Road traffic injuries in urban Africa and Asia: a policy gap in child and adolescent health

OBJECTIVE: This study highlights the burden of urban road traffic injuries (RTIs) in children and young adults in South Asia and Sub-Saharan Africa to heighten awareness of current limitations in child health policies, and to direct future research and intervention development. METHODS: Comparative analysis of recent Sub-Saharan Africa and South Asia reviews of RTIs, World Health Organization (WHO) Global Burden of Disease statistics, and the Bangladesh Health and Injury Survey. PARTICIPANTS: Children aged 0-18 years in South Asia and Sub-Saharan Africa reviews, aged 0-14 years in the WHO data, and aged 1-17 years in the Bangladeshi data. RESULTS: Child pedestrians comprise the largest proportion of urban RTI victims. More healthy life years were lost per 1000 children aged 0-18 years in South Asia than Sub-Saharan Africa. Disability-adjusted life years lost per 1000 children aged 0-14 years was greater in Africa than South-east Asia. South-east Asia has the greatest overall incidence of RTIs; however, Africa has poorer reported outcomes for children aged 0-14 years. CONCLUSION: These data sources point to the salience of intervening in RTIs in children to prevent a predicted boom in the RTI burden in children, particularly in the poorest regions of the world. However, child health policies in these regions have not yet embraced RTI, either in research or programmes.     

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.     

The Global Impact of Alcohol Consumption on Premature Mortality and Health in 2016

This study aimed to estimate the impact of alcohol use on mortality and health among people 69 years of age and younger in 2016. A comparative risk assessment approach was utilized, with population-attributable fractions being estimated by combining alcohol use data from the Global Information System on Alcohol and Health with corresponding relative risk estimates from meta-analyses. The mortality and health data were obtained from the Global Health Observatory. Among people 69 years of age and younger in 2016, 2.0 million deaths and 117.2 million Disability Adjusted Life Years (DALYs) lost were attributable to alcohol consumption, representing 7.1% and 5.5% of all deaths and DALYs lost in that year, respectively. The leading causes of the burden of alcohol-attributable deaths were cirrhosis of the liver (457,000 deaths), road injuries (338,000 deaths), and tuberculosis (190,000 deaths). The numbers of premature deaths per 100,000 people were highest in Eastern Europe (155.8 deaths per 100,000), Central Europe (52.3 deaths per 100,000 people), and Western sub-Saharan Africa (48.7 deaths per 100,000). A large portion of the burden of disease caused by alcohol among people 69 years of age and younger is preventable through the implementation of cost-effective alcohol policies such as increases in taxation.     

The burden of road traffic injuries in developing countries: the 1st national injury survey of Pakistan

OBJECTIVES: To assess the burden of road traffic injuries in Pakistan-a developing country in South Asia. METHODS: A nationally representative household interview survey, to measure the burden of all injuries for all ages and in both genders using a three-month recall period. RESULTS: The overall incidence of injury events was 41 (CI: 39.2-43.8) per 1000 per year and for road traffic injuries 15 (CI: 13.7-16.5) per 1000 per year. The relative risk for road traffic injuries was found to be higher in males, those 16-45 years old, and those in the professional category of laborers and vendors. CONCLUSIONS: This first national survey reflects the growing impact of injuries, especially road traffic injuries in Pakistan and portends a challenge for the national health system.     

Walking, cycling and transport safety: an analysis of child road deaths

OBJECTIVE: To examine trends in road death rates for child pedestrians, cyclists and car occupants. DESIGN: Analysis of road traffic injury death rates per 100 000 children and death rates per 10 million passenger miles travelled. SETTING: England and Wales between 1985 and 2003. PARTICIPANTS: Children aged 0-14 years. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Death rates per 100,000 children and per 10 million child passenger miles for pedestrians, cyclists and car occupants. RESULTS: Death rates per head of population have declined for child pedestrians, cyclists and car occupants but pedestrian death rates remain higher (0.55 deaths/100,000 children; 95% confidence interval [CI] 0.42 to 0.72 deaths) than those for car occupants (0.34 deaths; 95% CI 0.23 to 0.48 deaths) and cyclists (0.16 deaths; 95% CI 0.09 to 0.27 deaths). Since 1985, the average distance children travelled as a car occupant has increased by 70%; the average distance walked has declined by 19%; and the average distance cycled has declined by 58%. Taking into account distance travelled, there are about 50 times more child cyclist deaths (0.55 deaths/10 million passenger miles; 0.32 to 0.89) and nearly 30 times more child pedestrian deaths (0.27 deaths; 0.20 to 0.35) than there are deaths to child car occupants (0.01 deaths; 0.007 to 0.014). In 2003, children from families without access to a vehicle walked twice the distance walked by children in families with access to two or more vehicles. CONCLUSIONS: More needs to be done to reduce the traffic injury death rates for child pedestrians and cyclists. This might encourage more walking and cycling and also has the potential to reduce social class gradients in injury mortality.     

The global burden of injuries

The traditional view of injuries as "accidents", or random events, has resulted in the historical neglect of this area of public health. However, the most recent estimates show that injuries are among the leading causes of death and disability in the world. They affect all populations, regardless of age, sex, income, or geographic region. In 1998, about 5.8 million people (97.9 per 100,000 population) died of injuries worldwide, and injuries caused 16% of the global burden of disease. Road traffic injuries are the 10th leading cause of death and the 9th leading cause of the burden of disease; self-inflicted injuries, falls, and interpersonal violence follow closely. Injuries affect mostly young people, often causing long-term disability. Decreasing the burden of injuries is among the main challenges for public health in the next century--injuries are preventable, and many effective strategies are available. Public health officials must gain a better understanding of the magnitude and characteristics of the problem, contribute to the development and evaluation of injury prevention programs, and develop the best possible prehospital and hospital care and rehabilitation for injured persons.     

2006-2008年河北省6家医院急诊室道路交通伤害监测分析

目的分析河北省部分城乡居民道路交通伤害状况和危害程度,为制定有效的干预措施提供科学依据。方法资料来源于秦皇岛市、藁城市各3家不同级别伤害监测哨点医院急诊室。对2006年1月1日至2008年12月31日首次就诊于哨点医院的道路交通伤害病人资料进行分析。结果共收集61 546例伤害病例,交通伤病例21 288例,占34.59%。患者男女性别比为1.94∶1,各年龄段之间男、女性别构成差异有统计学意义（χ^2=124.224,P〈0.05）;伤害性质以擦伤或浅表伤、骨折为主;交通伤发生时活动主要为驾乘交通工具和休闲活动;伤害严重程度以轻度为主;伤害部位以头部、下肢为主;机动车车祸发生时间有一定规律性。结论道路交通伤害发生存在一定规律,应充分利用医院急诊伤害监测系统,制定有针对性的预防条例并使其成为获取道路交通伤害发生情况的重要信息来源之一。     

柳州市道路交通伤害的流行特征和经济负担分析

目的 分析柳州城市道路交通伤害流行特点及经济负担,为节约社会资源、预防控制道路伤害提供科学依据.方法 从广西公安厅交警总队收集柳州市城区2000-2009年道路交通伤害资料,整理分析各年龄段受伤害人员交通事故和交通伤的特点,计算伤害的经济负担并描述其分布.结果 2000-2009柳州市年城区道路交通伤害发生男性多于女性(t=427.88,P＜0.001),道路伤害发生人员职业主要为个体户、运输业人员,分别占26.19％和16.74％.15 ～44岁年龄组的负担最重,共损失伤残调整寿命年(disability adjusted of life years,DALY)68472.81人年,占总损失的78.38％,10年间共造成的经济损失为14.96亿元.结论 柳州城市道路交通伤害形式十分严峻,应加强从事个体和运输等驾驶员的交通安全意识和行为教育,加强高危时段的道路安全疏导和监督检查,加强道路的安全设施建设,合理配置资源,为道路使用者提供一个安全的道路交通环境,从而减轻柳州市经济负担.     

中国道路交通伤害长期趋势及其影响因素分析

目的总结与分析中国道路交通伤害的长期趋势及其影响因素,为道路交通安全管理提供决策依据。方法以万车死亡率、10万人口死亡率、里程死亡率、机动化程度和死亡系数等指标综合评价,采用聚类分析、等级相关方法分析道路交通伤害的影响因素。结果2000年以前道路交通伤害的伤亡人数以每10年翻一番的速度上升,2000年以来每年车祸死亡人数在10万上下。万车死亡率从1970年代中期开始下降,10万人口死亡率、里程死亡率和死亡系数等道路交通伤害指标从2002年以后开始出现下降迹象。中国道路交通伤害比较严重的地区为西藏、宁夏、新疆、青海等西部地区和浙江、广东沿海地区。道路交通伤害死亡人员中男性多于女性,男女性别比为3:1。死者主要分布在21-50岁年龄组;65岁以上的死亡人数呈逐年上升趋势。行人、乘客、骑自行车者和摩托车驾驶者是道路使用者中的弱势人群。机动车驾驶者是道路交通伤害的主要肇事者,其中半数以上为职业驾驶员,驾驶员超速行驶是发生道路交通伤害的最主要原因。等级相关分析显示,10万人口死亡率与机动车辆数(X1)、公路货运量(X2)、公路客运量(X3)、等级公路(X4)呈正相关关系(相关系数: r1=0.986、r2=0 986、r3=0.987、r4=0.985,P=0.001)。结论中国道路交通伤害10万人口死亡率经过半个世纪的持续上升,在2003年开始出现下降的趋势。     

中国道路交通伤害的模式

目的 探讨中国道路交通伤害的模式。方法 分析中国1951～2001年的道路交通伤害资料,讨论道路交通伤害的时间趋势、发生特征和影响因素,并对中国31个省、市、自治区的道路交通伤害进行综合评价。结果 中国在1951～2001年的51年中道路交通伤害一直呈上升趋势,20世纪80年代以后这个趋势尤为明显。2001年道路交通伤害的发生数、受伤人数和死亡人数均比1951年增加了100倍以上;死亡率攀升至8.51/10万人口,比1990年翻了一番。在过去的10年中,广东、山东、浙江等省的道路交通伤害死亡人数始终占据前五位,2001年道路交通伤害的综合事故率显示,西藏、新疆、青海、宁夏和甘肃等西部诸省区是道路交通碰撞最严重的地区。道路交通伤害造成的死伤以男性青壮年为最多,65岁以上的伤亡者有逐年上升趋势。道路质量、机动化程度、交通运输量等交通环境,以及驾驶员或路人的过失等人为因素是道路交通伤害的影响因素。结论 改善道路交通条件,交通立法与执法,提高城乡居民的交通安全意识等,是预防和控制道路交通伤害的主要措施。     

Exploring the relationship between development and road traffic injuries: a case study from India

BACKGROUND: Road traffic injuries (RTI) are a major cause of mortality and disability in the world. Only after significant losses have communities in developed nations taken necessary steps to prevent crashes and their consequences. Increase in road safety is related to increasing socio-economic development. We aim to study the trends in injury and death rates in a developing country, India, define sub-national variations, and analyse these trends in relation to economic and population growth. METHODS: Public sector data from India were used to develop a standardized database on traffic injuries and indicator of economic development. The data were analysed using linear regression models to test the a priori hypothesis of a positive relationship between net domestic product (NDP), and injury and death rates from road crashes across states. RESULTS: The absolute burden of RTI in India has been consistently rising over the past three decades. The reported rates are lower than those estimated by global health agencies and may reflect under-reporting. Population-based rates provide a better assessment of the public health burden of RTI than vehicle-based rates. There is an inverted U-shaped relationship between NDP and injury and death rates. Even with the limited data, Kuznets phenomenon is evident for within-country level comparisons. CONCLUSIONS: India and other developing countries could learn from the experience of highly motorized nations to avoid the expected rise in RTI and deaths with economic development, by currently investing in road safety and prevention measures.     

山东省蓬莱市2006-2007年道路交通伤害疾病负担分析

目的 综合评价蓬莱市道路交通伤害的健康和社会经济负担.方法 以蓬莱市2006-2007年居民死亡原因登记系统中数据和伤害抽样调查资料为基础,估计道路交通事故导致的死亡和伤残现状,按照全球疾病负担研究中伤残调整寿命年(DALY)公式,利用直接法测算疾病健康负担,并评价道路交通伤害的经济负担.结果 蓬莱市平均每年因道路交通伤害造成31 373.04个健康寿命年损失,相当于每1000人损失70.59个健康寿命年;男性健康寿命年损失高于女性;15～44岁年龄段青壮年健康寿命年损失最高,占全部寿命损失的一半以上;DALY主要由失能所致的寿命损失年(YLD)构成(占79.45%).两年间总经济损失为21.85亿元,占同期GDP总量的4.89%,其中间接经济损失达21.52亿元,占全部损失的98.45%,男性造成经济损失明显高于女性,15～59岁年龄段经济损失占全部损失的97.65%.结论 道路交通伤害严重影响蓬莱市居民身体健康,给个人、家庭和社会带来沉重的负担.

Abstract：

Objective To evaluate the burden of road traffic injury (RTI) from perspectives both on the health of population and on social economic status so as to provide scientific evidence for policy making. Methods The status of mortality and disability caused by traffic accident in Penglai county was estimated, based on data from death registration and a sampling survey from 2006 to 2007.Together with the disability weights gained from global burden of disease (GBD) , health burden (DALY) was measured with GBD formula. The economic burden of RTI was evaluated. Results Average loss of the health life years (HLY) related to RTI was 31 373.04 per year. 70.59 HLY were lost per 1000 persons. Loss among the males was higher than females. The loss of DALY among the age group 15-44 years ranked the first place (39 209.71 HLY) which accounted for 62.42% of the total DALY. 79.45% of the total DALY were caused by disability. In 2006 and 2007 ,the economic loss caused by RTI was as high as 2.19 billion RMB, which accounted for 4.89% of the total amount of GDP while the indirect economic costs (2.15 billion RMB) accounted for 98.45% of the total costs in Penglai city. The economic loss of the males was obviously higher than the females and the loss by the group aged 15-59 years old accounted for 97.65% of the total. Conclusion RTI had severely influenced the health of the residents in Penglai city and brought heavy burden to the individuals,families as well as the society.     

2012—2021年重庆市儿童青少年交通伤害死亡特征及变化趋势

目的 了解2012—2021年重庆市儿童青少年交通伤害死亡特征及变化趋势,为开展交通伤害干预提供建议。方法 2012—2021年重庆市儿童青少年交通伤害死亡(ICD-10:V01-V99)个案信息来自重庆市死因监测系统,采用SPSS 25.0统计分析死亡率、构成比,不同性别、地区死亡率比较采用χ²检验,死亡率的趋势分析采用年度变化百分比(annual percent of change, APC)表示。结果 重庆市儿童青少年交通伤害死亡率由2012年的6.80/10万下降至2021年的1.83/10万,APC为-14.62%,变化趋势差异有统计学意义(t=15.088,P<0.001)。2016年前男性交通伤害死亡率高于女性,2014年前农村地区交通伤害死亡率高于城市,差异均有统计学意义(P<0.05)。男性、女性、城市、农村儿童青少年交通伤害死亡率分别以年均14.96%、14.02%、10.60%、15.21%下降,变化趋势差异均有统计学意义(P<0.05)。0～4岁、5～9岁、10～14岁、15～17岁交通伤害死亡率分别以年均13.84%、1...     

State-specific unintentional-injury deaths--United States, 1999-2004

Deaths from unintentional injuries account for approximately two thirds of deaths from all injuries in the United States. Among persons aged 1-44 years, unintentional injuries are the leading cause of death and the leading cause of potential years of life lost before age 65 years. A Healthy People 2010 national objective calls for reducing the rate of deaths caused by unintentional injuries to 17.5 per 100,000 population from a baseline of 35.0 in 1998 (objective 15-13). A second objective calls for reducing the rate of deaths caused by unintentional injuries involving motor-vehicle traffic to 9.2 per 100,000 population from a 1998 baseline of 15.6 (objective 15-15). To determine the progress of states toward meeting these objectives, CDC analyzed vital statistics data for the period 1999-2004. This report summarizes the results of that analysis, which determined that, as of 2004, none of the states had achieved the first Healthy People 2010 objective, and four states and the District of Columbia (DC) had achieved the second. From 1999 to 2004, a total of 13 states reduced their unintentional-injury death rates, and 19 states reduced their motor-vehicle--traffic death rates. Overall in the United States, the rate of deaths caused by unintentional injuries increased 7%, from 35.3 per 100,000 population in 1999 to 37.7 in 2004. These findings underscore the need for states to continue to develop, implement, and evaluate injury-prevention programs and policies to reduce the number of deaths from unintentional injuries.     

Epidemiologic study of traffic accidents occurring among the inhabitants of Algeria

An observation area was created in Algiers to improve both epidemiological knowledge of traffic accidents and the national information system. Carried out cooperatively by the police and the hospitals of the area, our cohort study revealed a high annual incidence (700 per 100,000) of traffic accidents among residents of Algiers. Children between 5 and 9, adolescents, young adults and people over 60 are the most vulnerable. Older persons and children are for the most part pedestrians. Fractures of lower limbs are relatively numerous and account for 10% of all registered injuries. Moreover, 92.1% of injuries, corresponding to the highest AIS in each part of the body affected, are either minor or moderate. The severity of injuries seems to be independent of age, sex and category (pedestrians, motorcyclists, etc.) of the road user. The ISS, which is correlated to the duration of hospital stay, gives much the same results. Only by linking the data from the different information sources can one perceive the various facets of the problem in an overall manner. However, even before accumulating highly refined data certain actions are manifestly urgent. One of them is an improved organization of traumatology in order to reduce lethality of injuries.     

桂林市机动车驾驶员道路交通伤害影响因素分析

目的探讨机动车驾驶员道路交通伤害(RTI)的影响因素,为预防和减少RTI的发生提供科学依据。方法通过广西省公安厅交警总队收集2000—2009年桂林市区的RTI数据,对机动车驾驶员RTI影响因素进行Logistic回归分析。结果 2000—2009年桂林市发生RTI共3603起,造成506人死亡,2 911人受伤,男女死亡比例为2.54∶1;RTI的伤亡主要发生在21～45岁青年;由机动车驾驶员造成的RTI共3 208起,占总数的89.04%;疲劳驾车(P=0.000,OR=4.280,95% CI=2.055～8.916)、超速行驶(P=0.000,OR=0.269,95% CI=0.125～0.578)、纵向间距不够(P=0.001,OR=1.606,95% CI=1.815～3.164)及违反交通信号(P=0.000,OR=2.118,95% CI=1.524～2.945)等4个因素进入多因素非条件Logistic回归分析模型。结论疲劳驾车、超速行驶、纵向间距不够及违反交通信号与RTI的发生密切相关。     

柳州市2004～2009年城市道路交通伤害的流行病学研究

目的 探讨柳州城市道路交通伤害的流行病学规律,为预防和控制伤害的发生及其危害提供依据.方法 应用广西公安厅交警总队提供的数据和2004～2009年柳州市统计年鉴描述柳州市道路交通伤害的发生率、死亡率、伤人率和直接经济损失及其变化趋势,并描述道路交通伤害的车辆类型、地区和道路分布情况等相关特征.结果 2004～2009年柳州城市道路交通伤害在总体上发生率、死亡率和伤人率呈下降趋势,但2009年4项数据有回升趋势,直接经济损失为69.9万元,是2008年的1.90倍,受伤人数为252人,是2008年的2.50倍,2项数据升高较快;2004～2009年间柳州市道路交通伤害的主要成因是与道路交通伤害相关的人员因素,所占比例为61.80％～91.03％,其中机动车驾驶员的违章行为是主要原因,包括纵向间距不够和酒后驾驶等;发生交通伤害的主要车种为汽车和摩托车,两者所占比例每年都超过90％以上;交通伤害主要发生在城市主干道上,占76％左右.结论 柳州市道路交通伤害发生率得到了有效控制,适当控制汽车保有量的快速增长对于减少道路交通伤害作用明显;柳州城市道路交通伤害的预防和控制应以控制汽车驾驶员和摩托车驾驶员的违章行为为重点,同时增加警力,加强城市主干道的监督检查.     

桂林市2000-2009年道路交通伤害死亡的疾病负担分析

目的 综合评价桂林市2000-2009年道路交通伤害(road traffic injuries,RTI)死亡造成的健康负担和社会经济负担.方法 从广西公安厅交警总队收集桂林市2000 -2009年的RTI资料,计算RTI死亡造成的潜在寿命损失年(years of potential life lost,YPLL)、潜在工作损失年(working years of potential life lost,WYPLL)及校正潜在价值损失年(correct valued years of potential life lost,CVYPLL),并评价其经济负担.结果 (1)桂林市RTI死亡所致的YPLL和WYPLL损失以2000年最多,而CVYPLL损失均以2001年最多;(2)桂林市2000-2009年RTI死亡所致的YPLL、WYPLL和CVYPLL损失总体呈下降趋势;(3)男性RTI死亡所致的YPLL、WYPLL和CVYPLL损失均占70％以上,男性的平均WYPLL和平均CVYPLL损失均高于女性;(4)21 ～50岁的青壮年YPLL和CVYPLL损失最严重,而WYPLL的损失则以11 ～40岁的人群损失最严重;(5)2008年桂林市RTI总的经济损失最多,其次分别为2007年和2006年,2000-2009年RTI总的经济损失占当年国内生产总值的百分比呈逐年下降趋势;(6)总的经济损失以雁山区最多,其次为象山区.结论 桂林市RTI给个人、家庭及社会带来沉重的健康负担和经济负担,政府有关部门应及时采取有效的措施预防和控制RTI的发生,以减轻其疾病负担.