Drivers' behavior confronting fixed and point-to-point speed enforcement camera: agent-based simulation and translation to crash relative risk change.

Utilizing a novel microsimulation approach, this study evaluates the impact of fixed and average point-to-point Speed Enforcement Cameras (SEC) on driving safety. Using the SUMO software, agent-based models for a 6-km highway without exits or obstacles were created. Telematics data from 93,160 trips were used to determine the desired free-flow speed. A total of 13,860 scenarios were simulated with 30 random seeds. The ratio of unsafe driving (RUD) is the spatial division of the total distance travelled at an unsafe speed by the total travel distance. The study compared different SEC implementations under different road traffic and community behaviours using the Power Model and calculated crash risk changes. Results showed that adding one or two fixed SECs reduced RUD by 0.20% (0.18-0.23) and 0.57% (0.54-0.59), respectively. However, average SECs significantly lowered RUD by 10.97% (10.95-10.99). Furthermore, a 1% increase in telematics enforcement decreased RUD by 0.22% (0.21-0.22). Point-to-point cameras effectively reduced crash risk in all implementation scenarios, with reductions ranging from - 3.44 to - 11.27%, pointing to their superiority as speed enforcement across various scenarios. Our cost-conscious and replicable approach can provide interim assessments of SEC effectiveness, even in low-income countries.

Effectiveness of road safety interventions: An evidence and gap map.

Background: Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge. Objectives: The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels. Search Methods: The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019. Selection Criteria: The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes. Data Collection and Analysis: The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2. Main Results: The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality. Authors' Conclusions: The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

The effect of Real-Time feedback and incentives on speeding behaviors using Telematics: A randomized controlled trial.

Speeding behaviour of drivers is highly correlated to their tangible consequence. Therefore, this study aimed to evaluate the effectiveness of telematics-based feedback and financial incentives in reducing speeding behaviors through a randomized controlled field trial. This randomized controlled trial included four groups of (1) control, (2) information-only, (3) gain-of-reward, and (4) loss-of-reward. While drivers of the control group were unobtrusively monitored using telematics devices, drivers of the information-only group received real-time, weekly, and monthly feedback via text message. In both groups with financial incentives, in addition to receiving feedback, drivers could receive payments at the end of each month based on observed speeding. The primary outcome was the distance traveled at speeds more than 10% (S10 + ) above the posted speed limit as a proportion of the total traveled distance. A total of 397 male taxi drivers consented to participate in the study. After the stratified randomization, the mean age of the participant was 46.0 (95% Confidence Interval: 43.8 to 48.2), 47.0 (44.7 to 49.3), 46.1 (43.7 to 48.5), and 48.8 (46.5 to 51.1) years for the control, the information-only, the gain-of-reward, and the loss-of-reward groups, respectively. The mean S10 + rate per 100 km was 0.9 (0.5 to 1.2) for the control, 0.8 (0.4 to 1.1) for the information-only, 0.7 (0.3 to 1.1) for the gain-of-reward, and 1.3 (0.4 to 2.2) for the loss-of-reward group at the start of intervention. During the intervention phase, the loss-of-reward group with 0.6 (0.5 to 0.7) had the lowest mean of S10 + rate, followed by the gain-of-reward group with 0.8 (0.7 to 0.8). The loss-of-reward and gain-of-reward groups were the most influenced groups by the intervention, with 38.0% (13.2 to 55.7; p-value < 0.01) and 29.4% (2.0 to 49.2; p-value = 0.04) less S10 + rate than the control group, respectively. It was figured out that providing information regarding drivers' behavior without appropriating motives or penalties would have a minuscule impact.In addition, the group of drivers who were treated with instant punishment was the most influenced group by the intervention.

Developing a national database of police-reported fatal road traffic crashes for road safety research and management in India.

Strengthening crash surveillance is an urgent priority for road safety in low- and middle-income countries. We reviewed the online availability and completeness of First Information Reports (FIRs; police reports) of road traffic crashes in India. We developed a relational database to record information extracted from FIRs, and implemented it for one state (Chhattisgarh, 2017-2019). We found that FIRs can be downloaded in bulk from government websites of 15 states and union territories. Another 14 provide access online but restrict bulk downloading, and 7 do not provide online access. For Chhattisgarh, 87% of registered FIRs could be downloaded. Most FIRs reported the date, time, collision-type, and vehicle-types, but important crash characteristics (e.g. infrastructure attributes) were missing. India needs to invest in building the crash surveillance capacity for research and safety management. However, in the interim, maintaining a national database of a sample of FIRs can provide useful policy guidance.

Assessing discrepancies in estimates of road traffic deaths in Brazil.

INTRODUCTION: The First UN Decade of Action for Road Safety (2011-2020) ended with most low/middle-income countries (LMICs) failing to reduce road traffic deaths. In contrast, Brazil reported a strong decline starting in 2012. However, comparisons with global health statistical estimates suggest that official statistics from Brazil under-report traffic deaths and overestimate declines. Therefore, we sought to assess the quality of official reporting in Brazil and explain discrepancies. METHODS: We obtained national death registration data and classified deaths to road traffic deaths and partially specified causes that could include traffic deaths. We adjusted data for completeness and reattributed partially specified causes proportionately over specified causes. We compared our estimates with reported statistics and estimates from the Global Burden of Disease (GBD)-2019 study and other sources. RESULTS: We estimate that road traffic deaths in 2019 exceeded the official figure by 31%, similar to traffic insurance claims (27.5%) but less than GBD-2019 estimates (46%). We estimate that traffic deaths have declined by 25% since 2012, close to the decline estimated by official statistics (27%) but much more than estimated by GBD-2019 (10%). We show that GBD-2019 underestimates the extent of recent improvements because GBD models do not track the trends evident in the underlying data. CONCLUSION: Brazil has made remarkable progress in reducing road traffic deaths in the last decade. A high-level evaluation of what has worked in Brazil could provide important guidance to other LMICs.

Estimated potential death and disability averted with vehicle safety interventions, Association of Southeast Asian Nations.

Objective: To evaluate road safety in member countries of the Association of Southeast Asian Nations and estimate the benefits that vehicle safety interventions would have in this group of countries. Methods: We used a counterfactual analysis to assess the reduction in traffic deaths and disability-adjusted life years (DALYs) lost if eight proven vehicle safety technologies and motorcycle helmets were entirely in use in countries of the Association of Southeast Asian Nations. We modelled each technology using country-level incidence estimations of traffic injuries, and the prevalence and effectiveness of the technology to calculate the reduction in deaths and DALYs if the technology was fitted in the entire vehicle fleet. Findings: The availability of electronic stability control, including the antilock braking systems, would provide the most benefits for all road users with estimates of 23.2% (sensitivity analysis range: 9.7-27.8) fewer deaths and 21.1% (9.5-28.1) fewer DALYs. Increased use of seatbelts was estimated to prevent 11.3% (8.11-4.9) of deaths and 10.3% (8.2-14.4) of DALYs. Appropriate and correct use of motorcycle helmets could result in 8.0% (3.3-12.9) fewer deaths and 8.9% (4.2-12.5) fewer DALYs. Conclusion: Our findings show the potential of improved vehicle safety design and personal protective devices (seatbelts and helmets) to reduce traffic deaths and disabilities in the Association of Southeast Asian Nations. These improvements can be achieved by vehicle design regulations and creating consumer demand for safer vehicles and motorcycle helmets through mechanisms such as new car assessment programmes and other initiatives.

Neighborhood infrastructure-related risk factors and non-communicable diseases: a systematic meta-review.

BACKGROUND: With rapid urbanization, the urban environment, especially the neighborhood environment, has received increasing global attention. However, a comprehensive overview of the association between neighborhood risk factors and human health remains unclear due to the large number of neighborhood risk factor-human health outcome pairs. METHOD: On the basis of a whole year of panel discussions, we first obtained a list of 5 neighborhood domains, containing 33 uniformly defined neighborhood risk factors. We only focused on neighborhood infrastructure-related risk factors with the potential for spatial interventions through urban design tools. Subsequently, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, a systematic meta-review of 17 infrastructure-related risk factors of the 33 neighborhood risk factors (e.g., green and blue spaces, proximity to major roads, and proximity to landfills) was conducted using four databases, Web of Science, PubMed, OVID, and Cochrane Library, from January 2000 to May 2021, and corresponding evidence for non-communicable diseases (NCDs) was synthesized. The review quality was assessed according to the A MeaSurement Tool to Assess Systematic Reviews (AMSTAR) standard. RESULTS: Thirty-three moderate-and high-quality reviews were included in the analysis. Thirteen major NCD outcomes were found to be associated with neighborhood infrastructure-related risk factors. Green and blue spaces or walkability had protective effects on human health. In contrast, proximity to major roads, industry, and landfills posed serious threats to human health. Inconsistent results were obtained for four neighborhood risk factors: facilities for physical and leisure activities, accessibility to infrastructure providing unhealthy food, proximity to industry, and proximity to major roads. CONCLUSIONS: This meta-review presents a comprehensive overview of the effects of neighborhood infrastructure-related risk factors on NCDs. Findings on the risk factors with strong evidence can help improve healthy city guidelines and promote urban sustainability. In addition, the unknown or uncertain association between many neighborhood risk factors and certain types of NCDs requires further research.

Addressing discrepancies in estimates of road traffic deaths and injuries in Ethiopia.

BACKGROUND: There are large discrepancies between official statistics of traffic injuries in African countries and estimates from the Global Burden of Disease (GBD) study and WHO's Global Status Reports on Road Safety (GSRRS). We sought to assess the magnitude of the discrepancy in Ethiopia, its implications and how it can be addressed. METHODS: We systematically searched for nationally representative epidemiological data sources for road traffic injuries and vehicle ownership in Ethiopia and compared estimates with those from GBD and GSRRS. FINDINGS: GBD and GSRRS estimates vary substantially across revisions and across projects. GSRRS-2018 estimates of deaths (27 326 in 2016) are more than three times GBD-2019 estimates (8718), and these estimates have non-overlapping uncertainty ranges. GSRRS estimates align well with the 2016 Demographic and Health Survey (DHS-2016; 27 838 deaths, 95th CI: 15 938 to 39 738). Official statistics are much lower (5118 deaths in 2018) than all estimates. GBD-2019 estimates of serious non-fatal injuries are consistent with DHS-2016 estimates (106 050 injuries, 95th CI: 81 728 to 130 372) and older estimates from the 2003 World Health Survey. Data from five surveys confirm that vehicle ownership levels in Ethiopia are much lower than in other countries in the region. INTERPRETATION: Inclusion of data from national health surveys in GBD and GSRRS can help reduce discrepancies in estimates of deaths and support their use in highlighting under-reporting in official statistics and advocating for better prioritisation of road safety in the national policy agenda. GBD methods for estimating serious non-fatal injuries should be strengthened to allow monitoring progress towards Sustainable Development Goal target 3.6.

The effectiveness of fixed speed cameras on Iranian taxi drivers: An evaluation of the influential factors.

Background: The adherence to speed limits can reduce deaths associated with road traffic injuries (RTIs) by more than a quarter. This study aimed to evaluate the effective factors on the speeding behavior of Iranian taxi drivers around fixed speed cameras. Method: Telematics devices used in this study collected the location and speed of the vehicles. The units of analysis in this study were trips per camera, including 2.5 km before and after each camera. Linear regression analysis was used to identify kangaroo driving (KD), defined as trips with a significant V-shape in speed distribution around the camera. In the clustered camera zones, cameras were placed at regular intervals of approximately 3.5 km. Findings: A total of 93,160 trips were recorded from 13,857,443 data points. There was an inverse association between drivers' age and KD with an odds ratio (OR) of 0.98 (95% confidence interval: 0.98-0.98). The intercity trips had a substantially higher probability of KD than urban trips (OR: 4.94 [4.73-5.16]). The tendency of drivers toward KD during the daylight hours vs. nighttime was significant for both urban (OR: 1.15 [1.06-1.25]) and intercity (OR: 1.18 [1.14-1.22]) trips. The 4 -8 a.m. period had the highest chance of KD in both urban (10.71% [7.41-14.53]) and intercity (44.13% [41.18-47.09]) trips. There was a significant decrease in the odds of KD inside the clustered camera zones (OR: 0.22 [0.20-0.25]). Conclusion: The heterogeneous occurrence of KD in different locations and times indicates the necessity of evidence-based decision-making in urban planning to improve safe driving behaviors. The lower occurrence of KD in clustered camera zones could be a practical key to the effective control of speeding behaviors by helping in the efficient placement of cameras through sustainable development of cities and roads.

The effect of non-punitive peer comparison and performance feedback on drivers' behavior using the telematics: The first randomized trial in Iran.

BACKGROUND: Aggressive driving is the leading behavior resulting in fatal or nonfatal disabling injuries. Therefore, programs with the main focus on driving behavior could reduce the risk of traffic injuries remarkably. We aimed to investigate the role of non-punitive performance feedback on drivers' behavior and evaluate the persistence of the altered behavior by using in-vehicle telematics. METHODS: This study was done as a randomized controlled trial by repeated-measures design to evaluate the non-punitive behavioral intervention's efficacy on the behavioral transition to safer driving for 1,289 bus and 104 taxi drivers. All participants were studied during 17 weeks through three stages: stage 0 (five weeks for collecting the baseline characteristics of the participants), stage 1 (nine weeks for randomizing the participants into intervention group or control group and sending the intervention group feedback via short message service), and stage 2 (three weeks for following-up the participants without sending feedback). The intervention group drivers received weekly text messages about the driving score and drivers' rank within their peer group.The study's primary outcome was the driver score changing pattern throughout the study calculated by a neuro-fuzzy scoring system composed of four factors: speed violation, harsh acceleration, harsh braking, and harsh turning. RESULTS: Among the bus drivers, a significant positive effect of the intervention was found in stage 1 (P<0.0001) and in stage 2 (P<0.0001) regarding the calculated scoring system. Among the taxi drivers, a significant positive effect of the intervention was found in stage 1 (P<0.0001), but the effect was not significant in stage 2 (P=0.15). CONCLUSION: The results of this study were in favor of using telematics and its positive effect on driving performance. The reformed behavior persisted even after the intervention ceased. PRACTICAL APPLICATION: Behavioral interventions could be considered a promising strategy to enhance and promote safe driving performance.

Estimates of road traffic deaths in Tanzania.

INTRODUCTION: There is considerable uncertainty in estimates of traffic deaths in many sub-Saharan African countries, with the Global Burden of Disease (GBD) and the Global Status Report on Road Safety (GSRRS) reporting widely differing estimates. As a case study, we reviewed and compared estimates for Tanzania. METHODS: We estimated the incidence of traffic deaths and vehicle ownership in Tanzania from nationally representative surveys. We compared findings with GBD and GSRRS estimates. RESULTS: Traffic death estimates based on the 2012 census (9382 deaths; 95% CI: 7565 to 11 199) and the 2011-2014 Sample Vital Registration with Verbal Autopsy (8778; 95% CI: 7631 to 9925) were consistent with each other and were about halfway between GBD (5 608; 95% UI: 4506 to 7014) and WHO (16 252; 95% CI: 13 130 to 19 374) estimates and more than twice official statistics (3885 deaths in 2013). Surveys and vehicle registrations data show that motorcycles have increased rapidly since 2007 and now comprise 66% of vehicles. However, these trends are not reflected in GBD estimates of motorcycles in the country, likely resulting in an underestimation of motorcyclist deaths. CONCLUSION: Reducing discrepancies between GBD and GSRRS estimates and demonstrating consistency with local epidemiological data will increase the legitimacy of such estimates among national stakeholders. GBD, which is the only project that models the road-user distribution of traffic deaths in all countries, likely severely underestimates motorcycle deaths in countries where there has been a recent increase in motorcycles. Addressing police under-reporting and strengthening surveillance capacity in Tanzania will allow a better understanding of the road safety problem and better targeting of interventions.

A systematic review and meta-analysis of the impact of curbs on crash outcomes.

INTRODUCTION: Road traffic crashes involving vertical curbs are commonly reported to occur on highways and expressways in India. We found a gap in terms of systematically assessing the evidence of the impact of curbs on road safety outcomes in the real world. METHOD: We conducted a systematic review and meta-analysis of the impact of curbs on the risk of road traffic injuries. We used keywords in a database of records prepared by an earlier evidence gap map (EGM). The EGM used a comprehensive search strategy including 6 academic database, 17 organizational websites, hand searching, contacting experts and back referencing. RESULTS: We found 4 studies that evaluated impact of a curbed median or a curbed shoulder. We found that the presence of a curb on a median increases the risk for all crashes, all single-vehicle crashes, all median-related crashes and median-related injury crashes. The data also indicate that the severity of accidents reduces for curbs on median while it increases for curbs on shoulder, though the latter effect is not statistically significant. All the epidemiological studies were conducted on rural highways and did not report effects for different traffic speeds or vehicle types. However, our review of crash tests and simulation studies indicates that the impact of a curb design may be highly sensitive to speed and vehicle types. CONCLUSIONS: The safety impacts of a curb depend on the context of the road. In an urban road, a curb should ensure safety of pedestrians from an errant vehicle. On high-speed rural roads, curbs should be avoided and treatments should facilitate safe departure of the vehicle from the roadway.

Comparing estimates of road traffic deaths and non-fatal road traffic injuries in Cambodia.

INTRODUCTION: Timely, accurate and detailed information about traffic injuries are essential for managing national road safety programmes. However, there is considerable under-reporting in official statistics of many low and middle-income countries (LMICs) and large discrepancies between estimates from the Global Burden of Disease (GBD) study and WHO's Global Health Estimates (GHE). We compared all sources of epidemiological information on traffic injuries in Cambodia to guide efforts to improve traffic injury statistics. METHODS: We estimated the incidence of traffic deaths and injuries and household ownership of motor vehicles in Cambodia from nationally representative surveys and censuses. We compared findings with GDB and GHE estimates. RESULTS: We identified seven sources for estimating traffic deaths and three for non-fatal injuries that are not included as data sources in GBD and GHE models. These sources and models suggest a fairly consistent estimate of approximately 3100 deaths annually, about 50% higher than official statistics, likely because most hospital deaths are not recorded. Surveys strongly suggest that the vehicle fleet is dominated by motorcycles, which is not consistent with GBD estimates that suggest similar numbers of motorcyclist and vehicle occupant deaths. Estimates of non-fatal injuries from health surveys were about 7.5 times official statistics and 1.5 times GBD estimates. CONCLUSION: Including local epidemiological data sources from LMICs can help reduce uncertainty in estimates from global statistical models and build trust in estimates among local stakeholders. Such analysis should be used as a benchmark to assess and strengthen the completeness of reporting of the national surveillance system.

Availability of population-level data sources for tracking the incidence of deaths and injuries from road traffic crashes in low-income and middle-income countries.

INTRODUCTION: Tracking progress towards Sustainable Development Goal (SDG) 3·6 of reducing traffic deaths and serious injuries poses a measurement challenge in most low-income and middle-income countries (LMICs) due to large discrepancies between reported official statistics and estimates from global health measurement studies. We assess the extent to which national population censuses and health surveys can fill the information gaps. METHODS: We reviewed questionnaires for nationally representative surveys and censuses conducted since 2000 in LMICs. We identified sources that provide estimates of household ownership of vehicles, incidence of traffic deaths and non-fatal injuries, and prevalence of disability. RESULTS: We identified 802 data sources from 132 LMICs. Sub-Saharan African countries accounted for 43% of all measurements. The number of measurements since 2000 was high, with 97% of the current global LMIC population having at least one measurement for vehicle ownership, 77% for deaths, 90% for non-fatal injuries and 50% for disability due to traffic injuries. Recent data (since 2010) on traffic injuries were available from far fewer countries (deaths: 21 countries; non-fatal injuries: 62 and disability: 12). However, there were many more countries with recent data on less-specific questions about unintentional or all injuries (deaths: 41 countries, non-fatal: 87, disability: 32). CONCLUSION: Traffic injuries are substantially underreported in official statistics of most LMICs. National surveys and censuses provide a viable alternative information source, but despite a large increase in their use to monitor SDGs, traffic injury measurements have not increased. We show that relatively small modifications and additions to questions in forthcoming surveys can provide countries with a way to benchmark their existing surveillance systems and result in a substantial increase in data for tracking road traffic injuries globally.

Effects of vehicle safety design on road traffic deaths, injuries, and public health burden in the Latin American region: a modelling study.

BACKGROUND: The Sustainable Development Goals (SDGs), which aim to halve global traffic deaths by 2020, will not be met by most low-income and middle-income countries (LMICs). In Latin America and the Caribbean (LAC) region, traffic deaths have remained stable at a high-level despite strong progress in other health domains. We evaluated the effects of road safety interventions in LAC and estimated the benefits that vehicle design improvements would have in this region. METHODS: In our study done in October, 2018, we used a counterfactual analysis to assess the reduction in deaths and disability-adjusted life years (DALYs) lost if eight proven vehicle safety technologies were made more widely available in LAC countries. We estimated: (1) country-level incidence of traffic injuries, (2) the effectiveness of technologies through a systematic literature review, (3) the prevalence of car safety technologies, and (4) the lives saved and DALYs averted if all cars had these technologies. We characterised uncertainty in estimates by reporting the sensitivity of the results to alternative modelling assumptions. FINDINGS: Increasing availability of electronic stability control, which includes antilock-brake systems, would have the largest benefits in the LAC region, estimated at 19·4% (sensitivity analysis range 8·6-31·1) fewer deaths and 17·0% (5·7-29·2) fewer DALYs. Increasing use of seatbelts would reduce deaths by 12·1% (9·1-15·5) and DALYs by 12·6% (9·4-16·3). Optimisation for side-impacts would result in 6·3% (3·1-6·5) fewer deaths, and improvements to vehicle front-end design would result in 6·0% (2·2-10·4) fewer deaths. The overall effect of improved vehicle design in the region would be 28·1% (12·8-39·2) fewer deaths, and 29·1% (13·5-39·8) fewer DALYs. Other safety technologies modelled, including airbag (front and side), side door beam, and side structure and padding, have smaller benefits. INTERPRETATION: Regulating and encouraging the use of proven vehicle safety technologies in LMICs would have large gains and needs to be prioritised in the SDG agenda for 2030. FUNDING: Inter-American Development Bank.