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Abstract
Road traffic injury (RTI) is a leading cause of death in developing countries. This burden affects not only locals, but also international travelers. Data on international travelers with RTIs in Thailand, especially from a medical perspective, are limited. This study aimed to analyze the factors associated with severe health outcomes following RTIs among international travelers at a university hospital emergency center in Thailand from January 2015 to December 2019. The retrieved data consisted of demographics, risks, preventive factors, and health outcomes. The severity of outcome was classified as fatality, hospitalization, or non-severe. A multinomial logistic regression model was used to identify the possible determinants of severity of health outcome among international travelers with RTI. A total of 720 travelers with RTIs (69% males; 82.5% were Southeast Asian) were included, with a mean age of 28.5 years. Of these, 144 (20%) had severe health outcomes: 64 (9%) fatalities and 80 (11%) hospitalizations. The level of severity of outcome was not associated with travelers’ demographics, but was associated with conventional risk factors, i.e., motorcycle use, alcohol/drug use, night-time driving, and less use of seatbelt/helmet. In a multinomial logistic regression analysis, alcohol drinking (adjusted odds ratio (AOR) 2.53, 95% confidence interval (CI) 1.41–4.55) and night-time driving (AOR 2.54, 95% CI 1.36–4.75) were associated with hospitalization. Patients who had a history of tetanus vaccination were less likely to die (AOR 0.37, 95% CI 0.17–0.81). In conclusion, one-fifth of RTIs resulted in severe health outcomes, and 9% were fatal. Road safety campaigns in Thailand should target travelers of all nationalities. Interventions that enhance travelers’ safety practices and proper preparation for road accidents should be explored further.
Highlights
Road traffic injury (RTI) is estimated by the World Health Organization (WHO) to be the leading cause of death for people aged less than 30 years and the eighth-leading cause of death for people of all ages [1]
Demographics of injured travelers were identical to those collected in the national database; travelers from Southeast Asia and Europe were the groups who had the highest number of RTI incidents in Thailand [8]
The WHO reported that Thailand had underperformed on 4 of 12 global road safety performance targets; most of these were related to insufficient law enforcement [38]
Summary
Road traffic injury (RTI) is estimated by the World Health Organization (WHO) to be the leading cause of death for people aged less than 30 years and the eighth-leading cause of death for people of all ages [1]. Ninety percent of road traffic deaths occur in developing countries, they hold only 54% of the world’s registered vehicles [2,3]. During 2013–2016, the rates of road traffic death were highest in Africa (26.6/100,000 population) and Southeast Asia (20.7/100,000). Thailand ranks among the countries with the highest rate of traffic deaths in the region and globally: 32.7/100,000 population [1]. RTIs are problematic for local populations; this was the leading cause of death among international travelers in developing countries [4,5]
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