Health services use for transport injuries among children and youth in Ontario from 2015–2022: a population-based study

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.