigation, Methodology, Validation, Visualization, Writing – review & editing.
Alex Zheng, British Columbia Children's Hospital Research Institute, Canada
Alex Zheng is a Biostatistician and Researcher at the BC Injury Research and Prevention Unit, BC Children’s Hospital. His research focuses on data analysis and visualization, cost modeling, prediction modeling, and injury prevention and surveillance.
CRediT contribution: Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – review & editing.
Shazya Karmali, British Columbia Children's Hospital Research Institute, Canada
Shazya Karmali is the Research Manager at the BC Injury Research and Prevention Unit, BC Children’s Hospital. Her research focuses on injury prevention, specifically related to concussion awareness and management, fire safety, and injury prevention among Indigenous populations.
CRediT contribution: Funding acquisition, Investigation, Methodology, Project administration, Writing – review & editing.
Brice Batomen, University of Toronto, Canada
Brice Batomen is an Assistant Professor in Epidemiology at the Dalla Lana School of Public Health, University of Toronto. He is motivated by understanding the distribution and the determinants of early mortality and morbidity. Hence, his motivation to work on injuries, which are the leading cause of death, disability, and health care costs for people under 40 years of age. Dr. Batomen’s work aims to improve access to trauma care and injury prevention in Canada. His research goals aim to identify the characteristics of the road network that promote active transportation and safety using innovative data collection and analytic methods.
CRediT contribution: Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Resources, Software, Validation, Visualization, Writing – review & editing.
Andrew Howard, SickKids Research Institute, Canada
Andrew Howard is an orthopaedic clinician-scientist specializing in the prevention of child road traffic injuries—the leading cause of death for children in developed nations. His research examines the biomechanics and epidemiology of injuries among child vehicle occupants, pedestrians, and cyclists, supported by CIHR and Industry Canada for 18 years. He also studies childhood falls and sports injuries, collaborating with the Toronto District School Board. As Director of the Office of International Surgery at the University of Toronto, Dr. Howard works to prevent and treat unintentional childhood injury globally and is active in the Canadian Network for International Surgery.
CRediT contribution: Formal analysis, Funding acquisition, Investigation, Methodology, Supervision, Writing – review & editing.
Natasha Saunders, University of Toronto, Canada | SickKids Research Institute, Canada | Hospital for Sick Children, Canada
Natasha Saunders is a general pediatrician at the Hospital for Sick Children, a Senior Associate Scientist at the SickKids Research Institute and an Associate Professor in the Department of Paediatrics and Dalla Lana School of Public Health, University of Toronto. Dr. Saunders leads an applied health system and policy research program, producing evidence needed to guide and advocate for policies for children and youth. Her scholarly contributions largely use linked health administrative and demographic datasets and focus on injury epidemiology and mental health system utilization.
CRediT contribution: Funding acquisition, Investigation, Methodology, Resources, Writing – review & editing.
Shelina Babul, British Columbia Children's Hospital Research Institute, Canada
Shelina Babul is a Clinical Professor in the Department of Pediatrics at the University of British Columbia (UBC), and Director and Sports Injury Specialist with the BC Injury Research and Prevention Unit, BC Children’s Hospital. Her research focus includes identifying gaps in injury prevention; concussion research and strategies to promote uptake of effective interventions; and coordination of local, provincial, and national concussion efforts. Dr. Babul developed the Concussion Awareness Training Tool (CATT), with eLearning modules for medical professionals, coaches, athletes, and other audiences. She is a member of the Canadian Traumatic Brain Injury Research Consortium and the International Brain Injury Association. Her awards include the 2025 Canadian Association for Medical Association Certificate of Merit, the 2025 Alumni UBC Global Citizenship Award, the 2023 UBC Faculty of Medicine, Clinical Faculty Award for Excellence in Research (Clinical or Applied), and the Canadian Collaborating Centres for Injury Prevention Award for Collaborative Excellence, 2022 for CATT for High Performance Athletes.
CRediT contribution: Funding acquisition, Investigation, Methodology, Resources, Writing – review & editing.
Omidreza Sadrmanesh, Toronto Metropolitan University, Canada
Omidreza Sadrmanesh holds an MSc in Kinesiology and Health Science from York University, Toronto. He is now working as a Research Assistant at Toronto Metropolitan University, working on volume data, cycling infrastructure, and injury patterns across Canadian cities. His main research interest is applying novel data approaches in road safety projects. He has worked with large-scale datasets related to transportation volumes and injuries. Omidreza is particularly passionate about applying data science to road safety research, with a growing focus on infrastructure-related interventions.
CRediT contribution: Investigation, Visualization, Writing – original draft.
Fahra Rajabali, British Columbia Children's Hospital Research Institute, Canada
Fahra Rajabali has been at the BCIRPU since 2000. She is a specialist in injury data, epidemiology, visualizations, and evaluation. Fahra manages the data at the BCIRPU and is responsible for the data and interface for the Injury Data Online Tool (iDOT). She is the evaluation manager for the Period of PURPLE Crying program in BC. She wears many other “hats” in her work on injury surveillance and conference planning. Along with her co-workers, Fahra was a recipient of the UBC President’s Staff Award in 2014.
CRediT contribution: Funding acquisition, Investigation, Methodology, Writing – review & editing.
Pamela Fuselli, Parachute, Canada
Pamela Fuselli, President & CEO at Parachute, Canada’s national charity dedicated to injury prevention has more than 25 years of experience in the health care and injury prevention sector. Pamela has focused on knowledge mobilization resulting in behaviour change, the impact of good public policy and the importance of collaboration to further the impact on social change. Pamela has written numerous national publications and is an investigator, and knowledge translation expert, for national and international research grants. She is a speaker and a media spokesperson on a wide range of injury prevention topics and public policy issues.
CRediT contribution: Funding acquisition, Investigation, Methodology, Writing – review & editing.
Alison K. Macpherson, York University, Canada
Alison Macpherson is a Professor in the School of Kinesiology and Health Science at York University and an adjunct senior scientist at ICES , an Ontario not-for-profit organization whose mission is translating data into trusted evidence that makes policy and healthcare better and people healthier. Her training in epidemiology was at McGill University and the University of Toronto. Her research is related to keeping kids active, healthy, and safe, including promoting the use of equitable, active, and sustainable transportation. Her research program focuses on the prevention of childhood injuries primarily through policies and laws designed to reduce injuries.
CRediT contribution: Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Supervision, Writing – original draft.
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Copyright (c) 2026 Linda Rothman, Ian Pike, Adrian Sammy, Saroar Zubair, Alex Zheng, Shazya Karmali, Brice Batomen, Andrew Howard, Natasha Saunders, Shelina Babul, Omidreza Sadrmanesh, Fahra Rajabali, Pamela Fuselli, Alison K. Macpherson
This work is licensed under a Creative Commons Attribution 4.0 International License.
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Institute of Population and Public Health
Grant numbers UIP-179228XX
