This study examined the association between the presence of pedestrian and bicycle plans to pedestrian and bicyclist nonfatal and fatal injuries from 1997 to 2009 among 553 North Carolina (NC) municipalities. We considered all municipal plans (n=92; 49 pedestrian; 34 bicycle; and 9 combined plans featuring pedestrian and bicyclist components) published through 2009. Counts of pedestrian and bicyclist nonfatal and fatal injuries came from the NC Department of Transportation crash database, and the estimated number of pedestrian and bicycle trips per municipality in one year were used to calculate pedestrian and bicyclist nonfatal and fatal injury rates. In the 13-year study period, pedestrian/combined municipality plans and bicycle/combined municipality plans were present for 189 (2.6%) and 238 (3.3%) municipality-years, respectively. There were 11,795 nonfatal injuries, 9237 possible nonfatal injuries, and 1075 fatal injuries sustained by pedestrians in pedestrian-motor vehicle crashes. There were 4842 nonfatal injuries, 3666 possible nonfatal injuries, and 134 fatal injuries sustained by bicyclists in bicyclist-motor vehicle crashes. Although not statistically significant, unadjusted nonfatal and fatal injury rates among pedestrians and bicyclists were lower in those municipality-years in which plans had been published that year or in a year prior, compared to municipality-years lacking a plan. Adjusted rate ratios (RR) indicated that pedestrian nonfatal and fatal injury rates decreased in municipality-years with publication of pedestrian/combined plans (nonfatal injury RR: 0.75, 95% confidence interval (CI): 0.68, 0.82; fatal injury RR: 0.63, 95% CI: 0.46, 0.85). However, bicyclist nonfatal and fatal injury rates did not significantly change with publication of bicyclist/combined plans. Our research suggests that plan publication is associated with lower rates of nonfatal and fatal injury in pedestrians; this association was not observed for bicyclists. Further work must determine how the extent of implementation and quality of safety-related content within these plans affects changes in nonfatal and fatal injury rates.
