Changes to the built environment are an often-overlooked area of pedestrian injury control. To help address the need for baseline information to inform policy, we conducted a meta-analysis on the association of the roadway environment with the risk of pedestrian injury and mortality. We searched multiple electronic databases for studies related to built environment and pedestrian injuries. We abstracted and converted results to ORs, and synthesised the effect sizes with Bayesian meta analytic methods by placing vague or non-informative prior distributions for the central measure of effect and its variance on the likelihood of a set of normally distributed effect size logits. We identified 23 studies. Thirteen involved interventions, consisting of reconstruction (7), closures (4), and signage or unspecified (2). Ten studies were based on observational data. Studies were conducted in Europe (11), North America (4), Oceana (3), Asia (2), Africa (2), and South America (1). The overall association between roadway characteristics and risk of injury or death was OR=1.6 (95% CrI 1.2 to 2.1). There was an 80% probability that a future study would demonstrate a similar positive association. Roadway environment plays a crucial role in pedestrian injury and mortality. Public health and policy interventions to reduce the burden of such injuries should include attention to the built environment.
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