Mortalidad en accidentes por moto en Venezuela, y su relación con Políticas Públicas de seguridad vial y preventiva,1996-2018 / Mortality in motorcycle accidents in Venezuela and relationship with public road safety and preventive policies, 1996 - 2018

Los accidentes de tránsito son un problema de salud pública de gran magnitud y gravedad, en las Américas; Venezuela ocupa un lugar destacado por su alta incidencia. El objetivo de la investigación es establecer la relación entre las políticas públicas para la prevención de los accidentes de motocicletas, y las tasas de mortalidad. Metodología: Estudio documental retrospectivo de las políticas viales y las tasas de mortalidad específicas de lesionados por accidentes de motocicletas en Venezuela durante el período 1996-2018. Resultados: como causa de muerte en Venezuela (2000-2018), representa casi 7% del total, entre 6 a 50% del total de las muertes por accidentes de tránsito terrestre y se mantiene muy alta al final del período, con fallecidos por motocicletas sobre 25%. La elevación de la curva endémica de mortalidad ocurrió simultáneamente al aumento en la producción e importación de motocicletas, y cayó durante la crisis económica, en el año 2014. La legislación actualizada mas no acatada en esta materia, es notoria Conclusiones: Los accidentes de motocicleta son un problema de salud pública de primer orden en Venezuela asociadas al clima económico y social, las tasas de mortalidad tuvieron su máxima meseta de elevación durante la bonanza petrolera 2005-2013. Las políticas asociadas a la prevención de accidentes viales en moto están fragmentadas, son ineficientes y reactivas a situaciones complejas, deficientemente aplicadas por los organismos de tránsito responsables a escala nacional, regional y municipal.

Introduction. Traffic accidents are a public health problem of great magnitude and gravity in the Americas; Venezuela occupies a prominent place for its high incidence. The objective of the research is to establish the relationship between public policies for the prevention of motorcycle accidents, and mortality rates. Methodology: Retrospective documentary study of road policies and specific mortality rates of those injured by motorcycle accidents in Venezuela during the period 1996-2018. Descriptive statistical analysis with trend lines, frequency distributions and annual average rates. Results: cause of death in Venezuela (2000-2018), represents almost 7% of the total. The burden of motorcycle injury deaths represents between 6 to 50% of total road traffic fatalities and remains very high at the end of the period, with motorcycle fatalities over 25%. The elevation of the endemic mortality curve occurred simultaneously with the increase in the production and import of motorcycles, and fell concomitantly with the economic crisis in 2014. Conclusions: Motorcycle accidents are a public health problem of the first order in Venezuela associated with the economic and social climate, mortality rates had their maximum plateau of elevation during the oil economic boom 2005-2013. The policies associated with the prevention of road accidents by motorcycle are fragmented, inefficient and reactive to complex situations and poorly applied by the responsible traffic agencies at national, regional and municipal level.

Experiencia en el manejo y tratamiento de lesiones tipo degloving en el Centro Nacional de Quemados, Montevideo, Uruguay / Experience in the management and treatment of degloving injuries at the National Burn Center, Montevideo, Uruguay

Introducción. Las lesiones tipo degloving o avulsiones extensas de partes blandas representan un desafío para el equipo médico tratante. Es fundamental el adecuado manejo de estos pacientes dada la alta morbilidad. Objetivos. Estudio de las lesiones tipo degloving de partes blandas tratados en el Centro Nacional de Quemados, su manejo y tratamiento en los últimos 18 años. Analizar la situación actual de estas heridas a fin de proporcionar herramientas para el desarrollo de estrategias de prevención y tratamiento. Materiales y métodos. Estudio retrospectivo período enero 2004 - enero 2022, análisis de base de datos del Centro Nacional de Quemados del Hospital de Clínicas, Montevideo, Uruguay, incluyendo todos los ingresos por degloving extensos de partes blandas Resultados. La población estuvo compuesta por 38 pacientes, en su mayoría con lesiones por siniestro de tránsito (92,1%) en rol peatón (57,9%). Se encontró una tasa de complicaciones de 55,3% y una mortalidad de 15,8%. Se vio asociación entre complicaciones infecciosas y mortalidad y entre cultivo positivo al ingreso y demora en el ingreso al centro de quemados. Conclusiones. Las lesiones graves de miembros inferiores se han presentado con elevada tasa de mortalidad y de complicaciones infecciosas. Estas complicaciones se asociaron con un mayor tiempo de internación. Las complicaciones infecciosas a su vez se asociaron con la mortalidad, igual que la extensión lesional.

Introduction. Degloving injuries or extensive soft tissue avulsions represent a challenge for the medical team. Proper management of these patients is essential given the high morbidity. Objectives. To study of soft tissue degloving injuries treated at the National Burn Center, their management and treatment in the last 18 years. To analyze the current situation of these injuries in order to provide tools for development of prevention and treatment strategies. Materials and methods. Retrospective study from January 2004 to January 2022, database analysis of the National Burn Center of "Hospital de Clínicas" (Montevideo-Uruguay), including all admissions for extensive soft tissue degloving. Results. The population consisted of 38 patients, mostly with injuries due to traffic accidents (92.1%) of which 57.9% were pedestrians. A complication rate of 55.3% and a mortality of 15.8% were found. An association arised between infectious complications and mortality and between a positive culture on admission and a delay in time to enter to the National Burn Center. Conclusions. Lower limbs severe injuries have presented a high rate of mortality and infectious complications. These complications were associated with a longer hospital stay. Infectious complications, in turn, were associated with mortality, as well as the extent of lesions.

Big data on the prevalence of injury deaths among 187 488 elderly Chinese in the past 20 years (2000-2020): a systematic review and meta-analysis.

BACKGROUND: This study systematically reviewed injury death and causes in the elderly population in China from 2000 to 2020, to prevent or reduce the occurrence of injuries and death. METHODS: The CNKI, VIP, Wan Fang, MEDLINE, Embase, SinoMed, and Web of Science databases were searched to collect epidemiological characteristics of injury death among elderly over 60 years old in China from January 2000 to December 2020. Random effects meta-analysis was performed to pool injury mortality rate and identify publication bias, with study quality assessed using the AHRQ risk of bias tool. RESULTS: (1) A total of 41 studies with 187 488 subjects were included, covering 125 million elderly. The pooled injury mortality rate was 135.58/105 [95%CI: (113.36 to 162.14)/105], ranking second in the total death cause of the elderly. (2)Subgroup analysis showed that male injury death (146.00/105) was significantly higher than that of females (127.90/105), and overall injury mortality increased exponentially with age (R2 = 0.957), especially in those over 80 years old; the spatial distribution shows that the injury death rate in the central region is higher than that in the east and west and that in the countryside is higher than that in the city; the distribution of death time shows that after entering an aging society (2000-2020) is significantly higher than before (1990-2000). (3) There are more than 12 types of injury death, and the top three are falling, traffic accidents, and suicide. CONCLUSIONS: China's elderly injury death rate is at a high level in the world, with more males than females, especially after the age of 80. There are regional differences. The main types of injury death are falling, traffic, and suicide. During the 14th Five-Year Plan period, for accidental injuries and death, a rectification list for aging and barrier-free environments was issued. PROSPERO REGISTRATION: The systematic review was registered in PROSPERO under protocol number CRD42022359992.

Incomplete decapitation with exenteration of the brain in a motorcyclist run over by a semitrailer.

Although decapitation is a well-known traumatic mechanism in road traffic deaths, incomplete decapitation of a motorcyclist with exenteration of the brain has not yet been reported in the forensic literature in a victim run over by a vehicle. This paper deals with an autopsy case of a 69-year-old motorcyclist, who had been run over by a semitrailer, as a result of which flattening of the head with extrusion of the brain and incomplete decapitation occurred at the level of the fourth cervical vertebra. This constellation allows to define a special mechanism of accident-related decapitation. Moreover, the case underlines the importance of a multidisciplinary approach for the reconstruction of the accident as well as for the assessment of its judicial consequences. On the suspicion of a hit-and-run accident, simulation tests were performed by technical experts. These tests revealed that the motorcycle may not have been conspicuous for the truck driver prior to and during the accident. Consequently, the charge of manslaughter and failure to render assistance against the truck driver was dropped.

Examining the Trends in Motor Vehicle Traffic Deaths in New York City, 1999-2020.

Monitoring and understanding the trends in motor vehicle traffic (MVT) mortality is crucial for developing effective interventions and tracking progress in reducing deaths related to MVT. This study aimed to assess the trends in MVT mortality in New York City from 1999 through 2020. Publicly available de-identifiable mortality data were abstracted from the Centers for Disease Control and Prevention's Wide-ranging Online Data for Epidemiologic Research. MVT deaths were identified using the International Classification of Diseases Codes, 10th Revision: V02-V04 (.1, .9), V09.2, V12-V14 (.3-.9), V19 (.4-.6), V20-V28 (.3-.9), V29-V79 (.4-.9), V80 (.3-.5), V81.1, V82.1, V83-V86 (.0-.3), V87 (.0-.8), and V89.2. Age adjusted mortality rates (AAMR) were abstracted by county (Bronx; Kings; Queens; New York), age (in years) (< 25; 25-44; 45-64; ≥ 65), sex (male; female), race/ethnicity (Non-Hispanic Black; Non-Hispanic White; Asian/Pacific Islander; Hispanic), and road user type (motor vehicle occupant; motorcyclist; pedal cyclist; pedestrian). Joinpoint regression models were fitted to estimate the annual percentage change (APC) and average annual percentage change (AAPC) in AAMR during the study period. The Parametric Method was used to compute 95% confidence intervals (CI). Between 1999 and 2020, a total of 8,011 MVT deaths were recorded in New York City. Mortality rates were highest among males (age adjusted mortality rate (AAMR) = 6.4 per 100,000; 95% CI: 6.2, 6.5), Non-Hispanic Blacks (AAMR = 4.8; 95% CI: 4.6, 5.0), older adults (AAMR = 8.9; 95% CI: 8.6, 9.3), and persons from Richmond County (AAMR = 5.2; 95% CI: 4.8, 5.7). MVT death rates, overall, have declined by 3% per year (95% CI: -3.6, -2.3) from 1999 to 2020. The rates have fallen or stabilized by race/ethnicity, county of residence, road user type, and age group. In contrast, rates have increased by 18.1% per year among females and by 17.4% per year in Kings County from 2017 to 2020.The results of this study draw attention to the worsening trends in MVT mortality among females and in Kings County, New York City. Further investigation is needed to determine the underlying behavioral, social, and environmental factors contributing to this increase, such as polysubstance or alcohol abuse, psychosocial stressors, access to medical and emergency care, and compliance with traffic laws. These findings emphasize the importance of developing targeted interventions to prevent MVT deaths and ensure the health and safety of the community.

Impact of high temperature on road injury mortality in a changing climate, 1990-2019: A global analysis.

BACKGROUND: Previous studies have shown that extreme heat likely increases the risk of road injuries. However, the global burden of road injuries due to high temperature and contributing factors remain unclear. This study aims to characterize the global, regional and national burden of road injuries due to high temperature from 1990 to 2019. METHODS: Based on the Global Burden of Disease (GBD) study 2019, we obtained the numbers and age-standardized mortality rates (ASMR) and age-standardized disability-adjusted life years (DALY) rates (ASDR) of the road injury due to high temperature at global, regional, and national levels from 1990 to 2019. The world is divided into five climate zones according to the average annual temperature of each country: tropical, subtropical, warm temperate, cold temperate, and boreal. We used the generalized additive models (GAM) to model the trends of road injuries globally and by region. RESULTS: Globally, between 1990 and 2019, the deaths of road injury attributable to high temperature increased significantly from 20,270 (95% uncertainty interval [UI], 7836 to 42,716) to 28,396 (95% UI, 13,311 to 51,178), and the DALYs increased from 1,169,309 (95% UI, 450,834 to 2,491,075) to 1,414,527 (95% UI, 658,347 to 2,543,613). But the ASMR and the ASDR slightly decreased by 8.49% and 13.16%, respectively. The burden of road injury death attributable to high temperature remained high in low SDI and tropical regions. In addition, road transport infrastructure investment per inhabitant is associated with the burden of road injuries attributable to high temperature. CONCLUSIONS: Globally, the ASMR and ASDR for road injuries attributable to high temperature decreased from 1990 to 2019, but the absolute death and DALYs continued to increase. Thus, concerning global warming, implementation of prevention and interventions to reduce road injuries from heat exposure should be stressed globally.

Desigualdades sociales relacionadas con la mortalidad por accidentes de tráfico / Social inequalities related to road traffic mortality

Objetivo: Sintetizar las desigualdades sociales relacionadas con la mortalidad por accidentes de tráfico reportadas en publicaciones científicas. Método: Se realizó una revisión exploratoria de la literatura siguiendo la guía PRISMA-ScR. Utilizando el vocabulario MesH se hizo una búsqueda sistemática de artículos publicados en inglés, portugués y español en las bases de datos EBSCO, Scielo, Scopus, Ovid y PubMed. Resultados: Se identificaron 47.790 registros en la búsqueda inicial, de los cuales 35 artículos cumplieron los criterios de selección. Nueve de cada diez publicaciones son de países de altos ingresos y existe un mayor interés en el análisis de la mortalidad en ocupantes y conductores de automotores. La mitad de las publicaciones utilizan la raza, la etnia y la geolocalización como variables de posición socioeconómica. Los artículos incluidos en esta revisión indican que las agrupaciones de personas de baja posición socioeconómica presentan una mayor mortalidad por accidentes de tránsito. Conclusiones: La mayor mortalidad por accidentes de tránsito se presenta en personas de baja posición socioeconómica, lo que sugiere el desarrollo de acciones de seguridad vial que estén vinculadas con otras agendas políticas a fin de reducir su incidencia para 2030. A pesar de que la mortalidad por accidentes de tránsito es mayor en los países de medianos y bajos ingresos, son pocas las publicaciones realizadas en ellos, por lo que se requiere fortalecer las capacidades de investigación en tales países.(AU)

Objective: To synthesize the social inequalities related to mortality from traffic accidents reported in scientific publications. Method: A scoping review following the PRISMA-ScR guide was carried out. Using the MesH vocabulary, we systematically searched for articles in English, Portuguese and Spanish published in the EBSCO, Scielo, Scopus, Ovid, and PubMed databases. Results: We identified 47,790 records in the initial search, of which 35 articles met the selection criteria. Nine out ten publications are in high-income countries; there is a greater interest in analyzing mortality in occupants and drivers of vehicles and motorcyclists. Half of the publications use race-ethnicity and geolocation as socioeconomic position variables. The articles included in this review indicate that groups of people with low socioeconomic positions have higher mortality due to traffic accidents. Conclusions: The highest mortality from traffic accidents occurs in people with low socioeconomic positions which suggests the development of road safety actions from a comprehensive, integrative perspective and linked to other political agendas to reduce their incidence by 2030. Although road traffic fatalities are higher in low and middle-income countries, few publications are available in these countries. It is necessary to strengthen the research capacities in these countries.(AU)

Determinantes sociales de la salud en los accidentes de tránsito en Honduras 2019 / Social determinants of health of traffic accidents in Honduras 2019

Antecedentes: En Honduras, los accidentes de tránsito (AT) se han incrementado en los últimos años, representando un problema para la salud pública nacional y mundial. Las muertes por AT según la Dirección Nacional de Vialidad y Transporte (DNVT) incrementaron en 23% entre 2020 y 2021. Objetivo: Caracterizar los determinantes sociales de la salud de muertes y lesiones por accidentes de tránsito en Honduras. Métodos: Estudio cuantitativo descriptivo, retrospectivo, basado en fuentes secundarias de AT a nivel nacional de la DNVT Honduras, 2019. Resultados: De 4,778 personas accidentadas, el sexo masculino representó 85.9% fallecidos y 75.2% lesiones. De cada diez personas que sufrieron lesiones, siete correspondieron al sexo masculino. El grupo etario con mayor número de fallecidos fue de 25 a 34 años. El mayor número de AT correspondió a los departamentos: Cortés y Francisco Morazán. La principal causa fue atropellamiento y colisión. La mayor ocurrencia fue los fines de semana en 35.9% y en el mes de diciembre por la tarde- noche. Tipo de vehículo más involucrado: transporte mediano, uso particular y motorizado, usuarios más vulnerables: peatones y conductores. Las principales causas de mortalidad fueron: exceso de velocidad, imprudencia del conductor y del peatón y obstrucción de vía pública. Discusión. Los determinantes sociales de la salud pueden influir sobre la ocurrencia y aumentar el riesgo de algunos individuos para morir o lesionarse a causa de AT, en Honduras al igual que otros países, se carece de información que relacione determinantes inherentes al accidente con una mirada completa a través de determinantes sociales de la salud...8AU)

Incidence and Risk of Fatal Vehicle Crashes Among Professional Drivers: A Population-Based Study in Taiwan.

Fatal vehicle crashes (FVCs) are among the leading causes of death worldwide. Professional drivers often drive under dangerous conditions; however, knowledge of the risk factors for FVCs among professional drivers remain scant. We investigated whether professional drivers have a higher risk of FVCs than non-professional drivers and sought to clarify potential risk factors for FVCs among professional drivers. We analyzed nationwide incidence rates of FVCs as preliminary data. Furthermore, by using these data, we created a 1:4 professionals/non-professionals preliminary study to compare with the risk factors between professional and non-professional drivers. In Taiwan, the average crude incidence rate of FVCs for 2003-2016 among professional drivers was 1.09 per 1,000 person-years; professional drivers had a higher percentage of FVCs than non-professional drivers among all motor vehicle crashes. In the 14-year preliminary study with frequency-matched non-professional drivers, the risk of FVCs among professional drivers was significantly associated with a previous history of involvement in motor vehicle crashes (adjustment odds ratio [OR] = 2.157; 95% confidence interval [CI], 1.896-2.453), previous history of benzodiazepine use (adjustment OR = 1.385; 95% CI, 1.215-1.579), and speeding (adjustment OR = 1.009; 95% CI, 1.006-1.013). The findings have value to policymakers seeking to curtail FVCs.

A Neuropathological Study of Diffuse Vascular Injury in Fatal Motor Vehicle Collisions.

In Canada, 42 929 people were involved in fatal motor vehicle collisions (MVCs) between 1999 and 2018. Traumatic brain injuries (TBIs), including diffuse vascular injury (DVI), were the most frequent cause of death. The neuroanatomical injury pattern and severity of DVI in relation to data on MVC dynamics and other MVC factors were the focus of the current study. Five cases of fatal MVCs investigated by Western University's Motor Vehicle Safety (MOVES) Research Team with the neuropathological diagnosis of DVI were reviewed. DVI was seen in single and multiple vehicle collisions, with/without rollover and with/without partial occupant ejection. DVI occurred regardless of seatbelt use and airbag deployment and in vehicles equipped with/without antilock brakes. All DVI cases sustained head impacts and had focal TBIs, including basal skull fractures and subarachnoid hemorrhages. DVI was seen in MVCs that ranged in severity based on the change in velocity (delta-V) during the crash (minimum 31 km/hour) and occupant compartment intrusion (minimum 25 cm). In all cases, DVI in frontal white matter, corpus callosum and pontine tegmentum were common. In cases with more extensive DVI, pronounced vehicle rotation occurred before the final impact. Extensive DVI was seen in drivers who experienced sudden acceleration during vehicle rotation and deceleration.

The Impact of the COVID-19 Pandemic on Disparities in Motor Vehicle Traffic Deaths and Injuries among North Carolina American Indians.

A Periodic Feature to Inform North Carolina Health Care Professionals About Current Topics in Health Statistics.

An Overview of Amish Mortalities at a Level I Trauma Center.

BACKGROUND: The Amish population is a unique subset of patients that may require a specialized approach due to their lifestyle differences compared to the general population. With this reasoning, Amish mortalities may differ from typical trauma mortality patterns. We sought to provide an overview of Amish mortalities and hypothesized that there would be differences in injury patterns between mortalities and survivors. METHODS: All Amish trauma patients who presented and were captured by the trauma registry at our Level I trauma center over 20 years (1/2000-2004/2020) were analyzed. A retrospective chart review was subsequently performed. Patients who died were of interest to this study. Demographic and clinical variables were analyzed for the mortalities. Mortalities were then compared to Amish patients who survived. RESULTS: There were 1827 Amish trauma patients during the study period and, of these, 32 (1.75%) were mortalities. The top 3 mechanisms of injury leading to mortality were falls (34.4%), pedestrian struck (21.9%), and farming accidents (15.6%). Pediatric (age ≤ 14y) (25%) and geriatric (age ≥ 65y) (28.1%) had the highest percentage of mortalities. Mortalities in the Amish population were significantly older (mean age: 39 years vs 27 years, P = .003) and had significantly higher ISS (mean ISS: 29 vs 10, P < .001) compared to Amish patients who survived. DISCUSSION: The majority of mortalities occurred in the pediatric and geriatric age groups and were falls. Further intervention and outreach in the Amish population should be done to highlight this particular cause of mortality. LEVEL OF EVIDENCE: Level III, epidemiological.

Fatality risk and issues of inequity among vulnerable road users in South Africa.

BACKGROUND: Contextual effects from the physical and social environment contribute to inequitable protection for a large proportion of road users, especially in low- and middle-income countries like South Africa where distorted urban planning and socio-spatial disparities from the apartheid era prevail. OBJECTIVES: This paper examines the differentiated risk of road traffic crashes and injuries to vulnerable road users in South Africa, including pedestrians, females and users of some modes of public transport, in relation to characteristics of the crashes that proxy a range of contextual influences such as rurality and socio-economic deprivation. METHODS: The study is based on a descriptive analysis of 33 659 fatal crashes that occurred in South Africa over a three-year period from 2016-2018. Measures of simple proportion, population-based fatality rate, "impact factor" and crash severity are compared between disaggregated groups using Chi-Square analysis, with the Cramer's V statistic used to assess effect size. RESULTS AND SIGNIFICANCE: Key findings show a higher pedestrian risk in relation to public transport vehicles and area-level influences such as the nature of roads or extent of urbanity; higher passenger risk in relation to public transport vehicles and rurality; and higher risk for female road users in relation to public transport vehicles. The findings have implications for prioritising a range of deprivation-related structural effects. In addition, we present a "User-System-Context" conceptual framework that allows for a holistic approach to addressing vulnerability in the transport system. The findings provide an important avenue for addressing the persistently large burden of road traffic crashes and injuries in the country.

Driver intoxication and risk for fatal crashes in South Africa: A 3-year review.

BACKGROUND:  Globally, alcohol intoxication has been shown to be significantly associated with increased risk for road traffic crash morbidity and mortality for all road users (drivers, passengers and pedestrians). This association relates to the diminished capacity of drivers while intoxicated to operate motor vehicles and the increased propensity for risk-taking behaviours. The overall prevalence of alcohol-related fatal crashes contributes significantly to the burden of disease in many countries. In South Africa, research into the relationship between alcohol intoxication and other driver risk behaviours is limited and variable, constraining appropriate and effective policy and programmatic options and interventions. OBJECTIVES:  To examine the risk for fatal crashes attributed to driver alcohol intoxication relative to speeding and other driver risk behaviours across a range of key crash and vehicle characteristics and temporal variables. METHODS:  The study used a sample of fatal crashes drawn from the Road Traffic Management Corporation database for the period 2016 - 2018, comprising 13 074 fatal crashes. An overview of the sample data is provided using descriptive statistics. Following this, logistic regression modelling was undertaken to examine and clarify the risk for alcohol-attributed fatal crashes against that for speeding and a combined category of all other driver risks using variables relating to crash complexity, vehicle characteristics and regulation, and temporal variables for day/night, weekday/weekend and vacation/non-vacation periods. RESULTS:  Compared with fatal crashes involving only the driver, the study revealed a significantly greater risk for alcohol-attributed fatal crashes in instances involving more complexity as measured by involvement of other road users (pedestrians and other drivers). Additionally, the risk for alcohol-attributed fatal crashes was significantly greater for light vehicles and buses/midibuses compared with trucks. Road users were also at greater risk for such crashes at night, over long and regular weekends, and during non-vacation periods of the year. CONCLUSIONS:  Improved enforcement to prevent alcohol intoxication using roadblocks is required in a focused manner during specific temporal periods (at night, over weekends and during non-vacation periods), while enforcement to prevent speeding and other driver risks should be prioritised during other periods using speed monitoring and mobile visible policing, respectively. There is an urgent need to improve the current measurement of alcohol attribution in fatal crashes, to ensure more accurate estimation of prevalence, and to improve analysis and understanding of the compound impact of alcohol intoxication on all other driver risk behaviours and associated fatal crashes.

Universal thermal climate index associations with mortality, hospital admissions, and road accidents in Bavaria.

When meteorological conditions deviate from the optimal range for human well-being, the risks of illness, injury, and death increase, and such impacts are feared in particular with more frequent and intense extreme weather conditions resulting from climate change. Thermal indices, such as the universal thermal climate index (UTCI), can better assess human weather-related stresses by integrating multiple weather components. This paper quantifies and compares the seasonal and spatial association of UTCI with mortality, morbidity, and road accidents in the federal state of Bavaria, Germany. Linear regression was applied to seasonally associate daily 56 million hospital admissions and 2.5 million death counts (1995-2015) as well as approximately 930,000 road accidents and 1.7 million people injured (2002-2015) with spatially interpolated same day- and lagged- (up to 14 days) average UTCI values. Additional linear regressions were performed stratifying by age, gender, region, and district. UTCI effects were clear in all three health outcomes studied: Increased UTCI resulted in immediate (1-2 days) rises in morbidity and even more strongly in mortality in summer, and lagged (up to 14 days) decreases in fall, winter, and spring. The strongest UTCI effects were found for road accidents where increasing UTCI led to immediate decreases in daily road accidents in winter but pronounced increases in all other seasons. Differences in UTCI effects were observed e.g. between in warmer north-western regions (Franconia, more districts with heat stress-related mortality, but hospital admissions for lung, heart and external reasons decreasing with summer heat stress), the touristic alpine regions in the south (immediate effect of increasing UTCI on road accidents in summer), and the colder south-eastern regions (increasing hospital admissions for lung, heart and external reasons in winter with UTCI). Districts with high percentages of elderly suffered from higher morbidity and mortality, particularly in winter. The influences of UTCI as well as the spatial and temporal patterns of this influence call for improved infrastructure planning and resource allocation in the health sector.

Understanding longevity in Hong Kong: a comparative study with long-living, high-income countries.

BACKGROUND: Since 2013, Hong Kong has sustained the world's highest life expectancy at birth-a key indicator of population health. The reasons behind this achievement remain poorly understood but are of great relevance to both rapidly developing and high-income regions. Here, we aim to compare factors behind Hong Kong's survival advantage over long-living, high-income countries. METHODS: Life expectancy data from 1960-2020 were obtained for 18 high-income countries in the Organisation for Economic Co-operation and Development from the Human Mortality Database and for Hong Kong from Hong Kong's Census and Statistics Department. Causes of death data from 1950-2016 were obtained from WHO's Mortality Database. We used truncated cross-sectional average length of life (TCAL) to identify the contributions to survival differences based on 263 million deaths overall. As smoking is the leading cause of premature death, we also compared smoking-attributable mortality between Hong Kong and the high-income countries. FINDINGS: From 1979-2016, Hong Kong accumulated a substantial survival advantage over high-income countries, with a difference of 1·86 years (95% CI 1·83-1·89) for males and 2·50 years (2·47-2·53) for females. As mortality from infectious diseases declined, the main contributors to Hong Kong's survival advantage were lower mortality from cardiovascular diseases for both males (TCAL difference 1·22 years, 95% CI 1·21-1·23) and females (1·19 years, 1·18-1·21), cancer for females (0·47 years, 0·45-0·48), and transport accidents for males (0·27 years, 0·27-0·28). Among high-income populations, Hong Kong recorded the lowest cardiovascular mortality and one of the lowest cancer mortalities in women. These findings were underpinned by the lowest absolute smoking-attributable mortality in high-income regions (39·7 per 100 000 in 2016, 95% CI 34·4-45·0). Reduced smoking-attributable mortality contributed to 50·5% (0·94 years, 0·93-0·95) of Hong Kong's survival advantage over males in high-income countries and 34·8% (0·87 years, 0·87-0·88) of it in females. INTERPRETATION: Hong Kong's leading longevity is the result of fewer diseases of poverty while suppressing the diseases of affluence. A unique combination of economic prosperity and low levels of smoking with development contributed to this achievement. As such, it offers a framework that could be replicated through deliberate policies in developing and developed populations globally. FUNDING: Early Career Scheme (RGC ECS Grant #27602415), Research Grants Council, University Grants Committee of Hong Kong.

Trends in Cannabis Involvement and Risk of Alcohol Involvement in Motor Vehicle Crash Fatalities in the United States, 2000‒2018.

Objectives. To assess cannabis and alcohol involvement among motor vehicle crash (MVC) fatalities in the United States. Methods. In this repeated cross-sectional analysis, we used data from the Fatality Analysis Reporting System from 2000 to 2018. Fatalities were cannabis-involved if an involved driver tested positive for a cannabinoid and alcohol-involved based on the highest blood alcohol concentration (BAC) of an involved driver. Multinomial mixed-effects logistic regression models assessed cannabis as a risk factor for alcohol by BAC level. Results. While trends in fatalities involving alcohol have remained stable, the percentage of fatalities involving cannabis and cannabis and alcohol increased from 9.0% in 2000 to 21.5% in 2018, and 4.8% in 2000 to 10.3% in 2018, respectively. In adjusted analyses, fatalities involving cannabis had 1.56 (95% confidence interval [CI] = 1.48, 1.65), 1.62 (95% CI = 1.52, 1.72), and 1.46 (95% CI = 1.42, 1.50) times the odds of involving BACs of 0.01% to 0.049%, 0.05% to 0.079%, and 0.08% or higher, respectively. Conclusions. The percentage of fatalities involving cannabis and coinvolving cannabis and alcohol doubled from 2000 to 2018, and cannabis was associated with alcohol coinvolvement. Further research is warranted to understand cannabis- and alcohol-involved MVC fatalities. (Am J Public Health. 2021;111(11):1976-1985. https://doi.org/10.2105/AJPH.2021.306466).

Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis.

BACKGROUND: The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels. METHODS AND FINDINGS: A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle-Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg's and Egger's tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case-control study, and 5 pre-post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p-value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law (p-value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present. CONCLUSIONS: In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.