Traffic Mortality Research Articles

Determinants of the Underlying Causes of Mortality during the First Wave of COVID-19 Pandemic in Saudi Arabia: A Descriptive National Study.

Since the emergence of the COVID-19 pandemic, the mortality statistics are constantly changing globally. Mortality statistics analysis has vital implications to implement evidence-based policy recommendations. This study aims to study the demographic characteristics, patterns, determinants, and the main causes of death during the first half of 2020, in the Kingdom of Saudi Arabia (KSA). Methodology: A retrospective descriptive study targeted all death (29,291) registered in 286 private and governmental health settings, from all over KSA. The data was extracted from the ministry of health’s death records after the ethical approval. The International Classification of Diseases (ICD-10) and WHO grouping, were used to classify the underlying causes of deaths. The collected data were analyzed using the appropriate tables and graphs. Results: 7055 (24.9%) died at the middle age (40–59 year), and 19,212 (65.6%) were males, and 18,110 (61.8%) were Saudi. The leading causes of deaths were non-communicable diseases (NCDs) 15,340 (62.1%), mainly Cardiovascular diseases (CVDs) 10,103 (34.5%). There was a significant relationship between the main causes of deaths and sex (p < 0.05) and nationality (p = 0.01). Conclusion: NCDs mainly CVDs are the leading cause of death. The COVID-19 mortalities were mainly in males, and old age > 55 year. The lockdown was associated with a reduction in the NCDs and Road traffic accidents mortalities.

Transportation noise exposure and cardiovascular mortality: 15-years of follow-up in a nationwide prospective cohort in Switzerland

BackgroundDeath from cardiovascular diseases (CVD) has been associated with transportation noise. This nationwide cohort, with state-of-the-art exposure assessment, evaluates these associations by noise source. MethodsRoad traffic, railway and aircraft noise for 2001 and 2011 were linked to 4.1 million adults in the Swiss National Cohort, accounting for address history. Mean noise exposure in 5-year periods was calculated. Time-varying Cox regression models, with age as timescale, were applied to all and cause-specific cardiovascular causes of death. Models included all three noise sources plus PM2.5, adjusted for individual and spatial covariates. Nighttime noise events for all sources combined (expressed as intermittency ratio or number of events) were considered in sensitivity analyses. Absolute excess risk was calculated by multiplying deaths/100,000 person-years by the excess risk (hazard ratio-1) within each age/sex group. ResultsDuring a 15-year follow-up, there were 277,506 CVD and 34,200 myocardial infarction (MI) deaths. Associations (hazard ratio; 95%-CIs) for road traffic, railway and aircraft noise and CVD mortality were 1.029 (1.024–1.034), 1.013 (1.010–1.017), and 1.003 (0.996–1.010) per 10 dB Lden, respectively. Associations for MI mortality were a respective 1.043 (1.029–1.058), 1.020 (1.010–1.030) and 1.040 (1.020–1.060) per 10 dB Lden. Blood pressure-related, ischemic heart disease, and all stroke mortality were significantly associated with road traffic and railway noise, while ischemic stroke mortality was associated with aircraft noise. Associations were mostly linear, often starting below 40 dB Lden for road traffic and railway noise. Higher levels of noise intermittency were also independently associated with each outcome. While the absolute number of deaths attributed to noise increased with age, the hazard ratios declined with age. Relative and absolute risk was higher in males compared to females. ConclusionIndependent of air pollution, transportation noise exposure is associated with all and cause-specific CVD mortality, with effects starting below current guideline limits.

Identification of Factors Affecting Road Traffic Injuries Incidence and Severity in Southern Thailand Based on Accident Investigation Reports

Thailand has the second-highest rates of road traffic mortality globally. Detailed information on the combination of human, vehicle, and environmental risks giving rise to each incident is important for addressing risk factors holistically. This paper presents the result of forensic road traffic investigation reports in Thailand and determines risk factor patterns for road traffic injuries. Detailed forensic reports were extracted for 25 serious traffic accident events. The Haddon matrix was used to analyze risk factors in three phases stratified by four agents. The 25 events analyzed involved 407 victims and 47 vehicles. A total of 65.8% of victims were injured, including 14.5% who died. The majority (66.1%) of deaths occurred at the scene. Human-error-related factors included speeding and drowsiness. Passenger risks included not using the seat belt, sitting in the cargo area and the cab of pickups. Overloaded vehicles, unsafe car modifications, no occupant safety equipment and having unfixed seats were vehicular risks. Environmental risks included fixed objects on the roadside, no traffic lights, no guard rails, no traffic signs, and road accident black spots. At present, traffic accidents cause much avoidable severe injury and death. The outcome of this paper identifies a number of preventable risk factors for traffic injury, and importantly examines them in conjunction. Road traffic safety measures need to consider how human, vehicle, and environmental risks intersect to influence injury likelihood and severity. The Haddon matrix is useful in identifying these pre- and post-accident risk factors. Furthermore, the sustainable preventions of road traffic injury need to address these risks together with active law enforcement.

A comprehensive study of macro factors related to traffic fatality rates by XGBoost-based model and GIS techniques

With the fast development of economics, road safety is becoming a serious problem. Exploring macro factors is effective to improve road safety. However, the existing studies have some limitations: (1) The existing studies only considered one aspect of macro factors and constructed models based on a few data samples. (2) The methods commonly used cannot address the non-linear relationship or calculate the feature importance. The findings obtained from such models may be limited and biased. To address the limitations, this study proposes a BO-CV-XGBoost framework to explore the macro factors related to traffic fatality rate classes based on a high-dimensional dataset that fully considers the impact of multi-factor interaction with adequate data samples. The proposed framework is applied to a dataset in the US. 453 county-level macro factors are collected from various data sources, covering ten macro aspects, including topography, transportation, etc. The optimized BO-CV-XGBoost model obtains the best classification performance with an AUC of 0.8977 and an accuracy of 85.02%. Compared with other methods, the proposed model has superiority on fatality rate classification. Ten macro factors are identified, including ‘Current-dollar GDP’, ‘highway miles per person’, etc. The ten factors contain four aspects of information, including economics, transportation, education, and medical condition. Geographic information system (GIS) techniques are further used for spatial analysis of the identified macro factors. Therefore, targeted and effective measures are accordingly proposed to prevent traffic fatalities and improve road safety

Road Traffic Safety Before and During COVID-19: Have Restrictions Reduced Fatalities?

During COVID-19 pandemic, many restrictions have been applied to reduce social interaction, which might be related with road traffic density. The aim of the current study was to examine the relationship between COVID-19 related restrictions and road traffic accidents by comparing the monthly rates between 2019 and 2020 (traffic fatalities, traffic injuries, traffic accidents with injuries and fatalities, and traffic accidents with property damage only). For the analyses, the traffic accident data were computed per 1000 people in province for all 81 cities in Turkey to make more accurate comparisons. The traffic accident-related injury rates decreased in all months between March and December. Similarly rate of accidents with injuries and fatalities decreased in all months except for July. However, the road traffic fatality rates decreased only in May and October and, the rates of accidents with property damage only decreased in March, April, May, June, and December. According to results, although the rates of accidents declined in general, the fatality rates did not show a similar pattern. The low traffic density, which is due to the restrictions, might be related with higher speeds on the roads. The findings were discussed based on timeline of restrictions that have been applied by the government. It can be suggested that speed related enforcements might be applied even there is lockdown in a province not just to decrease number of accidents but also fatalities.

Analysis of the regional distribution of road traffic mortality and associated factors in Japan

BackgroundRegional differences in road traffic (RT) mortality among municipalities have not been revealed in Japan. Further, the association between RT mortality and regional socioeconomic characteristics has not been investigated. We analyzed geographic differences in RT mortality and its associated factors using the Vital Statistics in Japan.MethodsWe used data on RT mortality by sex and municipality in Japan from 2013 to 2017. We calculated the standardized mortality ratio (SMR) of RT for each municipality by sex using an Empirical Bayes method. The SMRs were mapped onto a map of Japan to show the geographic differences. In addition, an ecological study investigated the municipal characteristics associated with the SMR using demographic socioeconomic, medical, weather, and vehicular characteristics as explanatory variables. The ecological study used a spatial statistical model.ResultsThe mapping revealed that the number of municipalities with a high SMR of RT (SMR > 2) was larger in men than in women. In addition, SMRs of capital areas (Kanagawa and Tokyo prefectures) tended to be low in men and women. The regression analysis revealed that population density was negatively associated with the SMR in men and women, and the degree of the association was the largest among explanatory variables. In contrast, there was a positive association between the proportion of non-Japanese persons and SMR. The proportions of lower educational level (elementary school or junior high school graduates), agriculture, forestry, and fisheries workers, service workers, and blue-collar workers were positively associated with the SMR in men. The proportion of unemployed persons was negatively associated with the SMR in men.ConclusionsSocioeconomic characteristics are associated with geographic differences in RT mortality particularly in men. The results suggested preventive measures targeted at men of low socioeconomic status and non-Japanese persons are needed to decrease RT mortality further.

Applying count time series to assess 13-year pedestrian mortality trend caused by traffic accidents in East-Azerbaijan province, Iran

In populated cities, pedestrian mortality is higher compared to other traffic mortalities. The current study aimed to describe the trend of pedestrian mortality in the East-Azerbaijan (Northwest of Iran) province from 2006 to 2019 and find the factors that affect the mortality number. Pedestrian mortality data from March 2006 to March 2019 was obtained from the Legal Medicine Organization database of Iran. Generalized Linear Auto Regressive Moving Average (GLARMA) models were used to assess the trend, and affecting factors of pedestrian mortality. According to the traffic accident data from 21 March 2006 until 20 March 2019 in East-Azerbaijan 24.11% of mortalities are related to pedestrians. Pedestrian mortality had a decreasing seasonal trend during 2006–2019. The result of the GLARMA model showed that age >65, being non-educated, cases with head trauma death cause, pre-hospital death, accident inside the city, vehicle type and self-employed jobs had a direct relation to pedestrian’s mortality.

Effects of stricter drunk-driving laws on alcohol-related road traffic death, injury, and crash rates in South Korea: A synthetic counterfactual approach using Bayesian structural time-series models

In December 2018, new drunk-driving laws were enacted in Korea to impose stricter penalties and standards for driving under the influence of alcohol. This study aimed to estimate the effects of stricter drunk-driving laws on alcohol-related road traffic death, injury, and crash rates in Korea. Using police-reported traffic accident data and registered vehicle data from 2013 to 2020, monthly road traffic outcome rates were calculated: the response series involved alcohol-related rates and the non-equivalent control series involved total and non-alcohol-related rates. Based on a controlled interrupted time-series design using Bayesian structural time-series models, effects of the laws on alcohol-related road traffic outcome rates were evaluated. After implementation of these laws, the alcohol-related road traffic crash rate decreased by 14.3% (95% credible interval [CrI] −26.8% to −1.9%), alcohol-related road traffic injury rate by 17.6% (95% CrI −31.6% to −3.8%), and alcohol-related minor road traffic injury rate by 20.2% (95% CrI –32.4% to −7.7%). Alcohol-related road traffic death and severe injury rates also decreased more than the declining trends in the pre-period, but reduced non-significantly by 15.0% (95% CrI −47.2% to 17.3%) and 9.9% (95% CrI –33.9% to 14.5%), respectively. The mixed effectiveness of Korea’s new drunk-driving laws on alcohol-related road traffic outcomes suggests that additional strategies are necessary to consistently and effectively reduce alcohol-related road traffic outcomes. More research is needed on ways to enhance the effectiveness of drunk-driving laws.

Time-varying effect of drunk driving regulations on road traffic mortality in Guangzhou, China: an interrupted time-series analysis

BackgroundChina has introduced a series of stricter policies to criminalize drunk driving and increase penalties since May 2011. However, there is no previous study examining the time-varying impacts of drunk driving regulations on road traffic fatalities based on daily data.MethodsWe collected 6536 individual data of road traffic deaths (RTDs) in Guangzhou from 2008 to 2018. The quasi-Poisson regression models with an inclusion of the intervention variable and the interaction of intervention variable and a function of time were used to quantify the time-varying effects of these regulations.ResultsDuring the 11-year study period, the number of population and motor vehicles showed a steady upward trend. However, the population- and motor vehicles- standardized RTDs rose steadily before May 2011, the criminalizing drunk driving intervention was implemented and gradually declined after that. The new drunk driving intervention were associated with an average risk reduction of RTDs (ER = -9.01, 95% eCI: − 10.05% to − 7.62%) during the 7.7 years after May 2011. On average, 75.82 (95% eCI, 54.06 to 92.04) RTDs per 1 million population annually were prevented due to the drunk driving intervention.ConclusionThese findings would provide important implications for the development of integrated intervention measures in China and other countries attempting to reduce traffic fatalities by stricter regulations on drunk driving.

Pedestrian mortality in Russia: a continuous decline over the last 25 years?

Using different data sources (HCoD, IRTAD, UNECE statistical database, police data), our research shows that the significant excess of pedestrian mortality over motor vehicle occupant mortality in 1988-1999 in Russia, according to RusFMD, is an abnormal phenomenon that most likely never occurred. Police data is preferable for assessing mortality levels by road user types in Russia. According to Russian police data, pedestrian mortality never exceeded motor vehicle occupant mortality. The steady decline of pedestrian mortality began in 2003, not in 1993, as vital statistics show. In 2008, pedestrian mortality for the first time reached the minimum level of the Soviet period. After significant fluctuations, motor vehicle occupant mortality dropped to the level of the early 1970s only in 2015-2017. The use of vital statistics is possible if it is necessary to differentiate road traffic mortality by sex, age, and type of settlements. Categorisation by road user types should be done with caution, using the following data sources: HCoD data from 1988 and RusFMD data from 1970 to 1988 and after 1999. It is suggested that difficulties in analysing long-term mortality by road user types based on vital statistics may occur in post-Soviet countries, where the Soviet abridged classification of causes of death (SC) was used. The prevalence of deaths coded by unspecified V-codes (V89) should also be considered.

The relationship between geographical region and perceptions of radiation risk after the Fukushima accident: The mediational role of knowledge

Since the Fukushima accident, radiation risk perception has been of public concern. Factors related to regional differences in radiation risk perception and the role that knowledge of radiation effects plays are still not clearly understood. Here, we first assessed the validity of the Lindell radiation risk perception scale by comparing it with the mortality rate of traffic accidents. We then investigated the relationship between the perceptions and both the geographical regions and the knowledge of genetic effects and, further, verified the mediating role of knowledge in the perception. The sample comprised of 832 participants who responded to an online questionnaire in August 2018 from Tokyo and Fukushima. There was a significant association between the Lindell scale and the perceived magnitude of genetic risk relative to traffic accident mortality. Knowledge of genetic effects, after the atomic bombs, was associated with perceptions of lower genetic risks. The relationship between geographical region and risk perception was mediated by knowledge. However, approximately 40% of those who had knowledge still perceived a high risk, indicating that perception is not governed by knowledge alone. In addition to efforts to share knowledge, it is important to interactively communicate regarding risk to alleviate the anxiety felt by individuals.

Driver intoxication and risk for fatal crashes in South Africa: A 3-year review.

Globally, alcohol intoxication has been shown to be significantly associated with increased risk for road traffic crash morbidity and mortality for all road users (drivers, passengers and pedestrians). This association relates to the diminished capacity of drivers while intoxicated to operate motor vehicles and the increased propensity for risk-taking behaviours. The overall prevalence of alcohol-related fatal crashes contributes significantly to the burden of disease in many countries. In South Africa, research into the relationship between alcohol intoxication and other driver risk behaviours is limited and variable, constraining appropriate and effective policy and programmatic options and interventions. To examine the risk for fatal crashes attributed to driver alcohol intoxication relative to speeding and other driver risk behaviours across a range of key crash and vehicle characteristics and temporal variables. The study used a sample of fatal crashes drawn from the Road Traffic Management Corporation database for the period 2016- 2018, comprising 13074 fatal crashes. An overview of the sample data is provided using descriptive statistics. Following this, logistic regression modelling was undertaken to examine and clarify the risk for alcohol-attributed fatal crashes against that for speeding and a combined category of all other driver risks using variables relating to crash complexity, vehicle characteristics and regulation, and temporal variables for day/night, weekday/weekend and vacation/non-vacation periods. Compared with fatal crashes involving only the driver, the study revealed a significantly greater risk for alcohol-attributed fatal crashes in instances involving more complexity as measured by involvement of other road users (pedestrians and other drivers). Additionally, the risk for alcohol-attributed fatal crashes was significantly greater for light vehicles and buses/midibuses compared with trucks. Road users were also at greater risk for such crashes at night, over long and regular weekends, and during non-vacation periods of the year. Improved enforcement to prevent alcohol intoxication using roadblocks is required in a focused manner during specific temporal periods (at night, over weekends and during non-vacation periods), while enforcement to prevent speeding and other driver risks should be prioritised during other periods using speed monitoring and mobile visible policing, respectively. There is an urgent need to improve the current measurement of alcohol attribution in fatal crashes, to ensure more accurate estimation of prevalence, and to improve analysis and understanding of the compound impact of alcohol intoxication on all other driver risk behaviours and associated fatal crashes.

Decreasing Trends in Road Traffic Mortality in Poland: A Twenty-Year Analysis

The aim of the study was to assess mortality trends due to road traffic accidents in Poland between 1999 and 2018. The study material was a database including 7,582,319 death certificates of all inhabitants of Poland who died in the analyzed period (104,652 people died of transport accidents). Crude deaths rates (CDR), standardized death rates (SDR) and joinpoint models were used. Annual percentage change (APC) for each segment of broken lines and average annual percentage change (AAPC) for the whole study period were calculated. CDR decreased from 19.7 per 100,000 population in 1999 to 9.6 per 100,000 population in 2018; APC was −4.1% (p < 0.05) while SDR decreased from 20.9 to 10.9 per 100,000; APC was −4.1% (p < 0.05). Large differences in traffic accident-related mortality were observed between men and women. An analysis by gender and age shows that the decline in the number of deaths due to traffic accidents has been slowed down in the oldest age group, 65+, in both males and females. There is a need for in-depth analyses aimed at introducing effective preventive solutions in the field of road traffic safety in Poland. Legal regulations should particularly refer to the most endangered groups of road users.

Prevalence of Protective Measures and Accident Among Motorcycle Riders with Road Safety Compliance in a Nigerian Semi-Urban Community

Introduction: The operation of commercial motorcycles has eased transport difficulties, but an increased rate of road traffic collisions, injuries, and deaths deserve attention. This study aimed to evaluate compliance with road safety preventive measures and accident prevalence among motorcycle riders in Ado-Odo Ota, Ogun State, Nigeria.&#x0D; Methods: This study was a descriptive cross-sectional survey that employed a structured questionnaire for collecting information related to compliance to protective measures and accident prevalence. A stratified random sampling technique was used to identify respondents from 20 motorcycle parks. Also, a multistage probability sampling method was used to select 374 respondents from all motorcycle parks listed. Data analysis was done using IBM-SPSS version 25.0&#x0D; Results: Of the 374 respondents, 69.0% owned motorcycles and 31.0% hired/rented theirs. Less than half (45.7%) of all riders were aware of the implications (health, financial, and psychological) of a motorcycle accident (MCA). Only 39.5% of owners and 59.5% rented/hire knew the implications (p&lt;0.001). Helmet use was significantly higher among owners (76.4%) than hired/rented (55.2%), p&lt;0.001. More owners (70.9%) had protective jackets than rented/hired (57.8%) (p&lt;0.05). Availability of bright/reflective clothing was poor (45.7%) though significantly higher among owners (50.0%) than rented/hired (36.2%) (p&lt;0.05). Overall accident prevalence was 45.2%, significantly higher among rented/hired riders (56.0%) than owners (40.3%) (p&lt;0.005). Respondents aged 18-24 years were more involved in MCA (52.9%) than the other age groups (p&lt;0.05). Respondents with no formal education had more accidents (73.1%) than the educated (p&lt;0.001).&#x0D; Conclusion: The knowledge of the consequences of motorcycle accidents was limited among motorcycle riders in Ado-Odo, and the prevalence of accidents was significantly higher among riders who rented/hired motorcycles than owners. Therefore, there is a need for accident documentation and cost implication of motorcycle accidents in the local government areas; this will help policymakers design intervention programs. Also, there is a need for regular training of the riders on road safety measures and the associated benefits.

The level and trend of road traffic injuries attributable mortality rate in Iran, 1990\u20132015: a story of successful regulations and a roadmap to design future policies

BackgroundRoad-Traffic-Injuries (RTIs) are predicted to rise up to the fifth leading cause of worldwide death by 2030 and Iran has the third highest RTIs mortality among higher-middle income countries. Although the high mortality of RTI in Iran is a warning, it provides the opportunity to indirectly assess the implemented RTI-related regulations’ effectiveness via high-resolution relevant statistics and, hence, Iran could serve as a guide for countries with similar context. In order to do so, we utilized this study to report the time and spatial trends of RTIs-related mortality in different age and sex groups and road user classes in Iran.MethodsBased on the national death-registration-system (DRS), cemeteries data, and the demographic characteristics, and after addressing incompleteness, we estimated mortality rates using spatiotemporal and Gaussian process regression models. We assessed Pearson seatbelt and helmet use and RTIs-attributable Age-Standardized-Morality-Rate (ASMR) associations. We also predicted RTIs-death-numbers, 2012–2020, by fitting a Generalized Additive Model to assess the status of achieving relevant sustainable development goal (SDG), namely reducing the number of RTIs-related deaths by half.ResultsOverall RTIs-attributable death and ASMR at the national level increased from 12.64 [95% UI, 9.52–16.86] to 29.1 [22.76–37.14] per 100,000 people in the time period of 1990–2015. The trend consisted of an increasing segment in 1990–2003 followed by a decreasing part till 2015. The highest percentage of death belonged to the three-or-more-wheels motorized vehicles. Pedestrian injuries percentage increased significantly and the highest mortality rate occurred in 85 years and older individuals. Low prevalence of seatbelt and helmet use were observed in provinces with higher than the median ASMR due to the relevant cause of each. RTIs-attributable death number is expected to reduce by 15.99% till 2020 which is lower than the established SDG goal.ConclusionsDespite the observed substantial moderation in the RTI-ASMR, Iran is till among the leading countries in terms of the highest mortality rates in the world. The enforced regulations including speed limitations (particularly for elder pedestrians) and mandatory use of seatbelt and helmet (for young adult and male drivers) had a considerable effect on ASMR, nevertheless, the RTI burden reduction needs to be sustained and enhanced.

Long-term impact of the 2008 economic crisis in Spain on road traffic collisions mortality by socioeconomic position.

We aimed to assess the effect of the 2008 crisis on road traffic collision (RTC) mortality in Spain, by socioeconomic position (SEP) and type of road use. This prospective, country-wide study covered all adults living in Spain and aged ≥30 years in November 2001. The long-term effect of the crisis was assessed by measuring the monthly percentage change (MPC) in RTC mortality between the pre-crisis (2002-2007) and crisis period (2008-2011). During the recession, RTC mortality fell more in people with low compared to high SEP, so MPCs difference between periods were of a higher magnitude in the low compared to high SEP groups, especially among men motorcyclists. RTC mortality trends were favorable following the 2008 crisis, particularly among low-SEP groups. In men motorcyclists, the upward trend of the pre-crisis period reversed course.

1285Distinctive variations in accident and suicide mortality rates among Japanese elderly in 2020

BackgroundIn April 2020, the Japanese government requested that people stay home except when unavoidable for their livelihood, as a COVID-19 emergency measure. Especially, elderly people refrained from going out. We investigated mortality rates from external causes in 2020 among Japanese elderly people.MethodsThe monthly mortality rates from accidents (V01-X59), traffic accidents (V01-V99) and suicides (X60-X84) among elderly from 2015 to November 2020 were analyzed. Ordinary monthly expected values and reference ranges (RR: 95% range) were calculated by cause and sex and compared with the observed values.ResultsAll accidents: Abnormal increases (beyond the RR) occurred in August for both sexes.Traffic accidents: Extreme decreases (below the RR) occurred in at least 3 months from March to October for each sex.Suicides: Extreme decreases occurred in at least 2 months from February to May for each sex. Abnormal increases occurred in November for males, and in September to November for females.ConclusionsExtreme decreases in traffic accident mortalities can be explained by people staying home. Abnormal increases in accident mortalities in summer might be explained by the heat. The increases might also be related to wearing face masks. Suicide results suggest that females are especially vulnerable to the social environment created by the preventive measures against COVID-19.Key messagesCOVID-19 measures might have affected the physical, mental, and social well-being of elderly people.AcknowledgementsThis study was supported by Mitsui Sumitomo Insurance Welfare Foundation.

Impact of Public Health Policies on Alcohol-Associated Liver Disease in Latin America: An Ecological Multinational Study.

Alcohol-associated liver disease (ALD) is the leading cause of liver-related mortality in Latin America, yet the impact of public health policies (PHP) on liver disease is unknown. We aimed to assess the association between alcohol PHP and deaths due to ALD in Latin American countries. We performed an ecological multinational study including 20 countries in Latin America (628,466,088 inhabitants). We obtained country-level sociodemographic information from the World Bank Open Data source. Alcohol-related PHP data for countries were obtained from the World Health Organization Global Information System of Alcohol and Health. We constructed generalized linear models to assess the association between the number of PHP (in 2010) and health outcomes (in 2016). In Latin America, the prevalence of obesity was 27% and 26.1% among male and female populations, respectively. The estimated alcohol per capita consumption among the population at 15 years old or older was 6.8 L of pure alcohol (5.6 recorded and 1.2 unrecorded). The overall prevalence of alcohol use disorders (AUD) was 4.9%. ALD was the main cause of cirrhosis in 64.7% of male and 40.0% of female populations. A total of 19 (95%) countries have at least one alcohol-related PHP on alcohol. The most frequent PHP were limiting drinking age (95%), tax regulations (90%), drunk-driving policies and countermeasures (90%), and government monitoring systems and community support (90%). A higher number of PHP was associated with a lower ALD mortality (PR, 0.76; 95% CI, 0.61-0.93; P=0.009), lower AUD prevalence (PR, 0.80; 95% CI, 0.65-0.99; P=0.045), and lower alcohol-attributable road traffic deaths (PR, 0.81; 95% CI, 0.65-1.00; P=0.051). Our study indicates that in Latin America, countries with higher number of PHP have lower mortality due to ALD, lower prevalence of AUD, and lower alcohol-attributable road traffic mortality.

Revised road traffic safety law and years of life lost due to traffic deaths in China, 2002–2019

Legal intervention is a powerful tool to reduce road traffic injuries (RTIs). China amended the Road Traffic Safety Law in 2011, but the impact of amended law on traffic crash deaths is still unknown. In this study, we conducted an interrupted time series analysis and examined years of life lost (YLLs) per 100,000 population as the assessment indicator to evaluate the association of road traffic safety law and traffic crash mortality. Annual YLLs data due to traffic deaths from 2002 to 2019 in China were obtained from the Global Burden of Disease (GBD) 2019. After implementation of the revised law, the average level of total YLLs per 100,000 population due to traffic deaths decreased from 1133.14 to 848.87, and the slope of annual YLLs per 100,000 population decreased by 30.11 (95% CI: 22.46, 37.75), indicating a steeper downward trend. The revised traffic law was associated with YLLs reduction due to traffic deaths for males, females, all age groups, pedestrians, motor vehicle users, and other road users, as well as traffic deaths attributed to alcohol use and tobacco use. These findings suggested that the revised Road Traffic Safety Law improved road safety by decreasing YLLs due to traffic deaths in China. However, the burden of RTIs is still heavy and efforts to further improve traffic laws and the adoption of other interventions are urgently needed.

Exposure to Primary Air Pollutants Generated by Highway Traffic and Daily Mortality Risk in Near-Road Communities: A Case-Crossover Study.

Most epidemiologic studies fail to capture the impact of spatiotemporal fluctuations in traffic on exposure to traffic-related air pollutants in the near-road population. Using a case-crossover design and the Research LINE source (R-LINE) dispersion model with spatiotemporally resolved highway traffic data, we quantified associations between primary pollutants generated by highway traffic-particulate matter with an aerodynamic diameter less than or equal to 2.5 μm (PM2.5), oxides of nitrogen (NOx), and black carbon (BC)-and daily nonaccidental, respiratory, cardiovascular, and cerebrovascular mortality among persons who had resided within 1 km (0.6 mile) of major highways in the Puget Sound area of Washington State between 2009 and 2013. We estimated these associations using conditional logistic regression, adjusting for time-varying covariates. Although highly resolved modeled concentrations of PM2.5, NOx, and BC from highway traffic in the hours before death were used, we found no evidence of an association between mortality and the preceding 24-hour average PM2.5 exposure (odds ratio=0.99, 95% confidence interval: 0.96, 1.02) or exposure during shorter averaging periods. This work did not support the hypothesis that mortality risk was meaningfully higher with greater exposures to PM2.5, NOx, and BC from highways in near-road populations, though we did incorporate a novel approach to estimate exposure to traffic-generated air pollution based on detailed traffic congestion data.