Global, regional, and national burden and attributable risk factors of transport injuries: Global Burden of Disease Study 1990-2019.

Abstract

To the Editor: Injuries are an important yet neglected cause of health burden, and the millions of injury-related deaths that occur each year reflect large disparities in terms of gender, race, and socioeconomic status.[1] With the progress of urbanization and the number of motor vehicles increasing, pedestrians, cyclists, and drivers are brought into close contact, increasing the risk for all.[2] In 2019, one of the leading causes of injury-related disability-adjusted life-years (DALYs) for all ages was road injuries (ranked seventh).[1] Understanding the burden of transport injuries and how they are distributed among different regions and countries worldwide is essential for policy-making.[3] Data utilized in this study are publicly available from the GBD 2019 via the Global Health Data Exchange website (http://ghdx.healthdata.org). This study was performed in compliance with the Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER) recommendations. In GBD 2019, transport injuries are divided into two categories: road injuries (pedestrian road injuries, cyclist road injuries, motorcyclist road injuries, motor vehicle road injuries, and other road injuries) and other transport injuries. The International Classification of Diseases tenth revision (ICD-10) codes used in the analyses for transport injuries are V00–V86.99, V87.2–V87.3, V88.2–V88.3, and V90–V98.8. The burden data (incidence, mortality, and DALYs) of transport injuries were estimated using DisMod-MR 2.1 (IHME, Seattle, WA, USA), which are Bayesian statistical models developed over the past 12 years for GBD analyses, and presented in absolute numbers and as age-standardized rates (per 100,000). The burden of transport injuries according to different age, sex, socio-demographic index (SDI) regions, and geographical locations was further described. Individual SDI was then placed in different categories: low, low-middle, middle, high-middle, and high. These 204 countries and territories were grouped into 21 different regions according to geographic location. There were 87 risk factors or risk clusters in GBD 2019, which were categorized into four levels (See https://www.healthdata.org/gbd for details). In GBD 2019, every estimate was calculated 1000 times, and the final data are presented as the mean of these estimates. The 95% uncertainty interval (UI) was calculated for each quantity in the analysis, which was determined using the 25th and 97.5th values of the ordered 1000 draws. A two-sided P <0.05 was considered statistically significant. We downloaded the data from the GBD website and used EXCEL software (Microsoft, Washington, USA) for descriptive statistical analysis. Other statistical analyses were performed using R, version 4.1.0 (R version 4.0.5; The R Foundation for Statistical Computing, Vienna, Austria). Supplementary Table 1 [https://links.lww.com/CM9/B603] shows the incidence, death, prevalence, and DALYs of transport injuries and their subtypes, as well as percentage change in age-standardized rates between 1990 and 2019 globally. Among all types of transport injuries, cyclist road injury was responsible for the highest age-standardized incidence rates, while pedestrian road injury was responsible for the highest age-standardized mortality rates, and motor vehicle road injury led to the highest age-standardized DALYs rates. There were substantial regional and country variations in age-standardized incidence, mortality, and DALYs rates. Among specific transport injuries, the age-standardized DALYs rates of motor vehicle road injury ranked first globally and in 14 of 21 GBD regions. The age-standardized DALYs rates of transport injuries generally presented a downward trend with increasing SDI among the 21 GBD world regions [Figure 1A–C]. For temporal trends, low SDI regions were always at the highest level for rates of death and DALYs.Figure 1: Age-standardized incidence (A), death (B), DALY rates with socio-demographic index (C) during 1990 and 2019, and rank of age-standardized YLDs in 2019 (D) for transport injuries globally or by GBD regions. DALY: Disability adjusted life-years; TBI: Traumatic brain injury; YLDs: Years lived with disability.In 2019, rates of age-standardized incidence, mortality, and DALYs of men were much higher than those of women [Supplementary Figure 1D–F, https://links.lww.com/CM9/B603]. The age-standardized incidence rates of men had a peak at 20–24 years old group, while the change of this parameter over age for women was relatively gentle [Supplementary Figure 1D, https://links.lww.com/CM9/B603]. Regardless of the gender, in different age groups, incidence and death number of transport injuries was still the highest for 20–24 years old group [Supplementary Figure 2A-D, https://links.lww.com/CM9/B603] and the greatest contribution to incidence and death number was cyclist road injuries and motor vehicle road injuries respectively. Similar patterns were observed for the DALYs across different age groups [Supplementary Figure 2E, F, https://links.lww.com/CM9/B603]. Supplement Table 2 [https://links.lww.com/CM9/B603] reports the contribution of each risk factor to the transport injuries burden. Of these, occupational injuries accounted for the largest proportion. Low bone mineral density and alcohol use were the next important risk factors. Among 20–44 years old group, the DALYs rate of transport injuries was mostly attributable to occupational injuries and alcohol use, which reached its peak in the 25–29 years old group [Supplementary Figure 3, https://links.lww.com/CM9/B603]. Injuries caused by transport injuries mainly include fractures, head injuries (moderate/severe traumatic brain injury [TBI] and minor TBI), amputation, burns and other injuries. Figure 1D shows the ranking of the burden caused by transport injuries globally and in 21 GDB world regions. We found that the mortality and DALYs rates in Central Sub-Saharan Africa and Southern Sub-Saharan Africa were significantly higher than the rest of the world; this may be associated with wars and the condition of economy and medicine in these regions. Although many countries have made effective policies and legislations for the purpose of improving road safety,[5,6] low-SDI and middle-SDI countries continue to suffer from the greatest share of the global burden of transport injuries. This phenomenon might be related to poorer health care for transport injuries, poorer awareness of road safety, worse road conditions, and lower political input in low-SDI and low-middle-SDI countries.[7] In terms of gender and age, we found that men have a higher burden of transport injuries than women, and young people in 20–24 years old have the highest burden of transport injuries; this can be explained by alcohol intake. In general, men drink more alcohol than women, and young adults have the highest prevalence of hazardous alcohol consumption among all age groups.[8] In terms of risk factors, occupational injuries have the largest contribution, which may be because drivers or other road workers have a higher probability of contact with various vehicles and pedestrians and the probability of traffic injuries increases accordingly. It is extremely important to strengthen the safety education and safety protection measures of these road workers, such as regular training and wearing hard hats. In summary, from 1990 to 2019, the incidence of transport injuries increased year by year. Relatively, the mortality and DALYs rates decreased in these years. In all types of transport injuries, cyclist road injury was responsible for the highest age-standardized incidence rates, while pedestrian road injury was responsible for the highest age-standardized mortality rates, and motor vehicle road injury led to the highest age-standardized DALYs rates. Young people in 20–24 years old have the highest rates of transport injury and death. Among the risk factors for traffic injuries, occupational injuries account for the largest proportion, with low bone mineral density and alcohol consumption ranking second and third. Disease burden from transport injuries remains a major public health concern. Our research provides a better understanding of the age and gender distribution of the traffic injury burden and how they are distributed across world regions and countries, which is critical for policy-making. Funding This work was supported by grants from the Program for Excellent Talents in the First Affiliated Hospital of Fujian Medical University (Nos. YJCRC-B-KDZ2021 and YYXQN-DCY2021). Conflicts of interest None.