Bicycling-Related Mortality in Ecuador: A Nationwide Population-Based Analysis from 2004 to 2017

Round 1

Reviewer 1 Report

Introduction chapter is very well concepted. Authors should use same number of decimals for all numbers throughout whole document.

Table format and naming should be according to the instructions for authors.

How authors describe peaks of mortality rates in 2006 and 2015?

Authors should correct spelling and grammar errors.

 

WHO age classification says:

 

Child - 6 - 12 years

 

https://www.ncbi.nlm.nih.gov/mesh/68002648

 

Adolescent - 13 - 18 years

 

https://www.ncbi.nlm.nih.gov/mesh/68000293

 

Young adult - 19 -24 years

 

https://www.ncbi.nlm.nih.gov/mesh/68055815

 

Adult - 19 - 44 years

 

https://www.ncbi.nlm.nih.gov/mesh/68000328

 

Middle aged - 45 - 64 years

 

After median value should stand interquartile range.

 

What is the reason of large number of unspecified categorization of accidents?

Table 5 is not correctly formatted, and it is not possible to see all data

 The authors did not mention what is approximate number of cyclists on the roads of Ecuador.

Did authors find any data regarding alcohol or drugs intake of those injured drivers?

Where injured drivers passed drivers exam or not?

Conclusion must be improved in a sense of education. Also, authors mentioned policy in conclusion and didn’t mention it before, so it is important to explain what policies exist regarding cyclists in Ecuador if they want to conclude in that way.

Abstract conclusion also needs to be rewritten.

Please state what are the limitations of this study.

Authors need to omit Patents section.

References need to be corrected according to the instructions.

Keyword traumatic brain injury does not correctly describe this manuscript, needs to be changed.

Author Response

Point by Point letter Sustainability

 

RE: Bicycling related mortality in Ecuador: A nationwide population-based analysis from 2004-2017

 

 

Thank you for your thoughtful and thorough review of our manuscript

Enclosed please find a revised manuscript, which is substantially improved as a result of the Reviewers’ suggestions. We have prepared a detailed outline of the changes that have been made in response to all comments. It is important to point out that several of the  observations raised by reviewer two were corrected during the response to reviewer one.

 

 

Introduction chapter is very well concepted. Authors should use same number of decimals for all numbers throughout whole document.

Many thanks for your comments, we have reviewed the manuscript and we have corrected all the decimals according to your suggestions

Table format and naming should be according to the instructions for authors.

Thanks for pointing this out. We have followed the journal’s guidelines

How authors describe peaks of mortality rates in 2006 and 2015?

Yes, a comment was added to the discussion

Authors should correct spelling and grammar errors.

We have corrected and reviewed the entire document

 

WHO age classification says:

 This classification was  used, thanks for the comments.

What is the reason of large number of unspecified categorization of accidents?

We explained within the limitations

Table 5 is not correctly formatted, and it is not possible to see all data

Fixed

 The authors did not mention what is approximate number of cyclists on the roads of Ecuador.

This was added

Did authors find any data regarding alcohol or drugs intake of those injured drivers?

No, sort this data is not available and we have added a comment within the limitation setion

Where injured drivers passed drivers exam or not?

We believe yes, since is a national law, we comment on this on the discussion

Conclusion must be improved in a sense of education. Also, authors mentioned policy in conclusion and didn’t mention it before, so it is important to explain what policies exist regarding cyclists in Ecuador if they want to conclude in that way.

Thanks, we have amended this

Abstract conclusion also needs to be rewritten.

The entire abstract was redone

Please state what are the limitations of this study.

We have added a limitation section

Authors need to omit Patents section.

done

References need to be corrected according to the instructions.

Done

Keyword traumatic brain injury does not correctly describe this manuscript, needs to be changed

This was changed

Reviewer 2 Report

The authors present a descriptive analysis of cyclist crashes in Ecuador. The authors highlight the need for the study and the growing road safety issues associated with cycling. While the study provides a useful insight into crash statistics. The authors need to undertake further proof reading of their work, substantiate claims being made and review the methodology utilized in the study.

Some specific comments are provided below:

Introduction

You need to substantiate claims being made with citations to the academic literature, for example the first paragraph.

The final sentence states that the aim of the research is to inform public policy, however the discussion does not provide explicit policy recommendations based on the findings of the research. Either reconsider the aim of the study or strengthen the discussion section.

Methods

The information included in the first three paragraphs are repetitive and should be written as concisely as possible.

Line 93 the authors mention spatial analysis, however this is not included in the manuscript. Either revise the method or include the spatial analysis.

Results

The authors claim that injuries have significantly increased in the abstract, however you have not included a test of statistical significance in section 3.1. Please report this test statistic.

The authors need to review the information presented in Table 2 and line 160. You are reporting relative risk, not Pearson’s R². The discussion demonstrates a lack of understanding of relative risk as it is not a predictive measure, it is a measure of risk relative to each group. Furthermore, the authors should highlight why the 80+ age group was selected as the reference category in the analysis.

There is very limited discussion of the sociodemographic variables, it would be useful to further investigate these factors and their relationship to crashes. The author may wish to consider including cross tabulations to expand the analysis.

Table 5 does not display correctly as some information is outside the page margins. Furthermore, the reporting of CI is inconsistent with previous tables and the values seem unusual as they do not align with the death rate value in the center.

The discussion does not address the aim of the manuscript and does not consider some of the variables presented in the findings and should be expanded to present specific policy recommendations applicable to Ecuador.

Paragraph 4 of the discussion states that findings can be compared to work undertaken internationally. It would be much more useful to the reader if the authors to include some of this comparative analysis in their discussion, to highlights similarities and differences between Ecuador and other nations.

Author Response

Point by Point letter Sustainability

 

RE: Bicycling related mortality in Ecuador: A nationwide population-based analysis from 2004-2017

 

 

Thank you for your thoughtful and thorough review of our manuscript

Enclosed please find a revised manuscript, which is substantially improved as a result of the Reviewers’ suggestions. We have prepared a detailed outline of the changes that have been made in response to all comments.

The authors present a descriptive analysis of cyclist crashes in Ecuador. The authors highlight the need for the study and the growing road safety issues associated with cycling. While the study provides a useful insight into crash statistics. The authors need to undertake further proof reading of their work, substantiate claims being made and review the methodology utilized in the study.

Thanks for your comments

 

Some specific comments are provided below:

 

Introduction

 

You need to substantiate claims being made with citations to the academic literature, for example the first paragraph.

Yes, many thanks, we have amended this

 

 

The final sentence states that the aim of the research is to inform public policy, however the discussion does not provide explicit policy recommendations based on the findings of the research. Either reconsider the aim of the study or strengthen the discussion section.

Thanks for your comments, we have reviewed the entire document and have added an entire recommendation’s section

 

Methods

 

The information included in the first three paragraphs are repetitive and should be written as concisely as possible

We have amended this, many thanks.

 

Line 93 the authors mention spatial analysis, however this is not included in the manuscript. Either revise the method or include the spatial analysis.

We have deleted the world spatial.

 

Results

 

The authors claim that injuries have significantly increased in the abstract, however you have not included a test of statistical significance in section 3.1. Please report this test statistic.

We have corrected this according to the type of study. Being this an observational study, no before and after comparision were performed.

 

The authors need to review the information presented in Table 2 and line 160. You are reporting relative risk, not Pearson’s R2. The discussion demonstrates a lack of understanding of relative risk as it is not a predictive measure, it is a measure of risk relative to each group. Furthermore, the authors should highlight why the 80+ age group was selected as the reference category in the analysis.

 Thanks for your valuable comments, we have specified that the relative ratios analysis is based on the difference between groups in terms of probability of dying due to a bicycle related accident within groups and we have amended the comments in the discussion section.

 

There is very limited discussion of the sociodemographic variables, it would be useful to further investigate these factors and their relationship to crashes. The author may wish to consider including cross tabulations to expand the analysis.

Thanks for your comments, we have redone the discussion section including the analysis you suggested

 

Table 5 does not display correctly as some information is outside the page margins. Furthermore, the reporting of CI is inconsistent with previous tables and the values seem unusual as they do not align with the death rate value in the center.

We have organized  the table  better and made it consistent with the rest of the manuscript

 

The discussion does not address the aim of the manuscript and does not consider some of the variables presented in the findings and should be expanded to present specific policy recommendations applicable to Ecuador.

We have included an entire section of recommendations

 

Paragraph 4 of the discussion states that findings can be compared to work undertaken internationally. It would be much more useful to the reader if the authors to include some of this comparative analysis in their discussion, to highlights similarities and differences between Ecuador and other nations.

Thanks for your comments, we have redone the discussion section

 

Round 2

Reviewer 1 Report

I am witnessing mayor improvements of this manuscript and can confirm that quality and subject area is now very well formed and described.

 

 

Author Response

Point by Point letter Sustainability, Second Round of reviews

RE: Bicycling related mortality in Ecuador: A nationwide population-based analysis from 2004-2017

Dear Reviewers,

Many thanks for your comments in relationship to our latest version of the manuscript

I am witnessing mayor improvements of this manuscript and can confirm that quality and subject area is now very well formed and described.

Many thanks for your comments

Reviewer 2 Report

The authors have presented an updated and improved manuscript. However the manuscript still requires further proof reading to fix grammatical errors and there remain inconsistencies in the presented data.

 

Line 137: Use consistent age ranges with the data presented in Table 2

Line 147: Reporting of Relative Risk remains incorrect and should not say R2

Table 5: Heading for males is missing

 

 

Author Response

Point by Point letter Sustainability, Second Round of reviews

RE: Bicycling related mortality in Ecuador: A nationwide population-based analysis from 2004-2017

Dear Reviewers,

Many thanks for your comments in relationship to our latest version of the manuscript

The authors have presented an updated and improved manuscript. However the manuscript still requires further proof reading to fix grammatical errors and there remain inconsistencies in the presented data.

thanks for your comments, we have reviewed the entire document

 

Line 137: Use consistent age ranges with the data presented in Table 2

We have used the classification displayed on table 2

 

Line 147: Reporting of Relative Risk remains incorrect and should not say R2

Thanks for your comment, the entire table was redone, and we decide not to use RR

Table 5: Heading for males is missing

 

Thanks so much for pointing this out, we have corrected the table

 

 

 

 

 

Round 3

Reviewer 2 Report

The manuscript still has inconsistencies between the methodology and the reported information.

The authors have removed the calculation of relative risk, but it is still mentioned in the methodology.

Please include a correct citation for the population data given as a link in text

https://www.ecuadorencifras.gob.ec/bases-de-datos-poblacion-demografia/ .

 

Author Response

Point by Point letter Sustainability, third  Round of reviews

RE: Bicycling related mortality in Ecuador: A nationwide population-based analysis from 2004-2017

Dear Reviewer, Please find attached the latest version, were all your suggestions were accepted

The manuscript still has inconsistencies between the methodology and the reported information.

The authors have removed the calculation of relative risk, but it is still mentioned in the methodology.

We have amended this, we apologize for not having noticed the error earlier

Please include a correct citation for the population data given as a link in text

https://www.ecuadorencifras.gob.ec/bases-de-datos-poblacion-demografia/ .

 

The link was updated and reference 15 was added for readers to follow the link