Injury mortality in South Africa: a 2009 and 2017 comparison to track progress to meeting sustainable development goal targets.

BACKGROUND: Injuries, often preventable, prompted urgent action within the United Nations' 2030 Agenda for Sustainable Development Goals (SDGs) to improve global health. South Africa (SA) has high rates of injury mortality, but accurate reporting of official national data is hindered by death misclassification. OBJECTIVE: Two nationally representative surveys for 2009 and 2017 are utilised to assess SA's progress towards SDG targets for violence and road traffic injuries, alongside changes in suicide and under-5 mortality rates for childhood injuries, and compare these estimates with those of the Global Burden of Disease for SA. METHODS: The surveys utilised multi-stage, stratified cluster sampling from eight provinces, with mortuaries as primary sampling units. Post-mortem files for non-natural deaths were reviewed, with additional data from the Western Cape. Age-standardised rates, 95% confidence intervals (CIs), and incidence rate ratios (IRRs) were calculated for manner of death rate comparisons and for age groups. RESULTS: The all-injury age-standardised mortality rate decreased significantly between 2009 and 2017. Homicide and transport remained the leading causes of injury deaths, with a significant 31% decrease in road traffic mortality (IRR = 0.69), from 36.1 to 25.0 per 100 000 population. CONCLUSIONS: Despite a reduction in SA's road traffic mortality rate, challenges to achieve targets related to young and novice drivers and male homicide persist. Achieving SA's injury mortality SDG targets requires comprehensive evaluations of programmes addressing road safety, violence reduction, and mental well-being. In the absence of reliable routine data, survey data allow to accurately assess the country's SDG progress through commitment to evidence-based policymaking.

Main findings The significant decrease in South Africa's injury mortality rates between 2009 and 2017 appears to largely be driven by the significant 31% decrease in road traffic mortality rates.Added knowledge The 2009 and 2017 survey comparison provides an enhanced understanding of the profile for injury-related deaths, compared to misclassified vital statistics data, to track progress towards reaching Sustainable Development Goals.Global health impact for policy and action The significant reduction in road traffic mortality across all age groups suggests South Africa is making progress towards Sustainable Development Goal Target 3.6 for road safety. However, reducing violence, suicide, and newborn and under-5 injury mortality requires more targeted interventions.

Analyzing fatal crash patterns of recidivist drivers across genders and age Groups: A hazard-based duration approach.

Identifying factors that significantly affect drivers that are repeatedly involved in traffic violations or non-fatal crashes (defined here as recidivist drivers) is very important in highway safety studies. This study sought to understand the relationship between a set of variables related to previous driving violations and the duration between a previous non-fatal crash and a subsequent fatal crash, taking into account the age and gender of the driver. By identifying the characteristics of this unique driver population and the factors that influence the duration between their crash events strategies can be put in place to prevent the occurrence of future and potentially fatal crashes. To do this, a five-year (2015-2019) historical fatal crash data from the United States was used for this study. Out of 15,956 fatal crashes involving recidivist drivers obtained, preliminary analysis revealed an overrepresentation of males (about 75%). It was also found that the average duration between the two crash events was about a year and a half, with only an average of one month difference between male and female drivers. Using hazard-based duration models, factors such as number of previous crashes, previous traffic violations, primary contributing factors and some driver demographic characteristics were found to significantly be associated with the duration between the two crash events. The duration between the two events increased with driver's age for drivers who were involved in only one previous crash and the duration was shorter for those that were previously involved in multiple crashes. Previous DUI violations, license suspensions, and previous speeding violations were found to be associated with shorter durations, at varying degrees depending on the driver's age and gender. The duration was also observed to be longer if the fatal crash involved alcohol or drug use among younger drivers but shorter among middle-aged male drivers. These findings reveal interesting dynamics that may be linked to recidivist tendencies among some drivers involved in fatal crashes. The factors identified from this study could help identify crash countermeasures and programs that will help to reform such driver behaviors.

Trends in traffic accident mortality and social inequalities in Ecuador from 2011 to 2022.

BACKGROUND: Traffic accidents (TA) remain a significant global public health concern, impacting low-and middle-income countries. This study aimed to describe the trend in TA mortality and inequalities in Ecuador for 2011-2022, distributed by year, gender, age group, geographical location, type of accident, and social inequalities. METHODS: An ecological study was conducted using INEC national-level data on TA fatalities in Ecuador. Mortality rates were calculated per 100,000 population and analyzed by year, gender, age group, geographic region, and accident type. Annual percentage variation (APV) was determined using linear regression models. Inequality analyses examined associations between TA mortality and socioeconomic factors like per capita income and literacy rates. Complex measures such as the Slope Inequality Index (SII) were calculated to assess the magnitude of inequalities. RESULTS: There were 38,355 TA fatalities in Ecuador from 2011 to 2022, with an overall mortality rate of 19.4 per 100,000 inhabitants. The rate showed a non-significant decreasing trend (APV - 0.4%, p = 0.280). Males had significantly higher mortality rates than females (31.99 vs. 7.19 per 100,000), with the gender gap widening over time (APV 0.85%, p = 0.003). The Amazon region had the highest rate (24.4 per 100,000), followed by the Coast (20.4 per 100,000). Adults aged ≥ 60 years had the highest mortality (31.0 per 100,000), followed by those aged 25-40 years (28.6 per 100,000). The ≥ 60 age group showed the most significant rate decrease over time (APV - 2.25%, p < 0.001). Pedestrians were the most affected group after excluding unspecified accidents, with a notable decreasing trend (APV - 5.68%, p < 0.001). Motorcyclist fatalities showed an increasing trend, ranking third in TA-related deaths. Lower literacy rates and per capita income were associated with higher TA mortality risks. Inequality in TA mortality between provinces with the highest and lowest per capita income increased by 247.7% from 2011 to 2019, as measured by the SII. CONCLUSION: While overall TA mortality slightly decreased in Ecuador, significant disparities persist across demographic groups and geographic regions. Older adults, males, pedestrians, and economically disadvantaged populations face disproportionately higher risks. The increasing trend in motorcycle-related fatalities and widening socioeconomic inequalities are particularly concerning.

New Trauma Score versus Kampala Trauma Score II in predicting mortality following road traffic crash: a prospective multi-center cohort study.

INTRODUCTION: Mortality due to injuries disproportionately impact low income countries. Knowledge of who is at risk of poor outcomes is critical to guide resource allocation and prioritization of severely injured. Kampala Trauma Score (KTS), developed in 1996 and last modified in 2002 as KTS II, is still widely being used to predict injury outcomes in resource-limited settings with no further revisions in the past two decades, despite ongoing criticism of some of its parameters. The New Trauma Score (NTS), a recent development in 2017, has shown potential in mortality prediction, but a dearth of evidence exist regarding its performance in the African population. OBJECTIVES: To compare NTS to the modified Kampala Trauma Score (KTS II) in the prediction of 30-day mortality, and injury severity amongst patients sustaining road traffic crashes in Ugandan low-resource settings. METHODS: Multi-center prospective cohort study of patients aged 15 years and above. Of the 194 participants, 85.1% were males with a mean age of 31.7 years. NTS and KTS II were determined for each participant within 30-minutes of admission and followed-up for 30 days to determine their injury outcomes. The sensitivity, specificity, and area under receiver operating characteristics curve (AUC) for predicting mortality were compared between the two trauma scores using SPSS version 22. Ethical clearance: Research and Ethics Committee of Kampala International University Western Campus (Ref No: KIU-2022-125). RESULTS: The injury severity classifications based on NTS vs. KTS II were mild (55.7% vs. 25.8%), moderate (29.9% vs. 30.4%), and severe (14.4% vs. 43.8%). The mortality rates for each injury severity category based on NTS vs. KTS II were mild (0.9% v 0%), moderate (20.7% vs. 5.1%), and severe (50% vs. 28.2%). The AUC was 0.87 for NTS (95% CI 0.808-0.931) vs. 0.86 (95% CI 0.794-0.919) for KTS II respectively. The sensitivity of NTS vs. KTS II in predicting mortality was 92.6% (95% CI: 88.9-96.3) vs. 70.4% (95% CI: 63.0-77.8) while the specificity was 70.7% (95% CI: 64.2-77.2) vs. 78.4% (95% CI: 72.1-84.7) at cut off points of 17 for NTS and 6 for KTS II respectively. CONCLUSIONS: NTS was more sensitive but its specificity for purposes of 30-day mortality prediction was lower compared to KTS II. Thus, in low-resourced trauma environment where time constraints and pulse oximeters are of concern, KTS II remains superior to NTS.

Effect of spatial relationship between curves on crash severity at horizontal curves in a mountainous terrain.

The study aimed to model the effect of spatial relationship between adjacent curves on the severity of curve-based crashes along with driver and crash causal characteristics, reflecting driver's short-term expectancy. The crash and other associated data was retrieved from the web-based Road Accident Data Management System available in Himachal Pradesh, India, and curvature attributes were extracted using GIS. Overall, the study included 1113 curve based crashes. The driver's perception of the sharpness of a curve was quantified as a single representative categorical factor based simultaneously on its length and radius using K-Medoid Clustering. Separate crash severity models catering to the two possible approach directions of the subject curve were developed reflecting its independent interaction with its corresponding adjacent curve in each direction. Partial Proportional Odds models were developed to overcome the predictive limitations of Ordinal and Multinomial logit models. Indicators of spatial relationship and the intensity of sharpness of the subject curve were found to be statistically significant. A sharp approach curve (radius:40-60 m) increased the risk of fatality by 2.16 times with a similar increase (2.5 times) observed for a short (length:30-60 m) adjacent curve. Adjacent curves turning in the same direction were 2.34 times more prone to fatalities. A very sharp subject curve with radius ≤ 40 m increased the risk of fatal crashes by 2.5 times, as did the short subject curves (30-60 m) (at least 3 times). Subject curves characterized by a short length and a very sharp curvature contributed relatively 3-4 times more to fatal crashes. The identified risk factors and their impact can help the relevant stakeholders to take appropriate actions and can further assist them in identifying high risk scenarios.

Injury patterns in motor vehicle collision-youth pedestrian deaths.

OBJECTIVE: The objective of this study was to describe fatal pedestrian injury patterns in youth aged 15 to 24 years old and correlate them with motor vehicle collision (MVC) dynamics and pedestrian kinematics using data from medicolegal death investigations of MVCs occurring in the current Canadian motor vehicle (MV) fleet. METHODS: Based on a systematic literature review, MVC-pedestrian injuries were collated in an injury data collection form (IDCF). The IDCF was coded using the Abbreviated Injury Scale (AIS) 2015 revision. The AIS of the most frequent severe injury was noted for individual body regions. The Maximum AIS (MAIS) was used to define the most severe injury to the body overall and by body regions (MAISBR). This study focused on serious to maximal injuries (AIS 3-6) that had an increasing likelihood of causing death. The IDCF was used to extract collision and injury data from the Office of the Chief Coroner for Ontario (OCCO) database of postmortem examinations done at the Provincial Forensic Pathology Unit (PFPU) in Toronto, Canada, and other provincial facilities between 2013 and 2019. Injury data were correlated with data about the MVs and MV dynamics and pedestrian kinematics.The study was approved by the Western University Health Science Research Ethics Board (Project ID: 113440; Lawson Health Research Institute Approval No. R-19-066). RESULTS: There were 88 youth, including 54 (61.4%) males and 34 (38.6%) females. Youth pedestrians comprised 13.1% (88/670) of all autopsied pedestrians. Cars (n = 25/88, 28.4%) were the most frequent type of vehicle in single-vehicle impacts, but collectively vehicles with high hood edges (i.e., greater distance between the ground and hood edge) were in the majority. Forward projection (n = 34/88, 38.6%) was the most frequent type of pedestrian kinematics. Regardless of the type of vehicle, there was a tendency in most cases for the median MAISBR ≥ 3 to involve the head and thorax. A similar trend was seen in most of the pedestrian kinematics involving the various frontal impacts. Of the 88 cases, at least 63 (71.6%) were known to be engaged in risk-taking behaviors (e.g., activity on roadway). At least 12 deaths were nonaccidental (8 suicides and 4 homicides). Some activities may have been impairment related, because 26/63 (41.3%) pedestrians undertaking risk-taking behavior on the roadway were impaired. Toxicological analyses revealed that over half of the cases (47/88, 53.4%) tested positive for a drug that could have affected behavior. Ethanol was the most common. Thirty-one had positive blood results. CONCLUSION: A fatal dyad of head and thorax trauma was observed for pedestrians struck by cars. For those pedestrians hit by vehicles with high hood edges, which were involved in the majority of cases, a fatal triad of injuries to the head, thorax, and abdomen/retroperitoneum was observed. Most deaths occurred from frontal collisions and at speeds more than 35 km/h.

Generation of nighttime pedestrian fatal precrash scenarios at junctions in Tamil Nadu, India, using cluster correspondence analysis.

OBJECTIVE: Modern transportation amenities and lifestyles have changed people's behavioral patterns while using the road, specifically at nighttime. Pedestrian and driver maneuver behaviors change based on their exposure to the environment. Pedestrians are more vulnerable to fatal injuries at junctions due to increased conflict points with vehicles. Generation of precrash scenarios allows drivers and pedestrians to understand errors on the road during driver maneuvering and pedestrian walking/crossing. This study aims to generate precrash scenarios using comprehensive nighttime fatal pedestrian crashes at junctions in Tamil Nadu, India. METHODS: Though numerous studies were available on identifying pedestrian crash patterns, only some focused on identifying crash patterns at junctions at night. We used cluster correspondence analysis (CCA) to address this research gap to identify the patterns in nighttime pedestrian fatal crashes at junctions. Further, high-risk precrash scenarios were generated based on the positive residual means available in each cluster. This study used crash data from the Road Accident Database Management System of Tamil Nadu State in India from 2009 to 2018. Characteristics of pedestrians, drivers, vehicles, crashes, light, and roads were input to the CCA to find optimal clusters using the average silhouette width, Calinski-Harabasz measure, and objective values. RESULTS: CCA found 4 clusters with 2 dimensions as optimal clusters, with an objective value of 3.3618 and a valence criteria ratio of 80.03%. Results from the analysis distinctly clustered the pedestrian precrash behaviors: Clusters 1 and 2 on pedestrian walking behaviors and clusters 3 and 4 on crossing behaviors. Moreover, a hidden pattern was observed in cluster 4, such as transgender drivers involved in fatal pedestrian crashes at junctions at night. CONCLUSION: The generated precrash scenarios may be used to train drivers (novice and inexperienced for nighttime driving), test scenario creation for developing advanced driver/rider assistance systems, hypothesis creation for researchers, and planning of effective strategic interventions for engineers and policymakers to change pedestrian and driver behaviors toward sustainable safety on Indian roads.

Temporal instability of the determinants of fatal/severe elderly pedestrian injury outcomes in intersections and non-intersections before, during, and after the COVID-19 pandemic.

This study examines the variability in the impacts of factors influencing injury severity outcomes of elderly pedestrians (age >64) involved in vehicular crashes at intersections and non-intersections before, during, and after the COVID-19 pandemic. To account for unobserved heterogeneity in the crash data, a random parameters logit model with heterogeneity in the means approach is utilized to analyze vehicle-elderly pedestrian crash data from Seoul, South Korea, occurring between 2018 and 2022. Preliminary transferability tests revealed instability in factor impacts on injury severity outcomes, highlighting the need to estimate individual models across various road segments and time periods. Thus, the dataset was segregated by crash location (intersection/non-intersection) and period (before, during, and after COVID-19), with individual models estimated for each group. Results obtained from the analyses revealed that back injuries positively influenced fatalities at non-intersections after the pandemic and was negatively associated with fatalities at intersections before the pandemic. Additionally, several indicators demonstrated significant instability in their impact magnitudes across different road segments and crash years. During the pandemic, head injuries increased the probability of fatalities higher at non-intersections. After the pandemic, crosswalk locations decreased the possibility of fatalities more at intersections. Compared to intersection segments, the female indicator reduced the likelihood of fatal injuries at non-intersections more before, during, and after the pandemic. Before the pandemic, much older pedestrians experienced a greater decline in fatalities at intersections than non-intersections. This instability could be attributed to altered mobility patterns stemming from the COVID-19 pandemic. Overall, the study findings highlight the variability of determinants of fatal/severe injury outcomes among elderly pedestrians across various road segments and years, with the underlying cause of this fluctuation remaining unclear. Furthermore, the findings revealed that accounting for heterogeneity in the means of random parameters enhances model fit and provides valuable insights for safety professionals. The factor impact variability in the estimated models carries significant implications for elderly pedestrian safety, especially in scenarios where precise projections of the effects of alternative safety measures are essential. Road safety experts can leverage these findings to refine or update current policies to enhance elderly pedestrian safety at intersections and non-intersections.

Injury characteristics and mortality in an emergency department in Ethiopia: a single-center observational study.

INTRODUCTION: An injury is described as any damage to the body that impairs health, and its severity can span from mild to life-threatening. On a global scale, injuries account for approximately 4.4 million deaths annually and are anticipated to become the seventh leading cause of death by 2030. In Ethiopia, injuries account for 7% of all deaths, with one of the world's highest rates of road traffic injuries. This study, undertaken at a primary trauma centre in the capital of Ethiopia, aimed to explore the characteristics of injured patients and emergency department mortality as the patient outcome. Understanding the patterns and outcomes of injuries helps to anticipate needs, prioritize patients, and allocate resources effectively. METHODS: A retrospective single-center observational study utilised patient records from September 2020 to August 2021 at Addis Ababa Burn Emergency and Trauma Hospital, located in Ethiopia. A structured checklist facilitated the data collection. All patients arriving in the ED from September 2020 to August 2021 were eligible for the study while incomplete records (missing > 20% of wanted data elements) were excluded. RESULT: Of the 3502 injured patients recorded during the study period, 317 were selected. The mean patient age was 30 years, with 78.5% being male. About 8% arrived the emergency department within an hour after the injury. Ambulances transported 38.8% of patients; 58.5% of these were referred from other facilities. The predominant mechanism of injury both in and outside Addis Ababa was pedestrian road traffic injuries (31.4% and 38%). The predominant injury type was fractures (33.8%). The mortality rate was 5%, of which half were pedestrian road traffic incidents. CONCLUSION: Pedestrian road traffic injuries were the main cause of injury in and outside of Addis Ababa. A small proportion of patients arrived at the emergency department within the first hour after an injury event. A significant proportion of ambulance-transported patients were referred from other facilities rather than directly from the scene. The overall mortality rate was high, with pedestrian road traffic injury accounting for half of the proportion.

Evaluation and comparison of administrative division-level road traffic safety indices of Egypt, England, Turkey, and the United States.

INTRODUCTION: There is regional diversity inside countries regarding road safety indices (RSIs), and countries rarely have been compared based on these indicators. Thus, regional RSIs of England, the United States, Egypt, and Turkey were evaluated. Regional data were collected from the statistical center of each country. The adopted regional RSIs include road fatalities, health risk (HR) or fatalities per population, and traffic risk (TR) or fatalities per number of vehicles. The associations between variables were examined using correlation and regression analysis. The spatial distributions of subdivisions were evaluated using Moran's I, the local Moran index. RESULTS: Considerable differences between the countries were observed, including differences in the spatial distribution of regions and associations between RSIs. Significant relationships were detected between road fatality, population, and the number of motor vehicles. Higher exposure rates mean higher fatalities in regions. A robust linear relationship between the HR and TR indices was identified in developed countries. There is a nonlinear and significant association between motorization rates and TR indices of regions, and fatality risk decreases as the motorization rate increases. There is a considerable gap between developed and developing countries regarding regional RSIs, and the transferability of road safety models from one country to another is challenging. Huge hotspots regarding RSIs were observed in Turkey and the United States. The locations of hot spots in terms of the risk indices were identical in the developed countries.

Impact of COVID-19 pandemic on road traffic injuries in Iran: An interrupted time-series analysis.

INTRODUCTION: Globally, the COVID-19 pandemic has affected the number of road accidents and deaths caused by them. The present study aimed to identify the effect of this epidemic on traffic accidents and their casualties in Iran. METHODS: In this study, Interrupted Time Series Analysis (ITSA) was used in a semi-experimental design to measure the impact of the restrictive policies of COVID-19 on road accidents. Data were collected retrospectively from the Iran Red Crescent Society data set for 31 provinces from March 2017 to February 2022. The information related to the number of road accidents, injuries, deaths, and deaths in the hospital was collected. The Newey-West method is used for estimation. Statistical analyses were carried out using R software version 3.6.1. RESULTS: Since February 2020 in Iran, the reduction in the number of road accidents and the number of injuries and deaths in these accidents was significant at 5% but the reduction of deaths in the scene and hospital was significant at 10%. In general, for all variables, the reduction trend was established only in the first months, and then it had an upward trend. CONCLUSION: In the early months of the COVID-19 epidemic in Iran, the number of road accidents and their casualties decreased. Policies restricting traffic, quarantine, and fines for violators can be reasons for changing people's behavior and travel patterns and also lead to a reduction in traffic accidents and fatalities. Such studies can explain the importance of the policies in changing behavioural patterns and can be used as a guide in future policies.

Trends in injury-related mortality among residents of Jiangsu Province from 2012 to 2021: an age-period-cohort analysis.

Objective: We investigated the temporal trends and examined age-, period-, and cohort-specific effects of injury-related deaths among residents in Jiangsu to provide evidence for future injury prevention. Methods: This study included 406,936 injury deaths from the Jiangsu provincial population death registration system. The average annual percent change (AAPC) in age-standardized mortality rates (ASMRs) was analyzed using joinpoint regression. Age-period-cohort models were generated to explore the effects of age, period, and birth cohort effects on mortality risk. Results: ASMRs for all injuries (AAPC = -2.3%), road traffic accidents (AAPC = -5.3%), suicide (AAPC = -3.8%), and drowning (AAPC = -3.9%) showed a downward trend during 2012-2021(all p < 0.05), while unintentional falls showed an upward trend (AAPC = 5.1%, p < 0.05). From 2012 to 2021, the age-standardized mortality rates (ASMRs) for four primary types of injuries consistently exhibited higher among males compared to females, with rural regions displaying higher ASMRs than urban areas. Trends in ASMRs for road traffic accidents, drowning, and unintentional falls by sex and urban/rural areas were consistent with overall trends. Significant age, cohort, and period effects were identified in the trends of injury-related deaths for both sexes in Jiangsu. The age effect showed that the highest age effect for injury-related deaths was for the ages of 85 years and above, except for suicide, which was for the ages 80-84 years. Between 2012 and 2021, the period effect on road traffic accidents declined, while that on accidental falls increased. Initially, the period effect on suicide decreased but then rose, peaking in 2012 with a Relative Risk (RR) of 1.11 (95% CI: 1.04-1.19). Similarly, the period effect on drowning initially declined before rising, with the highest effect observed in 2013, at an RR of 1.12 (95% CI: 1.07-1.19). The highest cohort effects for road traffic accidents were observed in the 1957-1961 group, for accidental falls in the 1952-1956 group, and for both drowning and suicide in the 1927-1931 group. Conclusion: The mortality rate of unintentional falls has been increasing. Older adults are at high risk for the four leading injuries. The improvements in mortality rates can be attributed to advancements in education, urbanization, and the promulgation and implementation of laws and policies.

Risk and Protective Factors for Injury in Adult Front- and Rear-Seated Motor Vehicle Occupants in New York State.

Although seatbelt use is known to reduce motor vehicle occupant crash injury and death, rear-seated adult occupants are less likely to use restraints. This study examines risk and protective factors associated with injury severity in front- and rear-seated adults involved in a motor vehicle crash in New York State. The Crash Outcome Data Evaluation System (CODES) (2016-2017) was used to examine injury severity in front- and rear-seated occupants aged 18 years or older (N = 958,704) involved in a motor vehicle crash. CODES uses probabilistic linkage of New York State hospitalization, emergency department, and police and motorist crash reports. Multivariable logistic regression models with MI analyze employed SAS 9.4. Odds ratios are reported as OR with 95% CI. The mortality rate was approximately 1.5 times higher for rear-seated than front-seated occupants (136.60 vs. 92.45 per 100,000), with rear-seated occupants more frequently unrestrained than front-seated occupants (15.28% vs. 1.70%, p < 0.0001). In adjusted analyses that did not include restraint status, serious injury/death was higher in rear-seated compared to front-seated occupants (OR:1.272, 1.146-1.412), but lower once restraint use was added (OR: 0.851, 0.771-0.939). Unrestrained rear-seated occupants exhibited higher serious injury/death than restrained front-seated occupants. Unrestrained teens aged 18-19 years old exhibit mortality per 100,000 occupants that is more similar to that of the oldest two age groups than to other young and middle-aged adults. Speeding, a drinking driver, and older vehicles were among the independent predictors of serious injury/death. Unrestrained rear-seated adult occupants exhibit higher severe injury/death than restrained front-seated occupants. When restrained, rear-seated occupants are less likely to be seriously injured than restrained front-seated occupants.

Lost years, mortality burden: the impact of COVID-19 pandemic on premature death due to road traffic accidents in a northern state in Malaysia.

BACKGROUND: This study addresses the persistent global burden of road traffic fatalities, particularly in middle-income countries like Malaysia, by exploring the impact of the COVID-19 pandemic on Road Traffic Accident (RTA) fatalities in Perak state, Malaysia, with a secondary focus on applying Years of Life Lost (YLL) to understand the implications of these premature deaths. METHODOLOGY: The cross-sectional study retrospectively reviewed certified RTA fatalities from 2018 to 2021, individually counting fatalities in accidents and excluding cases with incomplete death profiles. Data were collected from all Forensic Departments in the government hospitals in Perak. RTA fatalities were confirmed by medical officers/physicians following established procedures during routine procedures. A total of 2517 fatal accident and victim profiles were transcribed into data collection form after reviewing death registration records and post-mortem reports. Inferential analyses were used for comparison between pre- and during COVID-19 pandemic. The standard expected YLL was calculated by comparing the age of death to the external standard life expectancy curve taking into consideration of age and gender in Malaysia. RESULTS: This study included 2207 (87.7%) of the RTA fatalities in Perak State. The analysis revealed a decreasing trend in RTA deaths from 2018 to 2021, with a remarkable Annual Percent Change (APC) of -25.1% in 2020 compared to the pre-pandemic year in 2019 and remained stable with lower APC in 2021. Comparison between pre-pandemic (2018-2019) and pandemic years (2020-2021) revealed a difference in the fatality distribution with a median age rise during the pandemic (37.7 (IQR: 22.96, 58.08) vs. 41.0 (IQR: 25.08, 61.00), p = 0.002). Vehicle profiles remained consistent, yet changes were observed in the involvement of various road users, where more motorcycle riders and pedestrian were killed during pandemic (p = 0.049). During pandemic, there was a decline in vehicle collisions, but slight increase of the non-collision accidents and incidents involving pedestrians/animals (p = 0.015). A shift in accident from noon till midnight were also notable during the pandemic (p = 0.028). YLL revealed differences by age and gender, indicating a higher YLL for females aged 30-34 during the pandemic. CONCLUSION: The decline in RTA fatalities during COVID-19 pandemic underscores the influence of pandemic-induced restrictions and reduced traffic. However, demographic shifts, increased accident severity due to risky behaviors and gender-specific impacts on YLL, stress the necessity for improved safety interventions amidst evolving dynamics.

U.S. Army mortality surveillance in active duty soldiers, 2014-2019.

Mortality surveillance is an important activity for capturing information on a population's health. This retrospective surveillance analysis utilizes administrative data sources to describe active duty U.S. Army soldiers who died from 2014 to 2019, and calculate mortality rates, assess trends by category of death, and identify leading causes of death within subpopulations. During the surveillance period, 2,530 soldier deaths were reported. The highest crude mortality rates observed during the 6-year surveillance period were for deaths by suicide, followed by accidental (i.e., unintentional injury) deaths. The crude mortality rates for natural deaths decreased significantly over the 6-year period, by an average of 6% annually. The leading causes of death were suicide by gunshot wound, motor vehicle accidents, suicide by hanging, neoplasms, and cardiovascular events. Significant differences were observed in the leading causes of death in relation to demographic characteristics, which has important implications for the development of focused educational campaigns to improve health behaviors and safe driving habits. Current public health programs to prevent suicide should be evaluated, with new approaches for firearm safety considered.

Identifying emerging hot spots of road traffic injury severity using spatiotemporal methods: longitudinal analyses on major roads in Ghana from 2005 to 2020.

BACKGROUND: Although road traffic injuries and deaths have decreased globally, there is substantial national and sub-national heterogeneity, particularly in low- and middle-income countries (LMICs). Ghana is one of few countries in Africa collecting comprehensive, spatially detailed data on motor vehicle collisions (MVCs). This data is a critical step towards improving roadway safety, as accurate and reliable information is essential for devising targeted countermeasures. METHODS: Here, we analyze 16 years of police-report data using emerging hot spot analysis in ArcGIS to identify hot spots with trends of increasing injury severity (a weighted composite measure of MVCs, minor injuries, severe injuries, and deaths), and counts of injuries, severe injuries, and deaths along major roads in urban and rural areas of Ghana. RESULTS: We find injury severity index sums and minor injury counts are significantly decreasing over time in Ghana while severe injury and death counts are not, indicating the latter should be the focus for road safety efforts. We identify new, consecutive, intensifying, and persistent hot spots on 2.65% of urban roads and 4.37% of rural roads. Hot spots are intensifying in terms of severity and frequency on major roads in rural areas. CONCLUSIONS: A few key road sections, particularly in rural areas, show elevated levels of road traffic injury severity, warranting targeted interventions. Our method for evaluating spatiotemporal trends in MVC, road traffic injuries, and deaths in a LMIC includes sufficient detail for replication and adaptation in other countries, which is useful for targeting countermeasures and tracking progress.

"We are pleading for the government to do more": Road user perspectives on the magnitude, contributing factors, and potential solutions to road traffic injuries and deaths in Ghana.

Road traffic collisions disproportionately impact Ghana and other low- and middle-income countries. This study explored road user perspectives regarding the magnitude, contributing factors, and potential solutions to road traffic collisions, injuries, and deaths. We designed a qualitative study of 24 in-depth interviews with 14 vulnerable road users (pedestrians, occupants of powered 2- and 3-wheelers, cyclists) and ten non-vulnerable road users in four high-risk areas in November 2022. We used a mixed deductive (direct content analysis) and inductive (interpretive phenomenological analysis) approach. In the direct content analysis, a priori categories based on Haddon's Matrix covered human, vehicle, socioeconomic environment, and physical environment factors influencing road traffic collisions, along with corresponding solutions. We used inductive analysis to identify emerging themes. Participants described frequent and distressing experiences with collisions, and most often reported contributing factors, implementation gaps, and potential solutions within the human (road user) level domain of Haddon's Matrix. Implementation challenges included sporadic enforcement, reliance on road users' adherence to safety laws, and the low quality of the existing infrastructure. Participants expressed that they felt neglected and ignored by road safety decision-makers. This research emphasizes the need for community input for successful road safety policies in Ghana and other low- and middle-income countries, calling for greater governmental support an action to address this public health crisis. We recommend the government collaborates with communities to adapt existing interventions including speed calming, footbridges, and police enforcement, and introduces new measures that meet local needs.

Incidence and predictors of mortality among road traffic accident victims admitted to hospitals at Hawassa city, Ethiopia.

BACKGROUND: Globally, road traffic accidents are the eighth-leading cause of death for all age groups. The estimated number of road traffic deaths in low income countries was more than three times as high as in high-income countries. Africa had the highest rate of fatalities attributed to road traffic accidents. Ethiopia has the highest number of road traffic fatalities among Sub-Saharan African countries. The main objective of this study was to determine the incidence and predictors of mortality among road traffic victims admitted to hospitals in Hawassa City. METHODS: A facility-based retrospective cohort study was conducted using secondary data from hospital records. A total of 398 road traffic accident victims admitted to selected hospitals in Hawassa city from January 2019 to December 2021 participated in the study. Data were analyzed using STATA version 14.1. The Cox regression model was used to determine the predictors of mortality. A hazard ratio with a 95% confidence interval and a cut-off value of P<0.05 was used to declare the risk and statistical significance, respectively. RESULT: The incidence rate of mortality for road traffic accident victims was 7.34 per 10,000 person-hours. The predictors of mortality were the value of GCS at admission <8 (aHR = 5.86; 95% CI: 2.00-17.19), GCS at admission 9-12 (aHR = 3.27; 95% CI: 1.28-8.40), the value of SBP at admission ≤89mmHg (aHR = 4.41; 95% CI: 2.22-8.77), admission to the ICU (aHR = 3.89; 95% CI: 1.83-8.28) and complications (aHR = 5.48; 95% CI: 2.74-10.01). CONCLUSION: The incidence of mortality among road traffic victims admitted to hospitals in Hawassa city was high. Thus, thorough follow-up and intensive management should be given to victims with critical health conditions.