Road traffic crashes,injury and fatality trends in Sri Lanka: 1938–2013

Objective

To analyse trends in road traffic crashes, injuries and fatalities over 75 years in Sri Lanka.

Methods

Data on road traffic crashes, injuries and fatalities between 1938 and 2013 were obtained from the Police Statistics Unit. Rates per 100 000 population were calculated and trends were analysed using joinpoint regression analysis.

Findings

Road traffic crashes and injuries rose substantially between 1938 and 2013: annual crashes increased from 61.2 to 183.6 per 100 000 people; injuries, from 35.1 to 98.6 per 100 000; and fatalities, from 3.0 to 10.8 per 100 000 people per year. Joinpoint analysis showed large fluctuations in crashes and injuries over time but the fatalities rose almost continuously. These fluctuations paralleled the country’s political and economic development. In some years, better traffic law enforcement and improved public transportation may have been associated with reduced crashes and injuries, whereas rapid growth in vehicle numbers, especially two- and three-wheeled vehicles, may have contributed to increased crashes and injuries. In addition, insurance policies that did not require a police report to claim may have led to underreporting of crashes and allowed drivers to avoid prosecution.

Conclusion

Fluctuations over time in road traffic crashes and injuries in Sri Lanka are associated with changes in political, economic and traffic policy. There is potential for reducing road traffic crashes and injuries through better traffic law enforcement, restrictions on the importation of two- and three-wheeled vehicles and policies to improve road safety and prevent underreporting of crashes.     

Impact of the 1994 alcohol production and sales deregulation policy on traffic crashes and fatalities in Japan

INTRODUCTION: . Many studies have demonstrated a strong relationship between alcohol availability and traffic crashes involving alcohol-impaired drivers. The present analysis focuses on the evaluation of the impact of alcohol availability on the Japanese population by comparing fatal and nonfatal motor vehicle crash rates before and after implementation of the alcohol deregulation policy in 1994. Participants and method. Poisson regression with robust standard error was used to model the before-to-after change in incidence rate ratios (IRRs) in the population. To control for potential confounders, per capita alcohol consumption, unemployment rate, and vehicle miles travelled (VMT) were also added to the model. The exponents of the fitted coefficients are equivalent to the IRRs. RESULTS: . Implementation of the policy deregulating alcohol sales and production did not appear to increase traffic fatalities and other traffic crashes in Japan. In the overall study results, nighttime fatalities were reduced statistically significantly by 6% since the implementation of the alcohol deregulation policy in 1994. Discussion. Contrary to previous research, the findings of this study demonstrated lower rates of fatalities and higher compliance with alcohol-related driving legislation. Further well-designed, nonaligned studies on alcohol availability and traffic fatalities in other countries are urgently needed.     

Business recession, alcohol consumption, drinking and driving laws: impact on Oklahoma motor vehicle fatalities and fatal crashes.

In 1982, Oklahoma enacted a series of drinking and driving laws. In the ensuing years, motor vehicle fatalities and fatal crashes were reduced by one-third. Factors contributing to this reduction were examined using interrupted time series analysis of monthly rates of motor vehicle deaths and fatal crashes for the period January 1980 to December 1986. Decreasing per capita alcohol consumption and increased unemployment apparently account for most of the fatality and fatal crash reduction in Oklahoma. The enactment of two traffic safety laws--one specifying the illegal blood alcohol concentration level (BAC law) and the other facilitating license withdrawal from suspected drunk drivers (administrative per se law)--together reduced Oklahoma traffic deaths and fatal crashes by about 9 percent. The effectiveness of the laws appeared to be greatest in the first two years following their enactment.     

Trends in injury mortality among young people in the European Union: a report from the EURORISC working group.

PURPOSE: To examine the trends in injury mortality among young people aged 15-24 years residing in the 15 current member states of the European Union between 1984 and 1993. METHODS: As part of a European Commission-funded project entitled European Review of Injury Surveillance and Control (EURORISC), mortality data for all externally caused physical injuries (International Classification of Disease Codes E800-999) were obtained from the World Health Organization. Data were analyzed to generate age-specific injury mortality rates and proportional differences in rates over the study period. Linear regression was used to represent the linear component of the mortality profile. RESULTS: Almost a quarter of a million young people died as a result of sustaining an externally caused physical injury (either unintentional or intentional) in the study countries between 1984 and 1993. Injury accounted for two-thirds of all deaths in this age group. Over three-quarters (76%) of deaths were due to unintentional injury, a further 17% to self-inflicted injuries, and the remaining 7% to homicide and other violent causes. Motor vehicle traffic fatalities accounted for 84% of unintentional injury deaths. Although a decline in injury mortality was observed throughout Europe, rates of mortality owing to both unintentional injuries and suicide varied widely among study countries at both the beginning and end of the study period. CONCLUSIONS: Whereas injury mortality rates in young people in most European countries are lower than in other parts of the world (including the United States), injuries represent a major public health problem in the European Union. The death toll from motor vehicle traffic crashes is a particular cause for concern.     

Macro Determinants of Cause-Specific Injury Mortality in the OECD Countries: An Exploration of the Importance of GDP and Unemployment

Gross Domestic Product (GDP) and unemployment has a strong documented impact on injury mortality. The aim of our study is to investigate the relationship of GDP per capita and unemployment with gender- and cause-specific injury mortalities in the member nations of Organization for Economic Cooperation and Development (OECD). Country-based data on injury mortality per 100,000 population, including males and females aged 1-74, for the 4?year period 1996-1999, were gathered from the World Health Organization's Statistical Information System. We selected fourteen cause-specific injury mortalities. Data on GDP, unemployment rate and population growth were taken from World Development Indicators. GDP and unemployment rate per 100 separately were regressed on total and cause-specific injury mortality rate per 100,000 for males and females. Overall in the OECD countries, GDP per capita increased 12.5% during 1996-1999 (P?=?0.03) where as unemployment rate decreased by 12.3% (P?=?0.05). Among males, most cause-specific injury mortality rates decreased with increasing GDP except motor vehicle traffic crashes (MTC) that increased with increasing GDP (coefficient?=?0.75; P?相似文献   

Exploring the economics of motorcycle helmet laws--implications for low and middle-income countries

This paper reviews economic evaluations of motorcycle helmet interventions in preventing injuries. A comprehensive literature review focusing on the effectiveness of motorcycle helmet use, and on mandatory helmet laws and their enforcement was done. When helmet laws were lifted between 1976-80, 48 states within the U.S.A. experienced a cost of $342,047 per excess fatality of annual net savings. Helmet laws in the USA had a benefit-cost ratio of 1.33 to 5.07. Taiwan witnessed a 14% decline in motorcycle fatalities and a 22% reduction of head injury fatalities with the introduction of a helmet law. In Thailand, where 70-90% of all crashes involve motorcycle, after enforcement of a helmet law, helmet-use increased five-fold, the number of injured motorcyclists decreased by 33.5%, head injuries decreased by 41.4%, and deaths decreased by 20.8%. There is considerable evidence that mandatory helmet laws with enforcement alleviate the burden of traffic injuries greatly. For low and middle-income countries with high rates of motorcycle injuries, enforced, mandatory motorcycle helmet laws are potentially one of the most cost-effective interventions available.     

我国车祸的流行病学特征及影响因素分析

本研究的目的在于分析1951～1994年我国车祸的流行病学特征及其影响因素，为车祸的预防和控制提供依据。43年中我国车祸发生数增加了42倍，死亡人数增加了77倍。1984～1994年车祸年死亡率由2．43／10万人上升到5．56／10万人，平均年增长率为12．9％。广东、浙江、辽宁、四川和江苏是车祸最多的省份，5省的车祸发生数占全国总发生数45％，死亡人数占38％。1994年30个省市区的车祸死亡率以北京市为最低（3．41／10万人），浙江省最高（12．09／10万人），广东省的升幅最大。致死性车祸多发生于天气晴朗时的平直路段，以20～50岁的农民和职工居多，死者2／3为行人、骑自行车者和乘车者。各类事故的原因中驾驶员责任、无证开车、骑自行车人责任和行人过失等人的因素占90％。驾驶员肇事原因主要是违章行车、判断错误或疏忽大意。车辆增加、运输繁忙和道路不足、交通条件欠完善是导致车祸的主要因素。预防和控制车祸的根本措施在于改善交通环境和加强交通安全教育。     

The case for improving road safety in Pacific Islands: a population‐based study from Fiji (TRIP 6)

Objective : To estimate the incidence and demographic characteristics associated with road traffic injuries (RTIs) resulting in deaths or hospital admission for 12 hours or more in Viti Levu, Fiji. Methods : Analysis of the prospective population‐based Fiji Injury Surveillance in Hospitals database (October 2005 – September 2006). Results: Of the 374 RTI cases identified (17% of all injuries), 72% were males and one third were aged 15–29 years. RTI fatalities (10.3 per 100,000 per year) were higher among Indians compared to Fijians. Two‐thirds of deaths (largely ascribed to head, chest and abdominal trauma) occurred before hospital admission. Conclusion and implications: While the RTI fatality rate was comparable to the global average for high‐income countries, the level of motorisation in Fiji is considerably lower. To avert rising RTI rates with increasing motorisation, Fiji requires a robust road safety strategy alongside effective trauma‐care services and a reliable population‐based RTI surveillance system.     

Economic development as a determinant of injury mortality - a longitudinal approach

Cross-sectional studies have produced clear inverted U-shaped curves between injury mortality and economic development; yet, this does not mean that single countries will necessarily follow similar curves as they grow richer over time. This study was conducted to examine whether previous cross-sectional findings can be verified using a longitudinal approach. Data for both injury mortality and gross domestic product (GDP) per capita were obtained from an official health database for the member countries of the Organization for Economic Cooperation and Development (OECD) for the period of 1960-1999. Regression models were then used to examine the longitudinal relationship between these two variables. Substantial improvements in injury mortality were observed in all income categories in the selected countries. For higher and middle high-income countries, injury mortality rates (all causes) increased until 1972, peaking in 1972 and then declining. For industrialized countries with relatively low GDP, injury mortality rates increased until 1977 and then declined. Using cubic regression lines for injury mortality rates, for all income categories, injury mortality rates increased up to a GDP per capita of USD 3,000-USD 4,000, then decreased significantly. The rising trends of suicide and homicide rates were observed until countries attained a GDP per capita of around USD 13,000-USD 14,000 for all income categories. It is noteworthy that compared to the intentional injury categories, mortality due to road traffic accidents and injuries from falls declined earlier on in the economic development process. Longitudinal analysis among high-income countries confirms earlier cross-sectional findings; that is, most injury categories seem to follow inverted U-shaped trend lines, with declining trends after peaking at various stages of temporal and economical development. A comparison between time and economy suggests that differences in peaking time between countries for the same injury category is partly a reflection of temporal differences in economic development.     

Estimation of fatalities due to road traffic crashes in Karachi, Pakistan, using capture-recapture method

The objective of the study was to estimate the magnitude of road traffic fatalities occurring in Karachi, Pakistan. A 2-source capture-recapture model was applied to obtain a reliable estimate of the magnitude of the problem. A conservative adjusted estimate of fatalities generated, using data from 2 sources matched by at least name, gender, age, and location. In 2008, police reported 616 fatalities whereas hospitals recorded 1092 fatalities due to road traffic crashes. The capture- recapture analysis estimated at least 1375 fatalities. Police data show 55% deficit from the estimated figure and 43.6% deficit from the observed one, whereas hospital data show 20.6% deficit from the estimation. Road traffic crashes and resulting fatalities and injuries are a much more substantial health problem than is evident from official statistics. The capture-recapture analysis can be used as a tool to provide affordable and reliable estimates in developing countries where routine official statistics suffer from underreporting.     

Reducing alcohol-impaired driving in Massachusetts: the Saving Lives Program.

OBJECTIVES: The purpose of this study ws to assess whether a community program begun in March 1988 that organized multiple city departments and private citizens could reduce alcohol-impaired driving, related driving risks, and traffic deaths and injuries. METHODS: Trends in fatal crashes and injuries per 100 crashes were compared in Saving Lives Program cities and the rest of Massachusetts from March 1984 through February 1993. In annual roadside surveys conducted at randomly selected locations, safety belt use among occupants of 54577 vehicles and travel speeds of 118442 vehicles were observed. Four statewide telephone surveys (n = 15188) monitored self-reported driving after drinking. RESULTS: In program cities relative to the rest of Massachusetts during the 5 program years in comparison with the previous 5 years, fatal crashes declined 25%, from 178 to 120, and fatal crashes involving alcohol decreased 42%, from 69 to 36. Visible injuries per 100 crashes declined 5%, from 21.1 to 16.6. The proportions of vehicles observed speeding and teenagers who drove after drinking were cut in half. CONCLUSIONS: Interventions organized by multiple city departments and private citizens can reduce driving after drinking, related driving risks, and traffic deaths and injuries.     

The relationship between health and GDP in OECD countries in the very long run

This paper uses Johansen multivariate cointegration analysis to examine the relationship between health and GDP for 13 OECD countries over the last two centuries, for periods ranging from 1820–2001 to 1921–2001. A similar, long run, cointegrating relationship between life expectancy and both total GDP and GDP per capita was found for all the countries estimated. The relationships have a significant influence on both total GDP and GPD per capita in most of the countries estimated, with 1% increase in life expectancy resulting in an average 6% increase in total GDP in the long run, and 5% increase in GDP per capita. Total GDP and GDP per capita also have a significant influence on life expectancy for most countries. There is no evidence of changes in the relationships for any country over the periods estimated, indicating that shifts in the major causes of illness and death over time do not appear to have influenced the link between health and economic growth. Copyright © 2010 John Wiley & Sons, Ltd.     

Health care expenditures and gross domestic product: the Turkish case

Our study examines the long-term relationship among per capita gross domestic product (GDP), per capita health expenditures and population growth rate in Turkey during the period 1984–2006, employing the Johansen multivariate cointegration technique. Related previous studies on OECD countries have mostly excluded Turkey—itself an OECD country. The only study on Turkey examines the period 1984–1998. However, after 1998, major events and policy changes that had a substantial impact on income and health expenditures took place in Turkey, including a series of reforms to restructure the health and social security system. In contrast to earlier findings in the literature, we find that the income elasticity of total health expenditures is less than one, which indicates that health care is a necessity in Turkey during the period of analysis. According to our results, a 10% increase in per capita GDP is associated with an 8.7% increase in total per capita health expenditures, controlling for population growth. We find that the income elasticity of public health expenditures is less than one. But, in the case of private health care expenditures, the elasticity is greater than one, meaning that private health care is a luxury good in Turkey.     

The implications of external price referencing on pharmaceutical list prices in Europe

External price referencing (EPR) is a frequently applied cost-containment measure to control pharmaceutical prices. This study aims to determine the implications of EPR on ex-factory pharmaceutical prices in European countries.Prices of 21 pharmaceuticals and 17 non-pharmaceutical services were collected with a survey and price corridors were defined in 7 countries. To increase the sample size for further analysis, pharmaceutical prices were retrieved from EURIPID database for 8 additional countries. Regression analyses were applied to evaluate explanatory variables on pharmaceutical list prices including EPR components, GDP per capita, and population size in 15 European countries.Price corridor was narrower for pharmaceuticals compared to non-pharmaceutical services. In univariate regression analysis, higher GDP per capita and population size were associated with higher prices, and taking lowest price from referenced basket of countries was associated with lower prices. In multiple regression analysis, GDP per capita, population size and number of countries referencing a country had modest, but significant association with prices.Findings indicate small price variation for pharmaceuticals that points towards the occurrence of price-convergence. The relatively minor association of EPR with pharmaceutical list prices could be explained by manufacturers’ compensatory mechanisms including confidential price reductions and discounts while maintaining high list prices in countries with strong price-control measures or delayed product launch in countries with traditionally lower prices. Consequently, EPR cannot be directly associated with narrow European price corridor, and lower income countries still have slightly lower list prices.     

One less for the road. International trends in alcohol consumption and vehicular fatalities.

We used data for the years 1965 to 1987 from 19 countries to study the relationship between per capita alcohol consumption and vehicular fatalities. Cross-sectional data for the most recent years show a strong relationship between per capita alcohol consumption and vehicular deaths (r = .83, P < .001). When we examined time trends, we noted an increase in per capita alcohol consumption and vehicular deaths for the years 1965 to 1973, a dissociation of the two variables in response to the oil crisis during the 1970s, and a recent gratifying reduction in both variables for the period 1980 to 1987. On average, for the years 1980 to 1987, a 1% reduction in per capital alcohol consumption was associated with a 1% reduction in vehicular deaths (95% confidence interval, .9 to 1.1). For many countries alcohol consumption has already peaked and these findings provide quantitative support for the beneficial effects of continued efforts to control overall per capita consumption of alcohol.     

What changes in survival rates tell us about us health care

Many advocates of US health reform point to the nation's relatively low life-expectancy rankings as evidence that the health care system is performing poorly. Others say that poor US health outcomes are largely due not to health care but to high rates of smoking, obesity, traffic fatalities, and homicides. We used cross-national data on the fifteen-year survival of men and women over three decades to examine the validity of these arguments. We found that the risk profiles of Americans generally improved relative to those for citizens of many other nations, but Americans' relative fifteen-year survival has nevertheless been declining. For example, by 2005, fifteen-year survival rates for forty-five-year-old US white women were lower than in twelve comparison countries with populations of at least seven million and per capita gross domestic product (GDP) of at least 60?percent of US per capita GDP in 1975. The findings undercut critics who might argue that the US health care system is not in need of major changes.     

Nonfatal motor-vehicle animal crash-related injuries--United States, 2001-2002

In 2000, an estimated 6.1 million light-vehicle (e.g., passenger cars, sport utility vehicles, vans, and pickup trucks) crashes on U.S. roadways were reported to police. Of these reported crashes, 247,000 (4.0%) involved incidents in which the motor vehicle (MV) directly hit an animal on the roadway. Each year, an estimated 200 human deaths result from crashes involving animals (i.e., deaths from a direct MV animal collision or from a crash in which a driver tried to avoid an animal and ran off the roadway). To characterize nonfatal injuries from these incidents, CDC analyzed data from the National Electronic Injury Surveillance System-All Injury Program (NEISS-AIP). This report summarizes the results of that analysis, which indicated that, during 2001-2002, an estimated 26,647 MV occupants per year were involved in crashes from encounters with animals (predominantly deer) in a roadway and treated for nonfatal injuries in U.S. hospital emergency departments (EDs). Cost-effective measures targeting both drivers (e.g., speed reduction and early warnings) and animals (e.g., fencing and underpasses) are needed to reduce injuries associated with MV collisions involving animals.     

Trends in Violent Deaths Among Young People 10–24 Years Old, in Switzerland, 1969–1997

PURPOSE: To assess violent death rates and trends between 1969 and 1997 among young people aged 10-24 years old in Switzerland. METHODS: Total causes of death, all external causes of injuries, traffic injuries, suicides and overdoses were retrieved from the databank of the Swiss Federal Statistical Office (SFSO), using the eighth and tenth revisions of the International Classification of Diseases (ICD). Mortality rates per 100,000 individuals were computed by gender and by age (10-14, 15-19, 20-24) using census records as denominators. RESULTS: In 1995-1997, violent deaths represented the primary cause of fatalities among young people. Rates of violent death were much higher among males than among females, with a ratio of 3.5:1 in 1995-1997 and also became increasingly elevated from the age range of 10-14 to 20-24 years (1.9:1-4.4:1). In 1995-1997, violent deaths accounted for 66% (n = 1221) of all fatalities among young people. Among violent deaths, 36% were due to traffic injuries, 13% to other types of injuries, 32% to suicide, 15% to overdoses, 3% to homicides and 1% to undetermined intent. Between 1969 and 1997, rates of traffic injuries decreased in both genders and in the three age groups considered, while rates of suicide remained stable and rates of overdoses stabilised during the nineties after a sharp increase during the eighties. CONCLUSION: Although violent deaths in Switzerland have become significantly less frequent over the last 30 years, they still represent the single greatest cause of fatalities among young people and, as such, constitute a major public health challenge.     

Adolescent injury mortality in New Zealand and opportunities for prevention

Injury is recognised internationally as the major threat to adolescent health. The purpose of this study was to describe the epidemiology of adolescent fatal injury in New Zealand, and to examine opportunities for prevention. National mortality data were searched to identify all 15-19 year-olds, who died from injuries in the period 1986-1995. Leading causes of injury were reviewed in light of known risk factors, injury mortality rates in other industrialised countries, and available prevention strategies. The results showed that injury accounted for 2,095 deaths (72.8 per 100,000 person years). Males comprised 77% of victims (110.6 per 100,000 person years), and there was a three-fold increase in mortality from age 15 (35.3 per 100,000 person years) to 19 years (106.4 per 100,000 person years). The leading causes of death were road traffic crashes (42.6 per 100,000 person years), suicide (16.4 per 100,000 person years), and unintentional drowning (3.6 per 100,000 person years). The Graduated Driver Licensing System addresses a range of risk factors for adolescent road traffic crashes. Despite inadequate enforcement, early indications are that it has yielded modest reductions in injury. Hazardous drinking is implicated in the high rates of road traffic crashes and drownings, and given recent liberalization of supply-side policies, proactive identification of hazardous drinkers followed by brief intervention holds promise as a prevention measure. Suicide accounts for an increasing rate of adolescent deaths in New Zealand. The effect of national policies to address a range of suicide risk factors remains to be fully evaluated.