Walkable neighborhoods provide significant sustainability, health, and motorized user safety benefits. Far less consideration is given to the potential pedestrian/bicyclist safety-related implications of macro-level walkability. Making it desirable to walk and bike without providing the proper physical environment to make it safe is clearly problematic. This study assessed the links between neighborhood walkability and pedestrian/bicyclist traffic fatalities across metropolitan areas in the U.S. We integrated and harnessed geocoded data on pedestrian/bicyclist and all mode traffic fatalities, travel behavior exposures (use of sedentary and active travel modes), sociodemographic, and control variables. Associations of pedestrian/bicyclist traffic fatality rates with walkability characteristics were estimated using multilevel Tobit models with treatment for hierarchical unobserved regional and state variations. Walkability index (mixed land use, street intersection density, and transit accessibility) was positively correlated with pedestrian/bicyclist fatality rates after adjusting for travel exposures, sociodemographic controls, and regional and state-level unobserved variations. A unit increase in the walkability index was associated with a 4.9% increase (95% CI: 4.2%, 5.7%) in pedestrian/bicyclist fatality rates. Conversely, the walkability index was negatively correlated with total or all-mode fatality rates. The positive association between walkability and pedestrian/bicyclist fatality rates appeared robust in different sensitivity analyses. Despite non-linearities, neighborhoods with greater population using active travel modes for commute had on-average higher pedestrian/bicyclist fatality rates. The reverse was true for neighborhoods with greater teleworking population. Neighborhoods with greater prevalence of black, low-income, and younger adults had on-average higher pedestrian/bicyclist fatality rates. Results emphasize the need to develop new conceptual definitions of walkability that consider safety within the built environments. Our results highlight the importance of understanding how pedestrian/bicyclist supportive design can be used to maximize the positive health benefits of walkability while reducing the risk of pedestrian/bicyclist deaths. Findings also suggest the need to enhance existing walkability assessment techniques (indices) to predict and simulate how different investments impact pedestrian/bicyclist safety. Incorporation of objective pedestrian/bicyclist safety in walkability assessments can assist practitioners to simultaneously improve health while minimizing safety risks to vulnerable road users.

中文翻译：

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重新定义步行性以确保安全：投资行人、自行车和街道设计功能，使步行和骑自行车变得安全

适合步行的社区可带来显着的可持续性、健康和机动用户安全效益。人们很少考虑宏观层面的步行性对行人/骑自行车者安全相关的潜在影响。如果不提供适当的物理环境来确保安全，那么让步行和骑自行车变得令人向往显然是有问题的。本研究评估了美国大都市区的社区步行适宜性与行人/骑自行车者交通死亡人数之间的联系。我们整合并利用了有关行人/骑自行车者和所有交通死亡人数、出行行为暴露（使用久坐和主动出行模式）、社会人口统计学的地理编码数据和控制变量。使用多级 Tobit 模型估计行人/骑自行车者交通死亡率与步行特性之间的关联，并处理分层的未观察到的区域和州变化。在调整旅行暴露、社会人口统计控制以及地区和州一级未观察到的变化后，步行适宜性指数（混合土地利用、街道交叉口密度和交通可达性）与行人/骑自行车者死亡率呈正相关。步行指数每增加一个单位，行人/骑自行车者死亡率就会增加 4.9%（95% CI：4.2%、5.7%）。相反，步行指数与总死亡率或全模式死亡率呈负相关。在不同的敏感性分析中，步行适宜性与行人/骑自行车者死亡率之间的正相关性似乎很强。尽管存在非线性，但使用主动出行方式通勤的人口较多的社区平均行人/骑自行车者死亡率较高。对于远程办公人口较多的社区来说，情况恰恰相反。黑人、低收入和年轻人较多的社区，行人/骑自行车者的平均死亡率较高。结果强调需要制定新的步行性概念定义，考虑建筑环境中的安全性。我们的结果强调了了解如何利用行人/骑自行车者支持设计来最大限度地发挥步行性的积极健康效益，同时降低行人/骑自行车者死亡风险的重要性。研究结果还表明，需要加强现有的步行性评估技术（指数），以预测和模拟不同投资如何影响行人/骑自行车者的安全。将客观的行人/骑自行车者安全纳入步行适宜性评估中可以帮助从业者同时改善健康，同时最大限度地减少弱势道路使用者的安全风险。