Distribution of road traffic deaths by road user group: a global comparison.

BACKGROUND: Road traffic deaths are a major global health and development problem. An understanding of the existing burden of road traffic deaths in the population is necessary for developing effective interventions. OBJECTIVE: To outline systematically the global distribution of road traffic deaths by road user groups (pedestrians, bicyclists, motorcyclists, motorised four-wheeler occupants). METHODS: Comprehensive searches of PubMed, Google, Google Scholar, TransportLink, grey literature and reference lists and communication with experts from international organisations and country-level institutions were conducted to identify eligible studies and data sources. All data sources that provided a breakdown of road traffic deaths by road user group at the national or sub-national level were eligible for inclusion. A breakdown of road traffic deaths by road user group was constructed for 14 epidemiologically defined World Health Organization (WHO) sub-regions in addition to World Bank income categories. In addition, the total number of road traffic fatalities by road user group in low-income, middle-income and high-income countries was estimated. RESULTS: The breakdown of road traffic deaths by road user group varies dramatically across epidemiological WHO sub-regions. The magnitude of pedestrian fatalities ranges from more than half in African sub-region AfrE (55%) to 15% or less in AmrA or EurA. The distribution also varies across low-income, middle-income and high-income countries. 45% of road traffic fatalities in low-income countries are among pedestrians, whereas an estimated 29% in middle-income and 18% in high-income countries are among pedestrians. The burden of road traffic injuries on vulnerable road users differs substantially across income levels. An estimated total of 227,835 pedestrians die in low-income countries, as opposed to 161,501 in middle-income countries and 22,500 in high-income countries each year. CONCLUSIONS: Ameliorating road safety requires the implementation of context-specific solutions. This review of the road traffic injury literature provides strong evidence that the distribution of road traffic fatalities varies dramatically across different parts of the world. Therefore, context-appropriate and effective prevention strategies that protect the particular at-risk road user groups should be carefully investigated.

Road-traffic deaths in China, 1985-2005: threat and opportunity.

OBJECTIVE: To examine recent trends and geographic variations in road-traffic deaths in China. DESIGN: A longitudinal descriptive analysis of national and provincial data on road-traffic deaths, examining recent trends and geographic variations. SETTING: China, 1985-2005. DATA SOURCES: The Transportation and communications yearbook of China (1986-2006) and the National statistics yearbook of China (1996-2006). MAIN OUTCOME MEASURES: The percentage change in death rates per 100,000 population was used to examine the trend. Epi Info was used to map the geographic distribution of road-traffic death rates and the increases in rates. Correlation coefficients were calculated between per capita gross regional product, road quality, and the number of motor vehicles in the 31 provinces, to help understand the geographic variations in road-traffic mortality at the provincial level in China. RESULTS: The road-traffic death rate increased by 95%, from 3.9/100,000 persons in 1985 to 7.6/100,000 persons in 2005. High death rates and the greatest increases in death rates occurred in both developed provinces in the southeast and underdeveloped northern and western provinces. Xizang/Tibet, Qinghai, and Xinjiang, with the lowest population density, had the highest death rates per 100 vehicles. CONCLUSIONS: China's government should introduce and support measures to prevent road-traffic injuries. Developed and underdeveloped provinces in China should both be considered when road-traffic policy and interventions are developed.

Injury control: an opportunity for China.

Injury control is an important health issue in China, but has been less well explored than in other countries. To encourage health policy makers to give greater attention to injury control, this report highlights the great damage caused by injuries and the neglected status of injury control in China. China's situation and the experiences and lessons from industrialized countries, especially the USA, are summarized. Finally, two opportunities to improve injury control in China are identified: establishment of a mechanism for multi-department coordination and collaboration; and improvement of injury data surveillance.

Familial study of prostate cancer in Jamaica.

OBJECTIVES: Rates of prostate cancer in Kingston, Jamaica are extremely high (occurring in more than 300 men out of 100,000 in 1989 to 1993). This article addresses the familial aggregation of prostate cancer in Jamaica. Early evidence for familial prostate cancer was found in the Utah Mormon population. Increased risk of prostate cancer in men with a family history of prostate cancer has been consistently observed in subsequent studies. There have been few studies, however, involving black men, who are known to have an overall higher risk of developing prostate cancer. METHODS: Two hundred sixty-three patients with prostate cancer documented by histology were studied. Two hundred sixty-three age-matched control patients were used for comparison. Extensive pedigrees were obtained for both patients with cancer and controls. Data on other malignancies including lung, breast, colon, stomach, and uterine were also collected. RESULTS: The patients with cancer and the controls were comparable with respect to age and family size. Thirty patients with cancer had a first degree relative (ie, brother, father, or son) with prostate cancer compared to 15 controls. The odds ratio is 2.1 (95% confidence interval 1.1 to 4.4). Nine patients with cancer had a second degree relative (ie, grandfather, grandson, or uncle) affected compared to 3 controls. The odds ratio is 3.1 (95% confidence interval 0.8 to 17.8). There was no statistically significant difference in the rates of any of the other cancers studied. CONCLUSIONS: Familial aggregation of prostate cancer is clearly evident in black Jamaican men. A man with one first degree relative with prostate cancer is twice as likely as the general population to develop prostate cancer. In addition, there may be a statistical difference in the risk of developing prostate cancer if an individual has one second degree relative affected.

The uncounted dead--American civilians dying overseas.

The Federal Government, U.S. physicians, their patients who travel, insurance companies, the travel industry, and multinational corporations should know the health hazards facing Americans overseas. However, the deaths overseas of almost 5,000 Americans every year have never been analyzed. A previously unreported, unexamined data source is analyzed by cause, sex, age, length of stay, and country of death of Americans dying overseas. The major findings are 1. Most Americans who die overseas die in the developed countries of Western Europe, where most Americans live or visit. The patterns of deaths in these countries are similar to death patterns in the United States. 2. Surprisingly, the deaths of Americans in less developed countries are not from infectious and tropical disease, as many health professionals would expect, but are from chronic diseases, injuries, suicides, and homicides. The importance of these findings for the Federal Government, travelers' clinics, insurance companies, multinational corporations, and Americans living and traveling overseas is discussed.

Lobbying for international health: the link between good ideas and funded programs: Bread for the World and the Agency for International Development.

Historically, the Agency for International Development (AIDS) health budget has been closely tied to overall development spending. A large increase in the international health appropriations in 1984 broke this pattern. Investigation shows that active grass roots organizing and congressional lobbying are the most likely responsible factors in the increase. Maintenance and expansion of this success will require increased recognition of and participation in these activities by individuals and organizations involved in international health.

A US International Health Service Corps. Options and constraints.

A US International Health Service Corps to place American health professionals in developing countries is under consideration. The various options for such a corps are examined in light of past attempts, present needs, and future potential. Justifications, costs, benefits, administrative/legislative mechanisms, and alternative ways to meet US international health goals are evaluated. We conclude that there are more feasible ways to meet US international health objectives than through a governmental International Health Service Corps.

Projected needs of health manpower in Saudi Arabia, 1974-90.

Although our projections are not completely accurate, due to inadequate data and crude methods of approximation, three conclusions are inescapable: 1. The nation should give priority to planning new schools for health administrators and rural health workers, and to generally expanding present schools for paramedicals. 2. Plans should proceed rapidly for the two new medical schools. 3. A Health Manpower plan based on census information and special studies should be developed over the next 2 years. This plan should have input from all concerned ministries. (The Ministry of Health has regarded a proposal from University Associate "a group of Harvard, Johns Hopkins and A.U.B. professors" for technical cooperation in health services planning.)

American travel deaths in Mexico. Causes and prevention strategies.

About 3 to 4 million Americans travel to Mexico every year, yet their mortality experience has never been analyzed. Fatalities among US travelers to Mexico during the years 1975 and 1984 were examined using a previously unanalyzed data source. The leading cause of death to all US travelers to Mexico was injuries (51%), with 18% of deaths resulting from motor vehicle crashes. Of all travelers' deaths, 37% were due to circulatory diseases and less than 1% were due to infectious diseases. While the proportion of all deaths from motor vehicle crashes was similar for US citizens traveling in Mexico and US residents, travelers had significantly higher proportions of injury deaths due to aircraft crashes and drowning. Injury, rather than infectious diseases, appears to pose the greatest risk of death to travelers to Mexico. Physicians and travel clinics need to place greater emphasis on injury prevention when giving advice to clients traveling to Mexico.

Overseas fatalities of United States citizen travelers: an analysis of deaths related to international travel.

STUDY OBJECTIVE: Studies of travel-related mortality and morbidity have been limited to nonfatal events. Causes of travel-related mortality may differ significantly from morbidity and thus have different prevention strategies. DESIGN: We examined the overseas fatalities of US citizen travelers for the years 1975 and 1984. The death certificates were abstracted; all deaths under age 60 and a 20% sample of deaths 60 and older were examined. SETTING AND TYPE OF PARTICIPANTS: All overseas travel fatalities of US citizens were examined excluding those occurring in Canada. INTERVENTIONS: None. RESULTS: Cardiovascular events (including myocardial infarctions and cerebrovascular accidents) and injuries accounted for 49% and 25% of the overseas deaths of US citizen travelers, respectively. Infectious diseases other than pneumonia accounted for only 1% of the deaths. Eighty percent of injury deaths occurred outside of hospitals. Injury death rates for male travelers were greater than US age-specific death rates. CONCLUSIONS: Greater emphasis on the prevention of fatal events, especially those resulting from injury, must be given by physicians and other individuals and organizations who advise travelers. Further studies are needed to explore the issues of preventable injury deaths, emergency medical services, and overseas travel.

Productivity losses from injury in China.

OBJECTIVE: To examine the productivity losses and costs of injury and disease in China using an improved approach. METHODS: Potentially productive years of life lost (PPYLL) were calculated for injury and four major disease groups (respiratory, cardiovascular, infectious, neoplastic). DATA SOURCES: The mortality data are from the 1999 National Health Statistics Report and the morbidity data from the 1998 Second National Health Service Survey Report. RESULTS: Injuries caused an annual PPYLL of 12.6 million years, more than for any disease group. The estimated annual economic cost of injury is equivalent to US dollars 12.5 billion, almost four times the total public health services budget of China. Motor vehicle fatalities accounted for 25% of the total PPYLL from all injury deaths. CONCLUSION: Injury control and prevention programs merit priority to reflect the social and economic burden of injury in China.

US physicians in international health. Report of a current survey.

Little is known about the magnitude and specifics of current involvement of US physicians in international health. This report presents results of a survey of 1,257 organizations with interests in international health work and discusses career opportunities and needed training for US physicians in international health.

United States health professionals in international health work.

This article reports results of a survey of 1,257 potential employers of US health professionals overseas, interviews with informants in international health, an analysis of career patterns of a small group of international health workers, and a review of numbers of health professionals trained in schools of public health for international health work. There are approximately 9,000 US health professionals in the international health field. Doctors (1,400), nurses (1,500) and administrators (900) are the largest groups. Church-related agencies (2,200 people), private voluntary agencies (1,700 people), and universities (1,000 people) are the largest employers.

The epidemiology of prostate cancer in Jamaica.

PURPOSE: Before this study, the highest reported incidence of prostate cancer in the world was thought to be among United States black men. The age adjusted rates in 1992 for United States black and white men were 249 and 182/100,000 respectively. The epidemiology of prostate cancer in Jamaica, a country of 2.5 million people of primarily African descent, was studied and compared with that of white and black Americans. MATERIALS AND METHODS: The study included 1,121 cases of prostate cancer diagnosed from 1989 to 1994. Sources of information included the Jamaican Cancer Registry, government pathology laboratory, hospital and clinic records, and physician office records. Incidence rates were computed using data from the 1991 Jamaican census. Age adjustments were made using the 1970 United States standard population. RESULTS: The average age adjusted incidence of prostate cancer in Kingston, Jamaica was 304/100,000 men. Median patient age at diagnosis was 72 years. More than 80% of the cases were pathologically confirmed. Of the patients 30% presented with acute urinary retention, 16% presented with bone metastases, 15% had gross hematuria at the time of diagnosis and an abnormal rectal examination suspicious for cancer was noted in 42%. Prostate specific antigen was measured in only 7% of cases in 1989 but in 48% of cases by 1994. CONCLUSIONS: These data demonstrate that Jamaican men in Kingston have a high incidence of prostate cancer, much higher than even black Americans during a similar period. Furthermore, the cancers are more significant clinically with greater morbidity in Jamaica than in the United States.