Health Benefits of Strategies for Carbon Mitigation in US Transportation, 2017‒2050.

Objectives. To quantify health benefits and carbon emissions of 2 transportation scenarios that contrast optimum levels of physical activity from active travel and minimal air pollution from electric cars. Methods. We used data on burden of disease, travel, and vehicle emissions in the US population and a health impact model to assess health benefits and harms of physical activity from transportation-related walking and cycling, fine particulate pollution from car emissions, and road traffic injuries. We compared baseline travel with walking and cycling a median of 150 weekly minutes for physical activity, and with electric cars that minimized carbon pollution and fine particulates. Results. In 2050, the target year for carbon neutrality, the active travel scenario avoided 167 000 deaths and gained 2.5 million disability-adjusted life years, monetized at $1.6 trillion using the value of a statistical life. Carbon emissions were reduced by 24% from baseline. Electric cars avoided 1400 deaths and gained 16 400 disability-adjusted life years, monetized at $13 billion. Conclusions. To achieve carbon neutrality in transportation and maximize health benefits, active travel should have a prominent role along with electric vehicles in national blueprints. (Am J Public Health. 2022; 112(3):426-433. https://doi.org/10.2105/AJPH.2021.306600).

Application of Quantile Mixed Model for modeling Traffic Barrier Crash Cost.

Run-off the road crashes account for a significant proportion of severe injuries to vehicle occupants. Traffic barriers have been installed with an objective to keep vehicles on the roadway, and prevent them from hitting natural obstacles like trees or boulders. However, still injuries and fatalities of barrier crashes account for high proportion of fatalities on roadway. Due to challenging geometrics characteristics of Wyoming's roadway, a high mileage of barriers has been installed in the state. The high mileages of barriers result in a high number of barrier crashes in terms of crash frequency and severity due to high exposure. Previous studies mainly focused on crash frequency or individual crash severity. However, it has been recognized the importance of accounting for both aspects of crash severity, and crash frequency. So, in this study, crashes are aggregated across different barriers, and those crashes were converted into costs by considering the impacts of both crash severity and frequency. However, one of the main challenges of this type of dataset is highly skewness of crash data due to its sparseness nature. An improper use of model distribution of crash cost would result in biased estimations of the covariates, and erroneous results. Thus, in order to address this issue, a semi-parametric method of quantile regression technique was implemented to account for the skewness of the response by relaxing model distribution parameters. Also, to account for the heterogeneity in the dataset due to barriers' types, a random intercept model accounting for the structure of the data was implemented. In addition, interaction terms between significant predictors were considered. Understanding what factors with which magnitude contribute to the barrier crash costs is crucial for the future barriers' optimization process. Thus, contributory factors to barriers crash cost with high, medium, and low values, corresponding to 95th, 70th, and 60th percentiles were considered, and a comparison was made across these models. It was found, for instance, that although factors such as rollover, driving under the influence, and presence of heavy truck all have contributory impacts on the cost of crashes, their impacts are greater on higher quantiles, or higher barriers' costs. These models were compared from various perspectives such as intra class correlation (ICC), and standard error of coefficients. This study highlights the changes in coefficient estimates while modeling crash costs.

Systematic review of unintentional injury prevention economic evaluations 2010-2019 and comparison to 1998-2009.

BACKGROUND: Health economic evaluation studies (e.g., cost-effectiveness analysis) can provide insight into which injury prevention interventions maximize available resources to improve health outcomes. A previous systematic review summarized 48 unintentional injury prevention economic evaluations published during 1998-2009, providing a valuable overview of that evidence for researchers and decisionmakers. The aim of this study was to summarize the content and quality of recent (2010-2019) economic evaluations of unintentional injury prevention interventions and compare to the previous publication period (1998-2009). METHODS: Peer-reviewed English-language journal articles describing public health unintentional injury prevention economic evaluations published January 1, 2010 to December 31, 2019 were identified using index terms in multiple databases. Injury causes, interventions, study methods, and results were summarized. Reporting on key methods elements (e.g., economic perspective, time horizon, discounting, currency year, etc.) was assessed. Reporting quality was compared between the recent and previous publication periods. RESULTS: Sixty-eight recent economic evaluation studies were assessed. Consistent with the systematic review on this topic for the previous publication period, falls and motor vehicle traffic injury prevention were the most common study subjects. Just half of studies from the recent publication period reported all key methods elements, although this represents an improvement compared to the previous publication period (25 %). CONCLUSION: Most economic evaluations of unintentional injury prevention interventions address just two injury causes. Better adherence to health economic evaluation reporting standards may enhance comparability across studies and increase the likelihood that this type of evidence is included in decision-making related to unintentional injury prevention.

Efficacy and cost-effectiveness of subsidized ridesharing as a drunk driving intervention in Columbus, OH.

BACKGROUND: No economic evaluations exist of free or subsidized ridesharing services designed to reduce impaired driving. OBJECTIVES: To evaluate the effects and economics of a 17-weekend program that provided rideshare coupons good for free one-way or round trips to/from the hospitality zones in Columbus, Ohio, coupled with a modest increase in enforcement and a media campaign that used messaging about enforcement to promote usage. METHODS: Web surveys of riders and intercept surveys of foot traffic in the hospitality zones yielded data on the reduction in driving after drinking and the change in alcohol consumption associated with coupon use. We estimated crash changes from trip data using national studies, then confirmed with an ARIMA analysis of monthly police crash reports. Costs and output data came from program and rideshare company records. RESULTS: 70.8% of 19,649 responding coupon redeemers said coupon use reduced the chance they would drive after drinking. An estimated 1 in 4,310 drink-driving trips results in an alcohol-attributable crash, so the coupons prevented an estimated 3.2 crashes. Consistent with that minimal change, the ARIMA analysis did not detect a drunk-driving crash reduction. Self-reports indicated alcohol consumption rose by an average of 0.4 drinks per coupon redeemer, possibly with an equal rise among people who rode with the redeemer. The program cost almost $650,000 and saved an estimated 1.8 years of healthy life. Across a range of discount rates and values for a year of healthy life, it cost $366,000 to $791,000 per year of healthy life saved. Its estimated benefit-cost ratio was between 0.31 and 0.59, meaning it cost far more than it saved. CONCLUSIONS: Ridesharing, coupled with a media campaign and increased enforcement, was not a cost-effective drunk-driving intervention. Although it reduced drink-driving crashes and saved years of healthy life, those savings were modest and expensive. Moreover, the self-reported increase in participant drinking imposed countervailing risks. Even sensitivity analyses that potentially overestimate the benefits and underestimate the costs indicate a significant imbalance between program costs and savings. Any funding devoted to ridesharing would divert scarce resources from interventions with benefit-cost ratios above 1. Thus, our evaluation suggests that governments should not devote energy or resources to ridesharing programs if their primary objective is to reduce drink-driving or harmful alcohol use.

Cost analysis of road traffic crashes in China.

Fatalities and injuries resulting from road traffic crashes is always a serious problem. The overall economic losses caused by road traffic crashes are beyond imagination. Including the economic cost of property damage, productivity loss, medical cost, travel delay time cost, legal cost and insurance cost, the total economic cost of traffic crashes in China in 2017 is calculated as 490.1 billion yuan (72.6 billion USD 2017), which is equivalent to 0.60% of the GDP. The cost of productivity loss accounts for the highest proportion of total economic cost, which is 72%. The second is the travel delay cost, accounting for 12% insurance cost, property damage cost and medical cost are followed. The more serious the injury, the higher the unit economic cost. The unit cost of a crash that caused only property damage is 11,274 yuan. The unit cost of a minor injured crash is 20,223 yuan. The highest unit economic cost is the unit cost of a fatal crash, which is 3,181,394 yuan. This study provides important insights into the cost-benefit analysis of China's road safety policies.

Revisiting the relationship between traffic accidents, real economic activity and other factors in Spain.

This paper analyzes the relationship between road traffic accidents and real economic activity in Spain, using data on accidents, fatalities and injuries from January 1975 to December 2016. Our results show the historical asymmetric cyclical behavior of traffic accidents variables. This relationship is more evident for accidents and injuries, while fatalities have shown a different pattern since 2002. Besides using aggregate data, we have analyzed urban and nonurban accidents separately. We analyze the effect of economic variables, public policy interventions and other potential factors affecting traffic series. Regarding policy interventions, we confirm a permanent reduction in all accident rates associated with the mandatory use of seatbelts on car passengers since 1992. However, the penalty points system introduced in July 2006 has only had temporary effects. We have also shown the effect of economic variables such as Industrial Production Index, gasoline and diesel consumption and registration of new vehicles and, as a novelty, the benefits of using the composite coincident and leading indicators of the Spanish economy.

Impact of law enforcement and increased traffic fines policy on road traffic fatality, injuries and offenses in Iran: Interrupted time series analysis.

BACKGROUND: Road traffic law enforcement was implemented on 1st April 2011 (the first intervention) and traffic ticket fines have been increased on 1st March 2016 (the second intervention) in Iran. The aim of the current study was to evaluate the effects of the law enforcement on reduction in the incidence rate of road traffic fatality (IRRTF), the incidence rate of road traffic injuries (IRRTI) and the incidence rate of rural road traffic offenses (IRRRTO) in Iran. METHODS: Interrupted time series analysis was conducted to evaluate the impact of law enforcement and increased traffic tickets fines. Monthly data of fatality on urban, rural and local rural roads, injuries with respect to gender and traffic offenses namely speeding, illegal overtaking and tailgating were investigated separately for the period 2009-2016. RESULTS: Results showed a reduction in the incidence rate of total road traffic fatality (IRTRTF), the incidence rate of rural road traffic fatality (IRRRTF) and the incidence rate of urban road traffic fatality (IRURTF) by -21.44% (-39.3 to -3.59, 95% CI), -21.25% (-31.32 to -11.88, 95% CI) and -26.75% (-37.49 to -16, 95% CI) through the first intervention which resulted in 0.383, 0.255 and 0.222 decline in casualties per 100 000 population, respectively. Conversely, no reduction was found in the incidence rate of local rural road traffic fatality (IRLRRTF) and the IRRTI. Second intervention was found to only affect the IRURTF with -26.75% (-37.49 to -16, 95% CI) which led to 0.222 casualties per 100 000 population. In addition, a reduction effect was observed on the incidence rate of illegal overtaking (IRIO) and the incidence rate of speeding (IRS) with -42.8% (-57.39 to -28.22, 95% CI) and -10.54% (-21.05 to -0.03, 95% CI which implied a decrease of 415.85 and 1003.8 in monthly traffic offenses per 100 000 vehicles), respectively. CONCLUSION: Time series analysis suggests a decline in IRTRTF, IRRRTF, and IRURTF caused by the first intervention. However, the second intervention found to be only effective in IRURTF, IRIO, and IRS with the implication that future initiatives should be focused on modifying the implementation of the traffic interventions.

Health Care and Productivity Costs of Non-Fatal Traffic Injuries: A Comparison of Road User Types.

This study aimed to provide a detailed overview of the health care and productivity costs of non-fatal road traffic injuries by road user type. In a cohort study in the Netherlands, adult injury patients admitted to a hospital as a result of a traffic accident completed questionnaires 1 week and 1, 3, 6, 12 and 24 months after injury, including the iMTA Medical Consumption and Productivity Cost Questionnaire. In-hospital, post-hospital medical costs and productivity costs were calculated up to two years after traffic injury. In total, 1024 patients were included in this study. The mean health care costs per patient were € 8200. The mean productivity costs were € 5900. Being female, older age, with higher injury severity and having multiple comorbidities were associated with higher health care costs. Higher injury severity and being male were associated with higher productivity costs. Pedestrians aged ≥ 65 years had the highest mean health care costs (€ 18,800) and motorcyclists the highest mean productivity costs (€ 9000). Bicycle injuries occurred most often in our sample (n = 554, 54.1%) and accounted for the highest total health care and productivity costs. Considering the high proportion of total costs incurred by bicycle injuries, this is an important area for the prevention of traffic injuries.

Trends in lawyer use in road traffic injury compensation claims.

Injury compensation claimants use legal services to help them navigate compensation schemes, including accessing benefits and resolving disputes. Little is known, however, about the extent of lawyer use by compensation claimants, including changes over time. This paper presents findings from one of the largest empirical investigations of lawyer use in an injury compensation setting to date. Using evidence from more than 275,000 claims in the road traffic injury scheme in the state of Victoria, Australia, this study examines the prevalence of, and changes in, lawyer use between 2000 and 2015. The analysis identifies a significant increase in the use of lawyers in the scheme, and explores possible explanations. This study provides critical insights into lawyer use in compensation settings: the steep increase in lawyer involvement has both access to justice and financial implications for compensation schemes, given the associations between lawyer use, claimant outcomes, and long-term scheme viability.

The economic and societal burden of excessive daytime sleepiness in patients with obstructive sleep apnea.

Excessive daytime sleepiness (EDS) is common in patients with obstructive sleep apnea (OSA) and continues to persist in many patients despite adequate OSA treatment. EDS in OSA is associated with decreased quality of life (QOL) as well as increased societal burden, which may impact health care utilization and costs. However, economic burden is often not the primary focus in the treatment of EDS in OSA. This targeted literature review aimed to examine the published literature on the economic burden of EDS in OSA. This review identified available literature using a targeted PubMed search strategy using search terms related to EDS in OSA in adults. Results demonstrate that there are few studies that detailed the direct costs associated with EDS in OSA, though several studies indicated an association between EDS in OSA and indirect economic burdens, including motor vehicle accidents (MVAs), near misses, work productivity, mood, and QOL. Data from the literature confirmed that persistent EDS in OSA following continuous positive airway pressure persists in 12%-65% of patients. Future studies should further describe the direct costs of EDS in OSA, quantify the cost associated with MVAs and lost work productivity, and detail QOL and social impacts of the condition.

Productivity costs among people involved in traffic accidents. / Custos de produtividade entre pessoas envolvidas em acidentes de trânsito.

This paper aimed to characterize the productivity costs of people involved in traffic accidents (TA) in a medium-sized municipality. A longitudinal household-based study was conducted from 2013 to 2015. During this period, individuals with TA were interviewed, and followed-up and costs of productivity were calculated. The measured and estimated values were considered for the calculation of the gross and per capita values and facilitated the establishment of costs of lost productivity (days off work) and costs of return to productivity (health professionals, medication, transportation, auxiliary devices and vehicle repair). It was shown that the costs of loss were more significant against the costs of return. Among the items that underpin the return to productivity, higher costs were observed in men, young adults, drivers, users of two-wheeled vehicles, people with public employment relationships, intermediate age groups and fracture-type injuries. It is necessary to evaluate and target the stages of recovery of those involved to minimize the social burden generated by these events.

Este artigo objetivou caracterizar os custos de produtividade de pessoas envolvidas em acidente de trânsito (AT) em um município de médio porte. Um estudo longitudinal de base domiciliar foi realizado entre 2013 e 2015. Neste período, foram entrevistados e acompanhados indivíduos com AT e calculados os custos de produtividade. Os valores mensurados e estimados foram considerados para cálculo dos valores brutos e per capita e ajudaram a constituir os custos de perda de produtividade (dias sem trabalhar) e custos de retorno à produtividade (profissionais de saúde, medicamentos, transporte, dispositivos auxiliares e reparo de veículos). Demonstrou-se que os custos de perda foram maiores em relação aos custos de retorno. Entre os itens que compõem os de retorno à produtividade, observaram-se maiores custos em homens, adultos jovens, condutores, usuários de veículos de duas rodas, pessoas com vínculo público, em faixas etárias intermediárias e lesões do tipo fratura. São necessárias a avaliação e o direcionamento nos estágios de recuperação dos envolvidos a fim de minimizar o ônus social gerado por estes eventos.

Understanding motorcyclist-related accidents in Colombia.

In 2016, Colombia's position regarding motorcyclist fatalities per 100,000 inhabitants was tenth worldwide and second in South America. In the seven years from 2012-2018, the proportion of deceased and injured motorcyclists among all road users was 50%. To analyse the significant aspects of the accident rate of motorcyclists in Colombia from 2016 to 2018 and estimate cost social value of motorcycle-related deaths. The global numbers of fatalities and injuries were compared to the Colombian context. Descriptive and inferential statistics were conducted to explore the association of fatal trauma and motorcycle accidents. P values and odds ratios were calculated. Bogotá, Cali, and Medellín were the cities with the most accidents. The month, day, time, age of the victims, and climatic conditions had a statistically significant association with the fatal trauma. Most victims were between the ages of 20-29 years. Motorcycles were involved in more than 60% of accidents. The social cost of a life lost in a motorcycle accident was estimated at $2,418 million Colombian pesos (725,400 USD) per year. The establishment of countermeasures for the road safety of vulnerable users should focus on associated causal factors in order to develop strategies to effectively reduce the number of accidents.

Custos de produtividade entre pessoas envolvidas em acidentes de trânsito / Productivity costs among people involved in traffic accidents

Resumo Este artigo objetivou caracterizar os custos de produtividade de pessoas envolvidas em acidente de trânsito (AT) em um município de médio porte. Um estudo longitudinal de base domiciliar foi realizado entre 2013 e 2015. Neste período, foram entrevistados e acompanhados indivíduos com AT e calculados os custos de produtividade. Os valores mensurados e estimados foram considerados para cálculo dos valores brutos e per capita e ajudaram a constituir os custos de perda de produtividade (dias sem trabalhar) e custos de retorno à produtividade (profissionais de saúde, medicamentos, transporte, dispositivos auxiliares e reparo de veículos). Demonstrou-se que os custos de perda foram maiores em relação aos custos de retorno. Entre os itens que compõem os de retorno à produtividade, observaram-se maiores custos em homens, adultos jovens, condutores, usuários de veículos de duas rodas, pessoas com vínculo público, em faixas etárias intermediárias e lesões do tipo fratura. São necessárias a avaliação e o direcionamento nos estágios de recuperação dos envolvidos a fim de minimizar o ônus social gerado por estes eventos.

Abstract This paper aimed to characterize the productivity costs of people involved in traffic accidents (TA) in a medium-sized municipality. A longitudinal household-based study was conducted from 2013 to 2015. During this period, individuals with TA were interviewed, and followed-up and costs of productivity were calculated. The measured and estimated values were considered for the calculation of the gross and per capita values and facilitated the establishment of costs of lost productivity (days off work) and costs of return to productivity (health professionals, medication, transportation, auxiliary devices and vehicle repair). It was shown that the costs of loss were more significant against the costs of return. Among the items that underpin the return to productivity, higher costs were observed in men, young adults, drivers, users of two-wheeled vehicles, people with public employment relationships, intermediate age groups and fracture-type injuries. It is necessary to evaluate and target the stages of recovery of those involved to minimize the social burden generated by these events.

Lowering the speed limit from 30 mph to 25 mph in Boston: effects on vehicle speeds.

INTRODUCTION: Effective 9 January 2017, the default speed limit on Boston streets was reduced from 30 mph to 25 mph. This study evaluated the effects of the speed limit reduction on speeds in Boston. METHOD: Vehicle speeds were collected at sites in Boston where the speed limit was lowered, and at control sites in Providence, Rhode Island, where the speed limit remained unchanged, before and after the speed limit change in Boston. A log-linear regression model estimated the change in vehicle speeds associated with the speed limit reduction. Separate logistic regression models estimated changes in the odds of vehicles exceeding 25 mph, 30 mph and 35 mph associated with the lower speed limit. RESULTS: The speed limit reduction was associated with a 0.3 % reduction in mean speeds (p=0.065), and reductions of 2.9%, 8.5% and 29.3 % in the odds of vehicles exceeding 25 mph, 30 mph and 35 mph, respectively. All these reductions were statistically significant. CONCLUSIONS: Local communities should consider lowering speed limits to reduce speeds and improve safety for all road users. The current practice of setting speed limits according to the 85th percentile free-flow speeds, without consideration of other characteristics of the roadway, can be a hurdle for local communities looking to lower speed limits. Updated state laws that allow municipalities to set lower speed limits on urban streets without requiring costly engineering studies can provide flexibility to municipalities to set speed limits that are safe for all road users.

Biopsychosocial factors associated with poor health-related quality of life after minor to moderate transport-related injuries: Insights into the Victorian compensable population.

OBJECTIVE: To investigate whether a range of previously identified biopsychosocial risk factors were associated with poorer health-related quality of life after transport-related injuries. METHODS: This study involved 1,574 participants who sustained a transport-related injury, claimed compensation through the Victorian compensation scheme (in the Australian state of Victoria), and contributed to their cross-sectional outcome survey. Health-related quality of life was assessed using the EQ-5D-3L instrument. RESULTS: Of the 1,574 participants (mean age 44.8 (standard deviation 16.6) years, 61% reported poor recovery expectations, 55% reported high pain intensity, 54% reported poor satisfaction with care provided, and 41% reported no improvement in their recovery. Poor quality of life was defined as EQ-5D-3L summary score 0-0.70. Predictors of self-reported poor health-related quality of life included older age (65+ years) patients (adjusted odds ratios (aOR) = 1.73, 95% confidence interval (95% CI) 1.04-2.87), higher pain intensity (aOR = 2.17, 95% CI 1.27-3.71), self-reported pre-injury chronic pain (aOR = 1.47, 95% CI 1.00-2.17), self-reported pre-injury mental health issues (aOR = 2.62, 95% CI 1.80-3.82), no improvement in recovery in the last 3 months (aOR = 1.54, 95% CI 1.15-2.06), longer hospital stay (>7 days) (aOR = 2.34, 95% CI 1.43-4.21) and no support from the family (aOR = 2.37, 95% CI 1.62-3.46). CONCLUSION: Biopsychosocial risk factors were associated with poorer health-related quality of life, regardless of the time since injury. Early assessment of these risk factors and tailored interventions will go some way towards improving outcomes among compensable patients with minor to moderate transport-related injuries. Key words: recovery; health outcomes; road trauma; non-catastrophic injuries; compensation.

Safeguarding injured Victorians: development and implementation of an evidence-informed system to manage therapeutic uncertainty and decision making in a compensable environment.

WorkSafe Victoria and the Transport Accident Commission are two Victorian government agencies that determine the policies that guide decisions to fund treatments and services provided to Victorians injured in transport or workplace accidents. These agencies identified that an internal system was required to manage requests for funding of new or emerging treatments. In particular, the agencies recognised a system that supported consistency in decision making in the context of therapeutic uncertainty and ensured the safety of injured Victorians was needed. The New, Emerging or Non-Established Treatments (NENETs) policy was launched in its current form by the agencies in 2013. The NENETs system includes a record of contemporary evidence for emerging treatments and an evidence-informed decision-making system to ensure consistency and information sharing. A system of recording decisions on emerging treatments was also implemented to ensure that funding decisions could later be reversed if necessary. The NENETs system has proved to be a robust and sustainable method of managing uncertainty for WorkSafe Victoria and the Transport Accident Commission and could be transferable to other funding bodies.

Intersection characteristics that influence collision severity and cost.

INTRODUCTION: Traffic engineers require robust tools to assist with their day-to-day decision making, and there is no better example of this than traffic signal warrants. North American traffic signal warrant systems are lacking in how they incorporate motor-vehicle collisions from both a severity and prediction perspective. The objective of this study was to produce reliable collision costs for the development of improved traffic signal warrants that accounted for the variations in severity that practitioners should expect based on the characteristics of the intersection being studied. METHOD: The primary data used for this analysis were from the National Automotive Sampling System (NASS) Crashworthiness Data System, with adjustments from the NASS General Estimates System and Fatality Accident Reporting System. Generalized ordered logit models were used to identify the most significant intersection characteristics, which were then used to segregate the data to determine expected the collision severity profiles and average costs of both casualty and total collisions at intersections. RESULTS: The average collision at a signalized intersection was found have a lower severity than the average collision at a stop-controlled intersection. A combination of posted speed limit, urban/rural, and divided/undivided were identified as the most significant intersection characteristics in most cases and were used to delineate the data for developing collision cost estimates. CONCLUSIONS: Posted speed limit, rural/urban land use, and the presence of divided approaches are intersection characteristics that traffic engineers can readily determine and/or control for that have significant effects on intersection collision severity. Practical applications: The collision costs produced through this process give traffic engineers a reliable estimate that can provide a more substantial foundation for justifying a proposed change in intersection traffic control.

[Analysis of the determinants of cost savings in traffic accidents on interurban roads in Spain]. / Análisis de los factores determinantes del ahorro de costes en accidentes de tráfico en la red de carreteras de España.

OBJECTIVE: The increase in traffic accidents depends on multiple factors; it generates an economic and public health problem that must be analyzed jointly by agents involved in road safety. The aim of the work was to quantify the effect of various factors in the cost savings due to traffic accidents on interurban roads in Spain. METHODS: It was analyzed, through a lineal regression with panel data model and in the period 2000-2017, how different factors affected cost savings due to the risk of mortality or injury avoided on Spanish interurban roads. RESULTS: A 1% increase in traffic volume led to a reduction in costs per MVKT (million vehiclekilometres travelled) of €162.46 referring to the risk of mortality, €115.32 for serious injuries and €10.10 for mild injuries. This increase in unemployment caused a cost reduction of €31.43, €10.76 and €0.98, respectively. The same increase in the investment in replacement implied a reduction of these costs of €11 for any risk. A 1% increase in the ageing index led to an increase in costs of €276.83 in terms of mortality risk and €257.49 in terms of injury. Foreign tourism generated a cost of more than €40 for any risk. A 1% increase in GDP per capita led to an increase in costs of €155.50, €138.09 and €8.21 for defined risks. The points driving license led to an increase in costs of €785.50 per MVKR when referring to mortality risks. CONCLUSIONS: Determining factors for cost savings: motorization rate, unemployment rate and investment in replacement interurban roads. Determining factors that increased costs: expiry of the effect of the penalty - points driving licence, ageing index of the population, increase in GDP or proportion of foreign travelers.

OBJETIVO: El incremento de los accidentes de tráfico depende de múltiples factores, generando un problema económico y de salud pública que debe ser analizado conjuntamente por los agentes intervinientes en la seguridad vial. El objetivo del trabajo fue cuantificar el efecto de diversos factores determinantes en el ahorro de costes por accidentes de tráfico en vías interurbanas en España. METODOS: Se analizó, a través de un análisis de regresión mediante datos de panel referidos al período 2000-2017, cómo afectaban diferentes factores al ahorro de costes por cada riesgo de mortalidad o lesividad evitado en las vías interurbanas españolas. RESULTADOS: El aumento del 1% del volumen de tráfico conllevó una reducción de costes por MVKR (millón de vehículos-kilómetros recorridos) de 162,46€ refiriéndonos al riesgo de mortalidad, 115,32€ para lesividad grave y 10,10€ para leve. El aumento en el desempleo supuso una reducción de costes de 31,43€, 10,76€ y 0,98€, respectivamente. Idéntico incremento de la inversión en la reposición implicó una reducción de estos costes de 11€ para cualquier riesgo. El aumento del 1% del índice de envejecimiento comportó un aumento de costes de 276,83€ hablando del riesgo de mortalidad y de 257,49€ si hablamos de lesividad. El turismo extranjero generó un coste superior a los 40€ para cualquier riesgo. El aumento del 1% del Producto Interior Bruto (PIB) per cápita conllevó un aumento de costes de 155,50€, 138,09€ y 8,21€ para los riesgos anteriormente definidos. El permiso de conducción por puntos condujo a un incremento de costes de 785,50€ por MVKR al referirnos a los riesgos de mortalidad. CONCLUSIONES: Los factores condicionantes del ahorro de costes son el volumen de tráfico, la tasa de paro y la inversión en reposición. Los factores condicionantes del incremento de costes son la caducidad del efecto del permiso de conducción por puntos, el índice de envejecimiento, el incremento del PIB y la proporción de conductores extranjeros.

The Economic Burden of Sleepy Driving.

Driving while sleepy on a regular basis may be due to sleep restriction associated with work schedules or with poor sleep hygiene. It also may be associated with sleep disorders or with sedative drugs. This review assesses the potential consequences of driving sleepy on a regular basis from a societal point of view. Driving while sleepy on a regular basis increases the risk of motor vehicle accidents (MVAs), impairs the ability to work, has an impact on productivity, and probably also has an impact on the risk of non-MVA occupational accidents and on public disasters.