Insights into vulnerable road user injury trends in the context of the COVID-19 pandemic: Canadian city trends 2012-2022.

INTRODUCTION: Over the last decade, there have been major changes in travel modes and the implementation of road safety interventions in Canadian cities. The COVID-19 pandemic acted as a catalyst for many of these rapid changes. It is, therefore, important to examine trends in vulnerable road user injuries (VRU), specifically among pedestrians and cyclists, that have occurred alongside these developments.The objectives of this study were to: (a) compare data availability and comprehensiveness of VRU injuries across cities and databases and (b)assess the short-term impact of the COVID-19 pandemicby describing the temporal trends in VRU injuries in the different databases across fourCanadian cities from 2012 to 2022. METHODS: We used four data sources from Montréal (Quebec), Toronto (Ontario), Calgary (Alberta), and Vancouver (British Columbia): police-reported, insurance-reported, hospital emergency department (ED) visits and hospitalizations. Descriptive analyses and comparisons of quarterly counts of VRU injuries from 2012 to 2022 were conducted by data source and by city. Injury trends were examined using an interrupted time series study design with March 11, 2020 (the World Health Organization declaration of the COVID-19 pandemic), as the interruption point. RESULTS: The VRU injury burden estimates differed by data source with police-reported injuries generally lower than ED visits and hospitalizations except for Calgary pedestrian hospitalizations. Across all cities, fewer pedestrian injuries than expected were observed after 2020 relative to pre-pandemic trends. Generally, there were more cyclist non-motor vehicle injuries after the start of the pandemic. CONCLUSIONS: VRU injury burden differs by database, as data are collected for different purposesusingdifferent injury definitions. Cities and provinces had different policy responses to the pandemic emphasizing that local context is important when examining VRU injury trends. PRACTICAL APPLICATIONS: Linked, comprehensive, standardized, and timely VRU data across Canada are needed to accurately assess injury burden andfacilitate safe sustainable transportation.