Traffic Injury Mortality Research Articles

Assessment of the impact of Uber system implementation on mortality from traffic injuries in Brazilian capital cities.

The rapid expansion of Uber Technologies, Inc.'s ride-sharing, courier service, and food delivery system and e-hailing applications has been transforming the logistics network and urban mobility around the world. We aimed to evaluate the impact of the Uber system on traffic injury (TI) mortality during its implementation in Brazilian capital cities. A quasiexperimental design of interrupted time series was used. The monthly mortality rates for TI standardized by age were analyzed. The date of availability of the Uber app, specific to each capital, was considered the start date. Data from the Brazilian Mortality Information System and the Brazilian Institute of Geography and Statistics were used. For the data analysis, from an interrupted time-series design, autoregressive integrated moving average (ARIMA) models with a transfer function were fitted. In 92.6% (n=25) of Brazilian capitals, there was no impact of Uber system implementation, 12 months after the start of its activities, on TI mortality. A reduction in mortality from this cause was observed after the system was implemented in Belo Horizonte and Rio de Janeiro. The impact on TI mortality was progressive and continuous in both. More studies are needed to establish the factors associated with the inequalities observed in the impact of Uber system implementation between different locations and the heterogeneity of effects.

Evaluating the effectiveness of implementing a more severe law on prevention of road traffic injury mortality in mainland China: an interrupted time series study based on national mortality surveillance

BackgroundIn China, road traffic injury (RTI) is the seventh-leading cause of death More than 1.5 million adults in China live with permanent disabilities due to road traffic accidents. In 2011,...

Attributable road traffic injury mortality: differences in statistical systems in Ecuador

This paper aims to estimate the differences in mortality from road traffic injuries according to the records present in the information sources in the Republic of Ecuador, 2017 - 2019. Methodologically, the cases of deaths and mortality rates are compared between police records and death certificates by age group and sex. During the study period, 7291 traffic fatalities were recorded in police records, compared to 9509 in medical certificates. Mortality rates vary significantly by age and sex between data sources, with police records showing a decreasing trend, but no significant change according to medical death certificates. The study reveals that there is no consistency between data sources, possibly to mask weaknesses in police actions inroad traffic policing.

Mortality of drowning and road traffic injury among children aged 5-14 in China from 2008 to 2019

Objective: To analyze the trajectory of drowning and road traffic injury mortality among children aged 5-14 years in China from 2008 to 2019. Methods: Mortality data of unintentional injuries were from the Mortality Surveillance Data Set of National Disease Surveillance System from 2009 to 2018 and grouped by regions, urban and rural areas, genders, and age groups. The trajectory model was used to analyze the trend of drowning and road traffic injury mortality with years. Results: The mortality of drowning and road traffic injury showed a similar trend. In the trajectory model of drowning mortality, east, middle and west rural boys and western urban boys of all ages belonged to the high mortality group. The moderate mortality group included eastern urban boys and western girls aged 5-9 years and also contained eastern and middle urban boys and western urban girls aged 10-14 years. The other combinations belonged to the low mortality group. In the trajectory model of road traffic injury mortality, western urban boys, all rural boys and western rural girls aged 5-9 years, middle and western rural boys and western urban boys aged 10-14 years belonged to the high mortality group. Eastern urban girls aged 5-9 years and 10-14 years belonged to the low mortality group. The other combinations belonged to the moderate mortality group. Conclusion: There are different groups in the trajectory model of drowning and road traffic injury mortality among children in China. Identifying the trajectory of injury mortality is helpful to carry out more targeted prevention in China.

Mortality due to road traffic injuries in older adults in the Republic of Ecuador between 1990 and 2018: a descriptive study

Mortality due to road traffic injuries in older adults in the Republic of Ecuador between 1990 and 2018: a descriptive study

Assessing the impact of the national traffic safety campaign: a nationwide cohort study in Japan

ObjectivesThis study aimed to examine the difference in mortality from serious road traffic injuries during the National Traffic Safety Campaign compared with other periods and identify the common mechanisms of...

Global trends in adolescents’ road traffic injury mortality, 1990–2019

ObjectiveThe aim of this study was to determine the trends of road traffic injury (RTI) mortality among adolescents aged 10–14 years and 15–19 years across different country income levels with...

Road traffic injury mortality and morbidity by country development status, 2011-2017

PurposeThis research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 – to halve the number of global deaths and injuries from road traffic accidents by 2020. MethodsData for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017. ResultsAge-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%–16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68–1.90 per 100,000 population) and morbidity (110.45–112.72 per 100,000 population for incidence and 487.48–491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07–4.50 per 100,000 population) but the highest morbidity (428.74–467.78 per 100,000 population for incidence and 1025.70–1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths. ConclusionGlobal road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

Impact of hospital type on risk-adjusted, traffic-related 30-day mortality: a population-based registry study.

BackgroundTraffic incidents are still a major contributor to hospital admissions and trauma-related mortality. The aim of this nationwide study was to examine risk-adjusted traffic injury mortality to determine whether hospital type was an independent survival factor.MethodsData on all patients admitted to Swedish hospitals with traffic-related injuries, based on International Classification of Diseases codes, between 2001 and 2011 were extracted from the Swedish inpatient and cause of death registries. Using the binary outcome measure of death or survival, data were analysed using logistic regression, adjusting for age, sex, comorbidity, severity of injury and hospital type. The severity of injury was established using the International Classification of Diseases Injury Severity Score (ICISS).ResultsThe final study population consisted of 152,693 hospital admissions. Young individuals (0–25 years of age) were overrepresented, accounting for 41% of traffic-related injuries. Men were overrepresented in all age categories. Fatalities at university hospitals had the lowest mean (SD) ICISS 0.68 (0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15), respectively, for fatal traffic incidents. The crude overall mortality in the study population was 1193, with a mean ICISS 0.72 (0.17). Fatalities at university hospitals had the lowest mean ICISS 0.68 (0.19). Regional and county hospitals had mean ICISS 0.75 (0.15) and 0.77 (0.15), respectively, for fatal traffic incidents.When regional and county hospitals were merged into one group and its risk-adjusted mortality compared with university hospitals, no significant difference was found. A comparison between hospital groups with the most severely injured patients (ICISS ≤0.85) also did not show a significant difference (odds ratio, 1.13; 95% confidence interval, 0.97–1.32).ConclusionsThis study shows that, in Sweden, the type of hospital does not influence risk adjusted traffic related mortality, where the most severely injured patients are transported to the university hospitals and centralization of treatment is common.

Decreasing Trends in Road Traffic Injury Incidence and Mortality in Nigeria: A Ten-Year Analysis

BackgroundRoad traffic accidents constitute a significant public health burden in Nigeria. In this study, we aim to (1) characterize the temporal burden of road traffic injury (RTI) and mortality rates in Nigeria over a decade, (2) identify regional RTI incidence, mortality trends, and high-risk regions, and (3) assess the impact of state population on injury and mortality. Materials and methodsWe retrospectively reviewed aggregate state-level RTI incidence and mortality counts reported by the Federal Road Safety Corps from January 2001 through December 2010. We also reviewed population data from the National Population Commission. In addition to national analyses, regional analyses were performed in Nigeria's six geopolitical zones and one Federal Capital Territory (FCT). Regression analysis was also performed to determine the relationship between population and RTI incidence and mortality. ResultsThe national median RTI incidence and mortality rates declined by 53% and 75%, respectively, between 2001 and 2010. Analysis by geopolitical zone yielded the greatest increases for both injury and mortality in the FCT and the greatest decreases for both in the South-South region. The average geopolitical zone, apart from the FCT, experienced a 24% decrease in the incidence rate and a 69% decrease in the mortality rate. An analysis of variance, run to assess potential differences in RTI incidence and mortality rates by state population, yielded significant values of P = 0.0023 for injury and P = 0.0002 for mortality. ConclusionsAcknowledging the potential for underreporting, a more holistic surveillance approach would generate more accurate data for future policy creation to improve clinical outcomes.

Trends in mortality from road traffic injuries in South Korea, 1983–2017: Joinpoint regression and age-period-cohort analyses

Although mortality trends can be influenced by different ages, periods, and cohorts, few studies have demonstrated the age-period-cohort (APC) effect on road traffic injury (RTI) mortality. Moreover, APC effects in Korea have never been documented despite the high mortality rates from RTIs. This study aimed to describe the trends in mortality from RTIs and examine APC effects on RTI mortality in Korea. Using the national death certificate and census mid-year population estimates data during 1983–2017, trends in age-standardized mortality rates from RTIs were analyzed using Joinpoint regression. Intrinsic estimator regression models were used to estimate APC effects on RTI mortality. Consistent with the trend in period effects, RTI mortality increased sharply with the economic growth in the 1980s, decelerated after the implementation of road safety policies in the early 1990s, plummeted owing to the 1997–1998 financial crisis, and gradually decreased from the early 2000s. A J-shaped age effect indicated that the relative risk of road traffic death surged in people aged ≥65 years. Educational expansion from the mid-1950s turned an increasing birth cohort effect into a continuously decreasing trend after peaking around the 1938–1943 birth cohorts. The risk of road traffic death was relatively high among the Korean Generation Y, i.e., those born in 1978–1983. RTI mortality trends in Korea have been affected by diverse socioeconomic changes through cohort and period effects. Despite the recent favorable trend, RTI mortality remains high, especially among older people. Road safety policies to address the burden of RTIs require further improvement.

Forecasting global road traffic injury mortality for 2030

ObjectiveTo forecast the number and rate of deaths from road traffic injuries (RTI) in the world in 2030.MethodsThis study was a secondary analysis of annual country-level data of RTI mortality...

Prediction of mortality risk in patients with traffic injury: A case study in tabriz hospitals, Iran

Background: Trauma caused by traffic accidents is one of the main causes of mortality in the world. The trauma is a time-dependent condition. Trauma scoring systems help service providers to determine the severity of the injury and mortality risk and provide appropriate and timely services. This study aimed to predict mortality risk in patients with traffic injuries in Tabriz hospitals. Materials and Methods: This descriptive cross-sectional study included 11,238 traffic-injured patients. Databases of the emergency medicine service and forensic medicine were used to collect information. Glasgow Coma Scale, Age, and Systolic Blood Pressure (GAP) scoring system, binary logistic regression model, odds ratio with 95% confidence interval, and sensitivity and specificity were used to predict mortality. Results: Overall, 71 cases of death were identified. Pedestrians had the most rates of deaths with 31 cases (43.66%). Head trauma with 31 cases (43.66%) was the main cause of death. Mean (standard deviation) of the GAP score was 21.8 (1.8). The death rates in high-, moderate-, and low-risk groups were 22.4%, 3.18%, and 0.42%, respectively. The likelihood of death in people with saturation of oxygen (SO2) ≤95 was 1.96 times higher than those with SO2>95. The likelihood of death increased by 0.001 times each year. Furthermore, when the GAP score was ≤18, sensitivity was 64%, and for the GAP score of ≤10, sensitivity was 15.5%. Conclusion: GAP score seems to be a reliable and easy-to-use scoring method for predicting traffic injury mortality in an Iranian setting and yields reasonable results concerning international standards.

China's Progress in Reducing Road Traffic Mortality: An Analysis of National Surveillance Data from 2006 to 2016

Background: The United Nations (UN) proclaimed the number of global deaths and injuries from road traffic accidents by as a target of the Sustainable Development Goals (SDGs). Using national Diseases Surveillance Points (DSPs) data, we examined progress in reducing road traffic injury mortality rates from 2006 to 2016 in China. Methods: Crude and age-standardized mortality with standard errors were calculated. Joinpoint regression analysis was used to examine and quantify trends in overall and subgroup road traffic mortality from 2006 to 2016. Subgroup analyses were performed by place (urban/rural), sex, age group, geographic location (province) and road user. Findings: In 2016, the crude road traffic mortality was 9·6 per 100,000 population in China. Overall age-adjusted road traffic mortality increased from 9·8 to 15·7 per 100,000 population from 2006 to 2011, and then gradually decreased to 9·1 per 100,000 population by 2016. Subgroup mortality rates generally followed similar trends. Males, older adults, rural residents, and a few provinces (e.g. Ningxia, Guangxi, Hubei) consistently had higher road traffic mortality rates than females, younger persons, urban residents, and most provinces. Mortality changes varied across place (urban/rural), sex, age group, and geographic location (province) between 2006 and 2016, revealing large urban-rural and provincial disparities, and illuminating pedestrians as the most vulnerable road users. Deaths among occupants of cars and three-wheeled motor vehicles respectively constituted 53% and 20% of total occupant mortality from road traffic crashes between 2006 and 2016. Interpretation: Despite the continuous and substantial decrease since 2011, road traffic mortality is unlikely to reach the SDGs target of halving by 2020 in China. Systematic and sustainable efforts are needed to accelerate progress in road traffic safety in China. Funding Statement: The authors state: None declared. Declaration of Interests: The authors have no conflicts of interest to declare. Ethics Approval Satement: This analysis was approved by the ethics committee of Xiangya School of Public Health, Central South University (NO.XYGW-2017-01). Data analyses were de-identified.

Ecological study of road traffic injuries in the eastern Mediterranean region: country economic level, road user category and gender perspectives

BackgroundThe Eastern Mediterranean region has the second highest number of road traffic injury mortality rates after the African region based on 2013 data, with road traffic injuries accounting for 27% of the total injury mortality in the region. Globally the number of road traffic deaths has plateaued despite an increase in motorization, but it is uncertain whether this applies to the Region. This study investigated the regional trends in both road traffic injury mortality and morbidity and examined country-based differences considering on income level, categories of road users, and gender distribution.MethodsRegister-based ecological study linking data from Global Burden of Disease Study with the United Nations Statistics Division for population and World Bank definition for country income level. Road traffic injury mortality rates and disability-adjusted life years were compiled for all ages at country level in 1995, 2005, 2015 and combined for a regional average (n = 22) and a global average (n = 122). The data were stratified by country economic level, road user category and gender.ResultsRoad traffic injury mortality rates in the Region were higher than the global average for all three reference years but suggest a downward trend. In 2015 mortality rates were more than twice as high in low and high income countries compared to global income averages and motor vehicle occupants had a 3-fold greater mortality than the global average. Severe injuries decreased by more than half for high/middle income countries but remained high for low income countries; three times higher for males than females.ConclusionDespite a potential downward trend, inequalities in road traffic injury mortality and morbidity burden remain high in the Eastern Mediterranean region. Action needs to be intensified and targeted to implement and enforce safety measures that prevent and mitigate severe motor vehicle crashes in high income countries especially and invest in efforts to promote public, active transport for vulnerable road users in the resource poor countries of the Region.

Estimating the drink driving attributable fraction of road traffic deaths in Mexico.

To estimate the Drink Driving Attributable Fraction (DDAF) of road traffic injury mortality in car occupants in Mexico during 2010-13. A case-control study was conducted to examine the presence of alcohol in analysed body fluids of car occupants killed in fatal crashes (cases) compared with car drivers tested in alcohol-testing checkpoints who were not involved in a fatal collision (controls). Two data sets were used for the period 2010-13: the forensic module of the Epidemiological Surveillance System on Addictions that included car occupants killed in a collision (cases) and a data set from alcohol-testing at police checkpoints available for matching municipalities (controls). Mexico. The analysed study sample included 1718 car occupants killed in a traffic collision and 80 656 drivers tested at alcohol police checkpoints, all from 10 municipalities. Unadjusted and adjusted odds ratios (OR) of presence of alcohol in body fluids were obtained stratified by sex and age groups and the interaction with these two variables were assessed. The ORs were used to calculate the DDAF. It was estimated that 19.5% of car occupants' deaths due to road traffic injuries were attributable to alcohol consumption [95% confidence interval (CI)=19.1-19.9]. The adjusted OR of presence of alcohol was 6.84 (95% CI=6.06-7.71) overall. For males it was 7.21 (95% CI=6.35-8.18) and for females it was 4.45 (95% CI=3.01-6.60). The ORs were similar across younger age bands (10-19years: 9.61, 95% CI=6.72-13.73; 20-29years: 7.70, 95% CI=6.28-9.4; and 30-49years: 7.21, 95% CI=5.98-8.70); and lower but still elevated among older people (50+ years: 3.19, 95% CI=2.19-4.65). An estimated 19.5% of car occupant deaths in Mexico may have been caused by alcohol in 2010-13.

Child injury deaths linked with adult alcohol consumption: A time series analysis

ObjectiveThis paper aims to quantify the population-level associations between child injury deaths and adult (aged 15+ years) per capita alcohol consumption (PCC) and between child injury deaths and the impact of major alcohol and safety policy changes in Australia. MethodsAll child deaths due to external causes during 1910–2013, and child deaths due specifically to road crashes, assaults, suicide and other external causes, were obtained from the Australian Institute of Health and Welfare. Child (0–14 year) mortality rates were analysed in relation to PCC using an Autoregressive Integrated Moving Average model. ResultsA positive association between PCC and overall child external mortality was identified. The estimated coefficient was 0.326 (p = .002), indicating that a 10% decrease in PCC was associated with a 3.3% reduction in child injury mortality. A positive association was identified for road traffic and other child injury mortality, but not assault injuries. The introduction of compulsory seatbelt legislation in combination with random breath testing was associated with a reduction in overall injury and road traffic child mortality. Decreasing the legal drinking age was associated with an increase in the rate of other external-cause child mortality. ConclusionReducing PCC in Australia is likely to result in a small but significant reduction in the injury mortality rate of children aged 0–14 years.

Child road traffic injury mortality in Victoria, Australia (0–14 years), the need for targeted action

IntroductionExtensive efforts to reduce unintentional injury were enacted in the last three decades of the 20th century. Examination of road traffic injury mortality indicates the extent of fatal, unintentional child injuries (0–14 years) future interventions must address. Aims(1) describe in-depth child road traffic injury (RTI) deaths 2001–2012 in Victoria, Australia (2) identify the potential preventability of the RTI causes by currently available countermeasures and scope for enhanced implementation and novel solutions. MethodFatal Victorian child injury data were extracted from the National Coronial Information System (NCIS) for the 12 year period January 2001–December 2012. All on-road data was analysed. Data for passenger and pedestrian deaths was examined in depth. Associated factors were determined using univariate and pairwise analysis of factors. Published WHO key prevention strategies, and the recent literature were reviewed, focusing on the identified fatalities among children 0–14 years. ResultsFor 172 RTI deaths, head injury was the leading medical cause of death (68%). Significantly, the most vulnerable age group for both passengers and pedestrians was 0–4 years. Rural children were over-represented with children aged 0–4 years at greatest risk. Common factors for occupants were loss of control and veering to the incorrect side. For pedestrians the major factors related to rural residence and supervision. Discussion and ConclusionsThis study confirms that RTIs are complex and follow chains of events. Numerous promising interventions were identified. Wider implementation of these advanced engineering, education and enforcement strategies may further improve mortality rates in Victoria. Feasible solutions for aspects of the child pedestrian problem remain elusive. This study describes the RTI problem in greater depth than previous studies and reveals that some existing measures are not fully implemented. The need for targeted action in: 0–4 year olds; head injury; and rural regions of Victoria is highlighted. The need for a safe systems approach is paramount.

Exploring data sources for road traffic injury in Cameroon: Collection and completeness of police records, newspaper reports, and a hospital trauma registry

Road traffic injury surveillance systems are a cornerstone of organized efforts at injury control. Although high-income countries rely on established trauma registries and police databases, in low- and middle-income countries, the data source that provides the best collection of road traffic injury events in specific low- and middle-income country contexts without mature surveillance systems is unclear. The objective of this study was to compare the information available on road traffic injuries in 3 data sources used for surveillance in the sub-Saharan African country of Cameroon, providing potential insight on data sources for road traffic injury surveillance in low- and middle-income countries. We assessed the number of events captured and the information available in Yaoundé, Cameroon, from 3 separate sources of data on road traffic injuries: trauma registry, police records, and newspapers. Data were collected from a single-hospital trauma registry, police records, and the 6 most widely circulated newspapers in Yaoundé during a 6-month period in 2009. The number of road traffic injury events, mortality, and other variables included commonly in injury surveillance systems were recorded. We compared these sources using descriptive analysis. Hospital, police, and newspaper sources recorded 1,686, 273, and 480 road traffic injuries, respectively. The trauma registry provided the most complete data for the majority of variables explored; however, the newspaper data source captured 2, mass casualty, train crash events unrecorded in the other sources. Police data provided the most complete information on first responders to the scene, missing in only 7%. Investing in the hospital-based trauma registry may yield the best surveillance for road traffic injuries in some low- and middle-income countries, such as Yaoundé, Cameroon; however, police and newspaper reports may serve as alternative data sources when specific information is needed.

An exploratory investigation of child safety seat use among citizens of the United Arab Emirates

ABSTRACTChild car safety has significantly improved in Western nations with the use of proper child restraints over the last 40 years, but progress lags in other nations. High-income but developing Eastern Mediterranean countries experience one of the world's highest road traffic-injury mortality rates for children. This study provides a preliminary investigation of child safety seat utilization among United Arab Emirates (UAE) citizen parents. Cross-sectional survey research was used to determine child safety seat utilization proportions. Data were collected from a convenience sample composed of target citizens, which make up approximately 15% of the total population of the country. A total of 366 parents with at least one child younger than age 13 years participated. Despite prevalent car-seat giveaway campaigns and regardless of car-seat ownership, the overall percentage of car seat use among Emirati parents was low: less than 20% for their children younger than age 24 months. Additionally, of those who use a car seat, parents reported improper use. The UAE currently has no compulsory child safety seat legislation. The findings suggest the need for further studies on car-seat usage in the UAE, as well as intervention research to inform locally relevant and culturally appropriate public information campaigns.