Direct and indirect costs of nonfatal road traffic injuries in Iran: A population-based study

Objectives: The objective of this study was to assess the incidence rate as well as direct and indirect costs of nonfatal road traffic injuries (RTIs) in Iran in 2011.

Methods: Data from the 2011 national household survey were used. In this survey, data on demographics, history, and costs of injury were obtained in 2 steps: first, direct face-to-face interview and second, telephone calls. We estimated the incidence rate of nonfatal RTIs in this year. The direct costs included medical care as well as nonmedical costs paid by the patient or insurance services. The indirect costs were estimated by considering the cost of absence from work or education. We also used logistic regression analyses to investigate risk factors of nonfatal RTIs.

Results: We found 76 nonfatal RTI cases (0.96%) out of 7,886 whole reference study cases. These 76 injured patients had a history of RTI in the preceding 3 months. The annual incidence of RTIs was estimated at 3.84%. The mean age of RTI cases was 28.5 ± 10.6 and 88.16% of them were male. Male gender was a major risk factor (odds ratio [OR] = 9.64, 95% confidence interval [CI], 4.79–19.41) and marriage was a protective factor (OR = 0.44, 95% CI, 0.28–0.70) for RTI. The medians of direct, indirect, and total costs were US$214, US$163, and US$387, respectively. The total cost of nonfatal RTIs in Iran was estimated at 1.29% of the gross domestic product (GDP) in 2011.

Conclusions: In Iran, nonfatal RTIs imposed a total cost of almost US$7 billion to the country for one year. Extension and more serious implementation of preventive measurements seem necessary to decrease this notable burden of RTIs.     

Socioeconomic background and road traffic injuries: a study of young car drivers in Sweden

The aim of this study is to explore the manner in which different measures of original socioeconomic position (SEP) influence road traffic injuries (RTIs) among young car drivers in Sweden. The study consists of young people age 16-23. Subjects were taken from the Swedish Population and Housing Census of 1990 (n=727,995), and followed up by a search for cases of injury to car drivers in Sweden's National Hospital Discharge Register over the years 1991-96 (n=1,599). Household SEP was measured using social class, education, and disposable income. Relative risks were estimated by Poisson regression and population attributable risks were computed for each measure of SEP. Children of unskilled workers, of the self-employed, and of farmers, as well as children of parents with compulsory education only showed an increased risk of injury as car drivers compared to children in the highest socioeconomic group and children of highly educated parents. By contrast, level of household disposable income was found not to vary with RTI among young drivers. Twenty-five percent of the injuries could be avoided if all young people had the injury rate of the highest socioeconomic group, and 29% if all young people had the injury rate of those with highly educated parents. The reduction of risk differences based on household SEP calls for consideration of factors related to both differential exposure and differential susceptibility, which may be addressed in driver education.     

The psychological impact of traffic injuries sustained in a road crash by bicyclists: A prospective study

Objective: The objective of this study was to investigate the psychological impact of traffic injuries in bicyclists (cyclists) in comparison to car occupants who also sustained traffic injuries. Factors predictive of elevated psychological distress were also investigated.

Methods: An inception cohort prospective design was used. Participants included cyclists aged ≥17 years (mean age 41.7 years) who sustained a physical injury (n = 238) assessed within 28 days of the crash, following medical examination by a registered health care practitioner. Injury included musculoskeletal and soft tissue injuries and minor/moderate traumatic brain injury (TBI), excluding severe TBI, spinal cord injury, and severe multiple fractures. Assessment also occurred 6 months postinjury. Telephone-administered interviews assessed a suite of measures including sociodemographic, preinjury health and injury factors. Psychological impact was measured by pain catastrophization, trauma-related distress, and general psychological distress. The psychological health of the cyclists was compared to that of the car occupants (n = 234; mean age 43.1 years). A mixed model repeated measures analysis, adjusted for confounding factors, was used to determine differences between groups and regression analyses were used to determine contributors to psychological health in the cyclists 6 months postinjury.

Results: Cyclists had significantly better psychological health (e.g., lower pain catastrophizing, lower rates of probable posttraumatic stress disorder [PTSD], and lower general distress levels) compared to car occupants at baseline and 6 months postinjury. Factors predictive of cyclists' psychological distress included younger age, greater perceived danger of death, poorer preinjury health, and greater amount of time in hospital after the injury.

Conclusions: These data provide insight into how cyclists perceive and adjust to their traffic injuries compared to drivers and passengers who sustain traffic injuries, as well as direction for preventing the development of severe psychological injury. Future research should examine the utility of predictors of psychological health to improve recovery.     

Abdominopelvic injuries due to road traffic accidents: Characteristics in a registry of 162,695 victims

Objective: Road traffic accidents (RTAs) are the first cause of abdominopelvic injuries (APIs). The objective of this study was to describe the characteristics and severity of APIs due to traffic accidents in a large French trauma registry and to identify risk factors for API.

Methods: All victims from the French Rhône registry of victims of RTAs were analyzed from 1996 to 2013. This registry contained data that were issued over a 20-year period from 245 medical departments, from prehospital care until re-adaptation, and forensic medicine departments. All APIs, defined as an injury between the diaphragm and the pelvic bone, were extracted and studied.

Results: Among 162,695 victims, 10,165 had an API (6.7%). Accidents frequently involved young men and 2 cars. Mean Injury Severity Score (ISS) was 8.7. Mortality rate was 5.6%. Soft tissue injuries largely predominated (n = 6,388; 54.4% of patients). Overall, 2,322 victims had a pelvic bone injury. Internal abdominal organs were involved in 2,425 patients; the most frequent were the spleen, liver, and kidney. Wearing of the seat belt appeared to be a significant protective factor in API, including serious injuries. A partial analysis over the past 2 years among the most severe patients hospitalized in the intensive care unit indicated that nonoperative management was carried out in two thirds of the wounded. In uni- or multivariate analysis, sex, age, type of user, antagonist, time of occurrence, associated severe lesions, or wearing of the seat belt were statistically associated with the occurrence of API, highlighting a more dangerous user profile.

Conclusions: Abdominopelvic injuries concern a minority of road traffic injuries, but they are responsible for significant mortality. Large solid organs are the most frequently affected. Women drivers wearing a seat belt and driving in town during the day appear to be more protected against API.     

Cost-effectiveness of interventions to prevent road traffic injuries in low- and middle-income countries: A literature review

Objective: The objective of this study was to identify, critically appraise, summarize, and synthesize evidence from cost-effectiveness analyses (CEAs) of interventions aimed at preventing road traffic injuries (RTIs) in low- and middle-income countries (LMICs) by age group and road users targeted.

Methods: A search strategy was applied to 12 electronic databases for studies published between May 2002 and August 2015 that met prespecified inclusion criteria. Additional studies were identified by contacting authors and searching bibliographies. Included studies were critically appraised against published criteria and a narrative synthesis was conducted including a use of the strength of evidence criteria.

Results: Five studies were included in the final review that reported 9 interventions. Only 2 out of 9 interventions (drink-drive legislation with enforcement via breath testing campaign and combined interventions for reducing RTIs) showed moderate evidence of being cost-effective, whereas the evidence of cost-effectiveness of other interventions was weak. Only 2 interventions (bicycle and motorcycle helmet use legislation and enforcement) were explicitly targeted to children, young people and vulnerable road users such as pedestrians and cyclists. The cost-effectiveness of interventions to prevent RTIs in LMICs ranged from US$4.14 per disability-adjusted life years (DALYs) averted for building speed bumps at the most dangerous junctions that caused 10% of junction deaths in the area studied to US$3,403 per DALYs averted for legislation and enforcement of helmet use by motorcyclists in the World Health Organization (WHO) sub-Saharan Africa region.

Conclusions: Evidence of cost-effectiveness of interventions to prevent RTIs in LMICs is limited, particularly for children, young people, and vulnerable road users. Evaluation of the effectiveness and cost-effectiveness of a larger number of possible road safety interventions in a variety of LMIC settings is warranted to generate the evidence base for effective traffic injury prevention programs.     

Field data: a study on trend and prediction of fatal traffic injuries prevalence in Shanghai

OBJECTIVE: The main objectives of the study are to analyze fatal traffic-injury trends in 1987-2003 in Shanghai and predict its prevalence in near future and provide scientific data for the local governmental decision on developing practical working methods on traffic-injury prevention and control. METHODS: In this study, epidemiological method and Grey dynamic model GM (1,1) were introduced to analyze and forecast traffic-injury mortality rates respectively. RESULTS: There was an apparent increasing trend of traffic-related injuries in Shanghai from 1987 to 2003 with the rate of growth in motorization. The average rates of annual increase are 3.59% in fatalities (from 7.78 per 100,000 population to 14.18 per 100,000 population) during the period. Pedestrians were the most common type of victims (29.6%), followed by bicyclists (25.1%), and motorcyclists (24.1%). Males accounted for the majority of all victims, over 69%. The population of high-school and lower high-school education level represented 66.4% victims of total road-traffic injuries. And if no special factors effect its development, the traffic fatalities would be up to 17.84 per 100,000 population in 2010, when calculating from equations we found and validated Y(t) = 359.90 x e0.027(t-1)-352.13, (t = 1, 2, ..., N) for Shanghai. CONCLUSION: Our data indicate the risk of fatal traffic injuries has increased in recent years and will go on growing in the near future in Shanghai. The findings showed that Grey dynamic model GM (1,1) is eligible on the prediction and can be a tool for injuries forecasting, implementing effective policies, programs, and interventions for reducing traffic injuries in the big cities.     

Record linkage for road traffic injuries in Ireland using police hospital and injury claims data

IntroductionThe study of non-fatal road traffic injuries is growing in importance. Since there are rarely comprehensive injury datasets, it is necessary to combine different sources to obtain better estimates on the extent and nature of the problem. Record linkage is one such technique.MethodIn this study, anonymized datasets from three separate sources of injury data in Ireland: hospitals, police, and injury claims are linked using probabilistic and deterministic linkage techniques. A method is proposed that creates a ‘best’ set of linked records for analysis, useful when clerical review of undecided cases is not feasible.ResultsThe linkage of police and hospital datasets shows results that are similar to those found in other countries, with significant police understatement especially of cyclist and motorcyclist injuries. The addition of the third dataset identifies a large number of additional injuries and demonstrates the error of using only the two main sources for injury data.Practical applicationThe study also underlines the risk in relying on the Lincoln–Petersen capture–recapture estimator to provide an estimate of the total population concerned.ConclusionThe data show that road traffic injuries are significantly more numerous than either police or hospital sources indicate. It is also argued that no single measure can fully capture the range of impacts that a serious injury entails.     

A new approach to managing work-related road traffic injury: The development of a health investment framework

Objective: Statistics indicate that employees commuting or traveling as part of their work are overrepresented in workplace injury and death. Despite this, many organizations are unaware of the factors within their organizations that are likely to influence potential reductions in work-related road traffic injury.

Methods: This article presents a multilevel conceptual framework that identifies health investment as the central feature in reducing work-related road traffic injury. Within this framework, we explore factors operating at the individual driver, workgroup supervisor, and organizational senior management levels that create a mutually reinforcing system of safety.

Results: The health investment framework identifies key factors at the senior manager, supervisor, and driver levels to cultivating a safe working environment. These factors are high-performance workplace systems, leader–member exchange and autonomy, trust and empowerment, respectively. The framework demonstrates the important interactions between these factors and how they create a self-sustaining organizational safety system.

Conclusions: The framework aims to provide insight into the future development of interventions that are strategically aligned with the organization and target elements that facilitate and enhance driver safety and ultimately reduce work-related road traffic injury and death.     

A new challenge to child and adolescent survival in urban Africa: an increasing burden of road traffic injuries

OBJECTIVES: To develop an epidemiological profile and present the burden of urban road-traffic injuries (RTI) in children and adolescents in urban Sub-Saharan Africa. METHOD: A systematic review of published and gray literature of children and adolescents < or =19 years old involved in RTI in urban regions in Sub-Saharan Africa from January 1980-December 2003. RESULTS: The mean annual incidence for urban road-traffic injuries was 109.8 per 100,000 children, and males were twice as involved as their female counterparts. Children between 10 to 14 years constitute the most frequent group involved in road crashes (36%) while pedestrians represent an average of 68% of all childhood RTI cases. Twenty Healthy Life Years per 1,000 children and adolescents are being lost annually in the region from RTI. CONCLUSIONS: There is an urgent need to develop a regional health research agenda to generate an accurate estimate of the burden of road-traffic injuries on children. This is a new challenge for child health and there is a need to raise awareness among policy makers to promote appropriate interventions.     

Developing a theoretical foundation to change road user behavior and improve traffic safety: Driving under the influence of cannabis (DUIC)

Objectives: This study explored a theoretical model to assess the influence of culture on willingness and intention to drive under the influence of cannabis (DUIC). This model is expected to guide the design of strategies to change future DUIC behavior in road users.

Methods: This study used a survey methodology to obtain a nationally representative sample (n = 941) from the AmeriSpeak Panel. Survey items were designed to measure aspects of a proposed definition of traffic safety culture and a predictive model of its relationship to DUIC.

Results: Although the percentage of reported past DUIC behaviors was relatively low (8.5%), this behavior is still a significant public health issue—especially for younger drivers (18–29 years), who reported more DUIC than expected. Findings suggest that specific cultural components (attitudes, norms) reliably predict past DUIC behavior, general DUIC willingness, and future DUIC intention. Most DUIC behavior appears to be deliberate, related significantly to willingness and intention. Intention and willingness both appear to fully moderate the relationship between traffic safety culture and DUIC behavior.

Conclusions: This study explored a theoretical model to understand road user behavior involving drug (cannabis)-impaired driving as a significant risk factor for traffic safety. By understanding the cultural factors that increase DUIC behavior, we can create strategies to transform this culture and sustain safer road user behavior.     

A new approach for resource allocation for black spot treatment (case study: The road network of Iran)

Introduction: Currently, spatial and temporal distribution of safety resources in Iran is entirely based on expert opinions, regardless of network priorities. Considering the lack of resources for implementing safety treatments, prioritizing unsafe points is an important and complicated issue where the effectiveness of each safety treatment option should be thoroughly investigated. The political, social, and environmental aspects should also be taken into consideration, including social and political pressures and officials talks on less important topics. Obviously, this inappropriate resource allocation poses a serious challenge to the expected goals. In this study, a methodology based on economic and social issues is proposed to optimize the annual budget allocation for eliminating or reducing the risk of accident-prone points. In this methodology, the spatial and temporal distribution of budget is determined using a mathematical model aimed to maximize the benefits of reducing the accidents after deducting the costs of implementing the safety countermeasures. The outputs of this model include the safety countermeasure alternatives and a five-year time schedule for implementing them, or the alternative of no action with regard to budget, social, and judicial constraints. In order to evaluate the proposed method, it is applied to the road network of Iran and the results are compared with those of the conventional method that is currently used for resource allocation in this country. The results show that the proposed method leads to 15% higher benefits compared to the conventional method. Moreover, this method makes 641 safe points, which is about 17% more than the safe points resulted from the existing method. Therefore, the proposed method brings about a safer network as a result of the optimal allocation of available resources.     

Relationship between road traffic features and accidents: An application of two-stage decision-making approach for transportation engineers

Introduction: An efficient decision-making process is one of the major necessities of road safety performance analysis for human safety and budget allocation procedure. Method: During the road safety analysis procedure, data envelopment analysis (DEA) supports policymakers in differentiating between risky and safe segments of a homogeneous highway. Cross-risk, an extension of the DEA models, provides more information about risky segments for ranking purpose. After identification of risky segments, the next goal is to identify the factors that are major contributors in making that segment risky. Results: This research proposes a methodology to analyze road safety performance by using a combination of DEA with the decision tree (DT) technique. The proposed methodology not only provides a facility to identify problematic road segments with the help of DEA but also identifies contributing factors with the help of DT. Practical applications: The applicability of the proposed model will help policymakers to identify the major factors contributing to road accidents and analysis of safety performance of road infrastructure to allocate the budget during the decision-making process.     

Car safety and social differences in traffic injuries among young adult drivers: a study of two-car injury-generating crashes in Sweden

Objective—The study examines whether socioeconomic and sex differences in road-traffic crashes leading to injury vary according to car-safety level.Method—Individuals records of subjects born 1970–1972 registered in the Swedish Census of 1985 (n = 334,070) are linked to road-traffic-crash data for the period 1988–2000 for first police-registered two-car crashes leading to severe or fatal injury (n = 4875). Injuries are split into categories according to level of car safety on a five-point scale, based on criteria related to crash safety. Account is taken of both how the car is constructed and the effectiveness of its safety equipment (such as airbags and seat belts). For each car-safety level, relative risks are computed considering socioeconomic groups of origin, educational level, and sex.Results—No substantial differences between drivers in different socioeconomic positions of origin is observed except for crashes involving cars 30% better than average with regard to safety. There are consistent risk differences across all car-safety categories according to educational level. Male drivers show an elevated risk of injury in all car categories, except for cars with the poorest safety where they are at significant under-risk.Conclusions—Car-safety level impacts on social differences in road-traffic injury risks in specific and restricted manners. Car-safety development is an important factor in improved road safety, but it may not benefit all to the same extent.     

城市交通环境中NO_X浓度和噪声相关性的探讨

为了研究交通环境中NOX浓度和噪声的相关性 ,探索一种更为简洁的环境监测手段解决城市道路交通环境问题 ,在和兴路上沿道路横断面布点 ,对NOX浓度和噪声进行监测。实验表明 ,在交通环境中 ,对于同一点不同时刻的NOX浓度和噪声值有一定的相关性 ,而对同一时刻不同点则无明显的相关性。     

Pedestrian casualties and fatalities in road traffic crashes in a South African municipality

A study of the pedestrian casualties and fatalities in road traffic crashes in Durban, a South African municipality, for 1999 was undertaken using official road traffic accident data. The pedestrians age 25 to 44, although only 23.9% of the population, were 39.3% of the casualties and 48.2% of the fatalities. The most vulnerable pedestrians were those 30 to 34 years old who were 6.1% of the population, 11.7% of the casualties, and 14.6% of the fatalities; 35- to 39-year-olds who were 6% of the population, 8.8% of the casualties, and 13.5% of the fatalities; and the 40- to 44-year-olds who were 4.9% of the population, 7.5% of the casualties, and 10.2% of the fatalities. Cars were involved in 52% of the vehicle-pedestrian crashes but had fewer crashes than minibuses and buses, and fewer casualties and fatalities than minibuses, buses, and motorcycles. Minibuses recorded the most crashes at 1,037 per 100 million km, the highest casualty rate of 268 per 100 million km, and highest fatality rate of 17 per 100 million km. Buses, which were involved in 3% of the vehicle-pedestrian crashes, had 951 crashes per 100 million km, 182 casualties per 100 million km, and 11 fatalities per 100 million km. Motorcycles were involved in 1% of the vehicle-pedestrian crashes and had per 100 million km 508 crashes, 192 casualties, and 7 fatalities. There was no statistically significant difference in the monthly distribution of the road traffic crashes.     

Micro-level safety risk assessment model for a two-lane heterogeneous traffic environment in a developing country: A comparative crash probability modeling approach

Introduction: There have been a number of studies that have led to the development of safety risk assessment models to quantify the probability of crash frequencies on roadway facilities (both at micro- and macro-levels), over a specified time period. However, past research has rarely focused on heterogeneous traffic conditions in developing countries. Method: This paper puts forward several models related to the traditional count approach to estimate crash frequency at a micro-level in a non-lane based bi-directional heterogeneous traffic environment. The paper shows the results of dispersion, zero-inflation, and random heterogeneity effects of different exogenous factors by comparing Poisson (P); Negative Binomial (NB); random and fixed parameter Zero-Inflated Poisson (ZIP); and Latent Class Models (LCM). The empirical analysis is based on data from a section of a major national highway in Bangladesh. The performance of the models was validated using different statistical goodness-of-fit measures that compared the estimated and observed average crash frequencies at individual locations. With the identification of the most significant influencing factors, the paper discusses the practical policy implications using partial effects analysis and spatial distribution. Results: It was found that the Zero-Inflated Random Parameter model gives a slightly better statistical fit when compared to alternative approaches. Practical applications: This micro-level modeling approach would be useful to identify significant crash risk factors; to prioritize road sections according to their safety level; to select site-specific appropriate counter-measures; and devise proactive target oriented safety management strategies. Thus, the results shown here could be a point of reference in the planning, designing, maintaining, and managing two-lane highway sections in developing countries.     

Epidemiology and patterns of facial fractures due to road traffic accidents in Taiwan: A 15-year retrospective study

Objective: The facial region is a commonly fractured site, but the etiology varies widely by country and geographic region. To date, there are no population-based studies of facial fractures in Taiwan.

Methods: We conducted a retrospective study of patients diagnosed with facial fracture and registered in the National Health Insurance Research Database of Taiwan between 1997 and 2011. The epidemiological characteristics of this cohort were analyzed, including the etiology, fracture site, associated injuries, and sex and age distributions.

Results: A total of 6,013 cases were identified that involved facial fractures. Most patients were male (69.8%), aged 18–29 years (35.8%), and had fractures caused by road traffic accidents (RTAs; 55.2%), particularly motorcycle accidents (31.5%). Falls increased in frequency with advancing age, reaching 23.9% among the elderly (age > 65 years). The most common sites of involvement were the malar and maxillary bones (54.0%), but nasal bone fractures were more common among those younger than 18 years.

Conclusion: Most facial injuries in Taiwan occur in young males and typically result from RTAs, particularly involving motorcycles. However, with increasing age, there is an increase in the proportion of facial injuries due to falls.