Fatality risk and issues of inequity among vulnerable road users in South Africa.

Background: Contextual effects from the physical and social environment contribute to inequitable protection for a large proportion of road users, especially in low- and middle-income countries like South Africa where distorted urban planning and socio-spatial disparities from the apartheid era prevail.

Objectives: This paper examines the differentiated risk of road traffic crashes and injuries to vulnerable road users in South Africa, including pedestrians, females and users of some modes of public transport, in relation to characteristics of the crashes that proxy a range of contextual influences such as rurality and socio-economic deprivation.

Methods: The study is based on a descriptive analysis of 33 659 fatal crashes that occurred in South Africa over a three-year period from 2016-2018. Measures of simple proportion, population-based fatality rate, "impact factor" and crash severity are compared between disaggregated groups using Chi-Square analysis, with the Cramer's V statistic used to assess effect size.

Results And Significance: Key findings show a higher pedestrian risk in relation to public transport vehicles and area-level influences such as the nature of roads or extent of urbanity; higher passenger risk in relation to public transport vehicles and rurality; and higher risk for female road users in relation to public transport vehicles. The findings have implications for prioritising a range of deprivation-related structural effects. In addition, we present a "User-System-Context" conceptual framework that allows for a holistic approach to addressing vulnerability in the transport system. The findings provide an important avenue for addressing the persistently large burden of road traffic crashes and injuries in the country.