Estimating cost of road traffic injuries in Iran using willingness to pay (WTP) method

Multilevel structural equation modeling of willingness-to-pay for fatality risk reduction: perspectives of driver and district levels

Road accidents remain a serious problem and directly affect drivers. Therefore, the perspectives of drivers are important in improving road safety. The objectives of this study are to empirically examine damage due to road accidents using the willingness-to-pay (WTP) approach and to analyze the factors that influence WTP at the driver and district levels. This study obtained data on WTP derived from car drivers across Thailand, which covers 96 districts. The value of statistical life was 824,344 USD per fatality (2,296 million USD annually). The results of Multilevel Structural Equation Modeling revealed a statistically important insight. At the driver level, the Health Belief Model and sociodemographic exert influence on the intention to pay. The demographic factor that has the greatest influence on perceived risk and leads to a high intention to pay is the working age group (γ = 0.826). However, when considering the HBM, perceived susceptibility (γ = 0.901) emerges as the most valuable factor influencing drivers' concerns about road accidents. On the other hand, district-level factors have a negative influence on the intention to pay for road safety measures. Among these factors, the law enforcement (γ = -0.555) practices implemented by local authorities have the most significant impact on drivers' perspectives and intentions regarding WTP. This finding can be used as a guideline for budget allocation and policy recommendation for policymakers in improving road safety according to the area contexts.

11-Year Trend of Mortality from Fatal Road Traffic Injuries in The Center of Iran; a Cross-sectional Study

Introduction

Road traffic injuries (RTIs) are one of the major health problems in developed and developing countries. In Iran, RTIs are the first leading cause of years of life lost (YLL). So, the present study investigated the 11-year trend of RTI- related mortalities in Iran.

Methods

This study was a population-based cross-sectional study. All-cause deaths as well as RTI-related mortalities' data were collected from the Civil Registration Organization (CRO) and Legal medical organization (LMO) of Isfahan during 2011-2021. The mid-year population, number of deaths due to RTIs, the crude and age-standardized mortality (per 100,000) of RTIs, and the percentage of proportional mortality by sex and year of accident during the study period were calculated and reported. Also, trend analysis was done using join point regression program.

Results

During the study period, 11,248 deaths occurred due to RTIs in Isfahan province. 8,894 cases were male (79.03%), the highest number of deaths in both male and female cases was reported in those aged 15-39 years. Among the males, trend of standardized mortality in 2011-2015 was decreasing (annual percentage changes = -6.76(CI 95%: -2.53, -15.03)), while in 2015-2021 it was increasing (annual percentage changes = 3.00 (CI 95%: 0.63, 9.87)). However, no significant trend was observed among females.

Conclusion

The findings of the present study showed that the number and standardized mortality rate of RTIs decreased during the 11-year period. It seems that applying stricter policies, improving the quality of the roads of the province, improving the quality of cars, and increasing the number of hospital and pre-hospital medical facilities can play an effective role in reducing RTIs.

Unraveling preference heterogeneity in willingness-to-pay for enhanced road safety: A hybrid approach of machine learning and quantile regression

Investing in road safety enhancement programs highly depends on the economic valuation of road traffic accidents and their outcomes. Such evaluation underpins road safety interventions in cost-benefit analysis. To this end, understanding and modeling public willingness-to-pay for enhanced road safety have received significant attention in the past few decades. However, despite considerable modeling efforts, some issues still persist in earlier studies, namely, (i) using standard regression approaches that assume a homogeneous impact of explanatory variables on willingness-to-pay, not accounting for heterogeneity, and depends on a priori distribution of the dependent variable, and (ii) the absence of higher-order interactions from models, leading to omitted variable bias and erroneous model inferences. To overcome this critical research gap, our study proposes a new modeling framework, integrating a machine learning technique (decision tree) to identify a priori relationships for higher-order interactions and a quantile regression model to account for heterogeneity along the entire range of willingness-to-pay. The proposed framework examines the determinants of willingness-to-pay for enhanced road safety using a sample of car drivers from Peshawar, Pakistan. Modeling results indicate that variables not significant in a linear model become significant at specific quantiles of the willingness-to-pay distribution. Further, including higher-order interactions among the explanatory variables provides additional insights into the complex relationship between willingness-to-pay and its determinants. In addition, willingness-to-pay for fatal and severe injury risk reductions is estimated at different quartiles and used to calculate the values of corresponding risk reductions. Overall, the proposed framework provides a better understanding of public sensitivities to willingness-to-pay for enhanced road safety.

Correlated random parameters model with heterogeneity in means for analysis of factors affecting the perceived value of road accidents and travel time

Road safety funding and management have become important issues in improving the quality of life of road users and there is evidence of a difference in driving behavior and the factor of road use between urban and rural areas, which is, in turn, reflected in different road safety evaluations. The purpose of this study is to assess the financial losses caused by road accidents on Thailand's highways and the related factors empirically, deploying the willingness-to-pay (WTP) approach. Data were obtained from 640 urban and 960 rural car drivers using a stated choice questionnaire and face-to-face interviews. This study used Correlated Random Parameters Binary Logit with Heterogeneity in Means (CRPBLHM) approach to analyze factors affecting WTP. According to the results, the value of a statistical life and injury for urban drivers was 1.63 times higher than that for rural drivers, and the value of travel time reduction per hour for urban drivers is ∼1.14 times higher than that found for rural drivers. Furthermore, the results of the CRPBLHM model reported that there are significant differences between urban and rural drivers' safety intentions and WTP. In the urban model, it was found that driving behavior (ticket, seatbelts, and speed) and weekday trips significantly increase the WTP, whereas household size and gender are unobserved characteristics among drivers. The rural model revealed that a driver's education (bachelor's and master's degrees held), and a necessary trip were significantly associated with drivers' valuation of safety; moreover, it was found that household size, sole earner status, own accident, in possession of a doctoral degree, and being young were significant in acting as unobserved characteristics. The results demonstrated differences in the value of road safety and unobserved heterogeneity among drivers, which influence risk perception and valuation with reference to the area context. Relevant agencies can use the results as a guideline for budget allocation and practical policy-related road safety management.

Global, Regional, and National Burden of Road Injuries from 1990 to 2019

(1) Background: Understanding occurrence can help formulate effective preventative laws and regulations. However, the most recent global burden and road injuries (RIs) trends have not been reported. This study reports the burden of RIs globally from 1990 to 2019. (2) Methods: RIs data were downloaded from the Global Burden of Disease 2019. Incidence, deaths, and disability-adjusted life years (DALYs) described the trend and burden of RIs. We calculated age-standardized rates (ASRs) and estimated annual percentage change (EAPC) for the above indexes to evaluate the temporal trend of RIs. We evaluated the social-demographic index (SDI) with epidemiological RI parameters and reported proportions of age-standardized rates due to RI. (3) Results: In 2019, the global incidence of RIs reached 103.2 million. The EAPC of RI incidence increased, whereas deaths and DALYs decreased. Age-standardized incident rate (ASIR) was highest in low-middle SDI regions, age-standardized death rate (ASDR) was high in middle SDI regions, and age-standardized DALYs increased in low SDI regions. The highest accident rates were found in those aged 20-24 years old. Cyclist injuries were the leading RIs (34%), though pedestrian and motor vehicle accidents were the leading cause of death (37.4%, 37.6%) and DALYs (35.7%, 32.3%), respectively. (4) Conclusions: Over the past 30 years, RIs incidence increased annually, though death and DALY rates decreased. RIs places a considerable burden on public health in low SDI countries. Data should be used to develop and implement effective measures to reduce the burden of RIs.

Influence of Psychological Perspectives and Demographics on Drivers’ Valuation of Road Accidents: A Combination of Confirmatory Factor Analysis and Preference Heterogeneity Model

Property damage and loss from road traffic accidents are a major concern in developing countries; thus, studies on accident damage in such countries may include more latent factors. This study aims to examine the effect of psychological perspectives and sociodemographic status on drivers’ willingness-to-pay (WTP) for road accident risk reduction, using confirmatory factor analysis (CFA) and the random parameters multinomial logit model with heterogeneity in means and variances (RPMNLHMV). The CFA results from interviews with 1650 car drivers in Thailand demonstrate that concepts of the theory of planned behavior and health access process approach are key factors for describing drivers’ behavioral intention and WTP. The RPMNLHMV results indicate that drivers’ demographics affected drivers’ WTP to reduce road accidents, and psychological perspectives were also found to have an influence on WTP. The results also reveal unobserved characteristics that could affect drivers’ WTP. The study concludes that ignoring unobserved heterogeneity in studies on WTP to reduce road accidents can lead to biased results and neglect important influential factors. The methodological approaches applied herein offer another layer of insight into unobserved characteristics in road accident valuation. These findings could be used to provide relevant authorities practical insights for policy development on road accident mitigation and road safety education programs in accordance with drivers’ characteristics.

Preserving natural teeth versus extracting them: a willingness to pay analysis

BACKGROUND

Maximum willingness to pay (WTP) for a health benefit is related to perceived value. The goal of this study was to find out how much Iranian healthy people would be willing to pay to keep their natural teeth instead of having them pulled. This was done separately for the anterior and posterior teeth.

METHODS

The highest value was posed as an open-ended question in this cross-sectional analysis conducted in 2021. Four distinct scenarios for treating a tooth with a poor prognosis for natural tooth preservation versus extraction were offered. WTP for the preferred treatment option was asked for painful and painless anterior and posterior teeth separately. A two-stage hurdle approach was employed to determine factors influencing the WTP for a hopeless case. The level of significance was fixed at 0.05.

RESULTS

Out of 795 individuals, 355 (44.7%) were male and 209 (26.3%) had poor self-stated dental health. Over 65% of those interviewed said they wanted to keep their teeth. The mean WTP was highest for dental preservation up to 94 USD and the lowest was for extraction without replacement 19 USD. The WTP for anterior tooth therapy was greater than the WTP for posterior dental care, regardless of treatment type or tooth discomfort. Participants with higher education, jobs, income-to-expenditure matching, older age, preference for the treatment in a private office, and female gender (except for WTP for a painful posterior tooth) were more likely to have a WTP of at least 1 USD.

CONCLUSION

The average WTP for treatment of teeth with a poor prognosis was lower than the average fee charged in dental facilities, and more than 65% of participants preferred to keep their teeth. Regardless of the treatment option or whether it was painful or not, WTP for anterior teeth treatment was higher than for posterior teeth. Generally, we found that sociodemographic factors influenced WTP decision-making the most. This study has practical implications for public oral health policymakers and insurance organizations.

Quantitative Analysis of the Social Costs of Road Traffic Crashes Literature

Despite recent improvements in tackling road safety challenges, particularly in developed countries, road traffic crashes account for 1.35 million deaths annually and cost over 65 us$ billion. This paper reviews the existing socio-economic costs literature, highlights research gaps, and draws attention to the lack of analysis in developing countries, which account for 90% of the fatalities. We rely on both simple descriptive analyses and formal econometric analyses. Our descriptive results show an upward trend over the recent years, mostly in high and middle-income countries. The paper focuses on the differences in estimating the socio-economic costs of road traffic crashes using two popular methodologies, the willingness-to-pay (wtp) and the human capital (hc). Our econometric analysis shows that papers that use wtp tend to compute the impact as a percentage of gdp that is on average ̃1% higher than those that use the hc approach. Likewise, studies using the human capital method tend to underestimate the total socio-economic costs by a factor of two compared to the cost derived from the wtp approach; this gap then reduces substantially when accounting for population density, countries' income levels, and road safety outcomes. Further, the paper stresses the underreporting problem and the inexistence of a mechanism to reasonably account for it in socio-economic costs calculations. The paper concludes by advocating for more studies focusing on low and middle-income countries using a combination of common approaches with other valuation methods.

Estimation of economic costs of air pollution caused by motor vehicles in Iran (Isfahan)

Since mobile sources are one of the most important sources of air pollution, this paper tries to estimate the health effects and economic burden due to fine particulate matter (PM_2.5) concentrations from motor vehicles. In this regard, we calculate the economic costs of air pollution emitted by vehicles in Isfahan over the period from March 2018 to March 2020. The concentration of urban traffic pollution based on the generalized additive model (GAM) as well as spatial distribution of pollution is estimated. Health effects are evaluated using AirQ⁺ updated by the WHO European Centre for Environment and Health. Economic burden of mortality attributable air pollution from traffic is calculated using value of a statistical life (VOSL), and the value of life years (VOLY) approach. The results indicated that the number of deaths attributable to PM_2.5 from motor vehicles in these two consecutive years was 136 (95%CI: 89-179), and 147 cases (95%CI: 96-194), respectively. The number of years of life lost due to premature death from air pollution was 2079 years annually. The economic costs imposed under VOSL approach were on average USD 51.7 (95%CI: 43-75) million per year, and according to VOLY approach USD 11.5 (95%CI: 9-13) million per year. These results help to analyze the cost-benefit and prioritize control measures to reduce air pollution. In addition, combination of these results with other externality cost of road traffic can take account for urban transportation planning.

The economic burden of road traffic injuries until one-year after hospitalization: A survey study

OBJECTIVE

Road Traffic Injuries (RTIs) are one of the most crucial and challenging public health problems in low and middle income countries. Despite continuous efforts to estimate both personal and societal costs of RTIs however, their long-term effects have remained marginal. The current study aimed to explore the economic burden of RTIs until one year after the victim's hospitalization.

METHODS

The study included a total of 1150 RTI victims, who were admitted to two trauma-referral hospitals during 2016. Data on direct medical costs, direct non-medical costs and indirect costs were gathered for each study sample via hospital records and phone surveys. Direct and indirect costs from a social perspective were estimated based on Micro Costing Approach followed by the Human Capital Approach. Also, the explanatory variables affecting the costs of RTIs were identified using the liner regression model.

RESULTS

The average amounts of direct (medical, non-medical), indirect, and total costs of RTI were estimated as 2,908 US$ (1,591 US$, 1,316 US$), 5,790 US$, and 8,701 US$ respectively. Also, several variables were significantly affecting the costs of RTIs including age, marital status, employment status, severity of injury, receiving physiotherapy care, victim's vehicle type in crash, crash time and location.

CONCLUSIONS

Findings suggest that RTIs are considered as an enormous burden on Iranian GDP per capita and health expenditure per capita occupying 167% and 347% respectively. This enormous economic burden caused by RTIs requires more policy regulations and prevention programs to decrease RTIs.

Factors influencing willingness to pay for accident risk reduction among personal car drivers in Thailand

Thailand ranks near the top for the road accident fatality rate worldwide, and more and more vehicles are being registered in Thailand every year. Obtaining the opinions of road commuters may help us reduce road accidents in Thailand. This study seeks to understand damage value in road accidents for personal car drivers in Thailand, using the willingness to pay approach and establishing factors affecting willingness to pay with the theory of planned behavior (TPB). This study obtained data using questionnaires in face-to-face interviews with 1,650 personal cars drivers in Thailand. The average willingness to pay (WTP) for 50% fatality or injury reduction was 23.00 baht/person/50 km trip (US $0.74/person/50 km trip). We obtained the value of statistical life (VSL), assessing this to fall between US $815,385 and US $872,942, and the value of statistical injury (VSI), between US $150,059 and US $160,652. Overall, national damage was assessed at US $4,701,981,170 annually. According to the analysis of factors affecting WTP, TPB comprises four factors, namely, driver attitude, subjective norm, perceived behavioral control, and behavioral intention. Analysis using structural equation modeling (SEM) found all mentioned factors were relevant and positively influenced personal car drivers' WTP in Thailand, with a statistical significance at a 99% confidence interval (p < 0.01). This study can develop recommendations for relevant organizations to analyze the results as part of considerations regarding budget allocation and developments on road safety policy due to driver attitude as important as environmental factors or any other factors.

The level and trend of road traffic injuries attributable mortality rate in Iran, 1990-2015: a story of successful regulations and a roadmap to design future policies

BACKGROUND

Road-Traffic-Injuries (RTIs) are predicted to rise up to the fifth leading cause of worldwide death by 2030 and Iran has the third highest RTIs mortality among higher-middle income countries. Although the high mortality of RTI in Iran is a warning, it provides the opportunity to indirectly assess the implemented RTI-related regulations' effectiveness via high-resolution relevant statistics and, hence, Iran could serve as a guide for countries with similar context. In order to do so, we utilized this study to report the time and spatial trends of RTIs-related mortality in different age and sex groups and road user classes in Iran.

METHODS

Based on the national death-registration-system (DRS), cemeteries data, and the demographic characteristics, and after addressing incompleteness, we estimated mortality rates using spatiotemporal and Gaussian process regression models. We assessed Pearson seatbelt and helmet use and RTIs-attributable Age-Standardized-Morality-Rate (ASMR) associations. We also predicted RTIs-death-numbers, 2012-2020, by fitting a Generalized Additive Model to assess the status of achieving relevant sustainable development goal (SDG), namely reducing the number of RTIs-related deaths by half.

RESULTS

Overall RTIs-attributable death and ASMR at the national level increased from 12.64 [95% UI, 9.52-16.86] to 29.1 [22.76-37.14] per 100,000 people in the time period of 1990-2015. The trend consisted of an increasing segment in 1990-2003 followed by a decreasing part till 2015. The highest percentage of death belonged to the three-or-more-wheels motorized vehicles. Pedestrian injuries percentage increased significantly and the highest mortality rate occurred in 85 years and older individuals. Low prevalence of seatbelt and helmet use were observed in provinces with higher than the median ASMR due to the relevant cause of each. RTIs-attributable death number is expected to reduce by 15.99% till 2020 which is lower than the established SDG goal.

CONCLUSIONS

Despite the observed substantial moderation in the RTI-ASMR, Iran is till among the leading countries in terms of the highest mortality rates in the world. The enforced regulations including speed limitations (particularly for elder pedestrians) and mandatory use of seatbelt and helmet (for young adult and male drivers) had a considerable effect on ASMR, nevertheless, the RTI burden reduction needs to be sustained and enhanced.

Investigating factors affecting severity of large truck-involved crashes: Comparison of the SVM and random parameter logit model

INTRODUCTION

Reducing the severity of crashes is a top priority for safety researchers due to its impact on saving human lives. Because of safety concerns posed by large trucks and the high rate of fatal large truck-involved crashes, an exploration into large truck-involved crashes could help determine factors that are influential in crash severity. The current study focuses on large truck-involved crashes to predict influencing factors on crash injury severity.

METHOD

Two techniques have been utilized: Random Parameter Binary Logit (RPBL) and Support Vector Machine (SVM). Models have been developed to estimate: (1) multivehicle (MV) truck-involved crashes, in which large truck drivers are at fault, (2) MV track-involved crashes, in which large truck drivers are not at fault and (3) and single-vehicle (SV) large truck crashes.

RESULTS

Fatigue and deviation to the left were found as the most important contributing factors that lead to fatal crashes when the large truck-driver is at fault. Outcomes show that there are differences among significant factors between RPBL and SVM. For instance, unsafe lane-changing was significant in all three categories in RPBL, but only SV large truck crashes in SVM.

CONCLUSIONS

The outcomes showed the importance of the complementary approaches to incorporate both parametric RPBL and non-parametric SVM to identify the main contributing factors affecting the severity of large truck-involved crashes. Also, the results highlighted the importance of categorization based on the at-fault party. Practical Applications: Unrealistic schedules and expectations of trucking companies can cause excessive stress for the large truck drivers, which could leads to further neglect of their fatigue. Enacting and enforcing comprehensive regulations regarding large truck drivers' working schedules and direct and constant surveillance by authorities would significantly decrease large truck-involved crashes.

Meta-synthesis of qualitative evidence in road traffic injury prevention: a scoping review of qualitative studies (2000 to 2019)

BACKGROUND

A considerable number of qualitative studies have been published in recent years on the issues that the quantitative studies have limitations on. This study aimed at performing a meta-synthesis on qualitative studies on Road Traffic Injuries (RTIs) with a scoping review approach.

METHODS

This meta-synthesis study was conducted as a scoping review in 2019. The Arkesy and O'Malley framework was applied which has six steps of identifying the research question, identifying the relevant studies, selecting the studies, charting the data, data analysis and reporting the results, and consultation exercise. The required data were gathered by searching the relevant keywords in databases of PubMed, web of knowledge, Scopus, Cochrane Library, Science Direct, Google scholar, Sid, IranMedex. Extracted data were analyzed by the Content-Analysis method.

RESULTS

Finally, 30 studies were included. Extracted data summarized in five main themes and 17 sub-themes. The main themes were: consequences (individual, family, social, financial), the needs of survivors (social support and healthcare), risk factors (general risk factors, risk factors for motorcyclists, risk factors for children and adolescents), barriers of prevention (general barriers, pre-hospital barriers, emergency, and hospital barriers), and prevention solutions (increasing safety, rules and regulations, education, increasing equipment, scientific solutions) of RTIs.

CONCLUSION

This study combined the methods of the scoping review and the meta-synthesis to mapping all qualitative studies on the RTIs, with this approach, this study provides extensive and practical information for policy-makers, managers, practitioners, and researchers in the field of RTIs. Also, by applying this approach, the gaps in the existing knowledge and areas in need of further research are identified.

Developing a National Integrated Road Traffic Injury Registry System: A Conceptual Model for a Multidisciplinary Setting

Introduction

Despite a high burden of traffic injuries, effective integrated or linked injury surveillance systems are rarely available in many low- and middle-income countries (LMICs). The aim of the current study was to define a conceptual model for developing a national integrated traffic injury registry in Iran.

Methods

A mult-method study financially and technically supported by the World Health Organization, Iranian Ministry of Health, Iranian Traffic Police, and the Iranian Legal Medicine Organization was conducted. A theoretical framework, forming the core conceptual components, was developed based on expert reviews. The preliminary conceptual model was developed by a panel of experts and tailored through a national workshop of 50 scientists, authorities and experts from nearly all sectors related to road safety promotion and injury management. It was then sent out to external reviewers in order to assess and improve the content validity of the model.

Results

The conceptual model was developed to have six components. These included 1) aims and core definitions; 2) content and core measurements; 3) data flow; 4) data collection routines; 5) organizational matrix; 6) implementation organization. The Haddon's matrix was adapted to be used as the theoretical framework in defining the content and data flow components of IRTIR. Five subcomponents were defined in the content and core measurements component with each having several subcategories. Each subcomponent/subcategory was finally divided into several item groups to guide defining the final data measurement variables. The data flow component was defined with six data sequence stations. Through the organizational matrix component, five major organizations relevant to road traffic safety were defined as core data production contributors. Some organizations also owned several sub-organizations which contributed in this regard.

Conclusion

It is concluded that the IRTIR conceptual model includes the required six components for developing a national integrated registry for Iran. Its main component called, content and core measurements, leads the researchers in developing final data collection tools in developing the national registry of road traffic injuries in Iran.

The protocol for validating phone interview tools on post-discharge consequences of road traffic injuries

BACKGROUND

Road Traffic Injuries (RTIs) impose a worldwide burden on public health and economy. RTIs result in a wide range of immediate and long-term consequences. However, little is known about post-discharge consequences of RTIs at national levels. In addition, reliable and producing valid data mostly through prospective studies is fundamentally required to address the issue. The aim of this paper was to describe the research protocol for development and psychometric evaluation of post-discharge consequences of road traffic injuries as part of the Persian Traffic Cohort (PTC) and complementary to the Iranian Integrated Road Traffic Injury Registry (IRTIR).

METHODS

Literature review and expert's opinion were used to develop data collection tools. Registry timeframe was designed based on experts' opinion. Reliability of tools will be assessed using intra- and inter-rater reliability. The pilot phase of the Phone interviews on Post-discharge Consequences of Road Traffic Injuries (PCRTI) will be conducted in Tabriz in 2019.

RESULTS

The PCRTI is designed to be applied at three different time points: one, six and twelve months after the crash. The PCRTI tools' main domains are: demographic, psychological, medical, social and financial which will be assessed through PC-PTSD, PHQ2, WHODAS, SES-Iran, EQ-5D-3L and Economic assessment standardized tools. The descriptive outcomes will be reported to the Ministry of Health and Medical Education of Iran.

CONCLUSIONS

The protocol satisfies the requirements of developing valid data collection tools for PCRTI.

Dimensions of aberrant driving behaviors and their association with road traffic injuries among drivers

Objective

Road traffic injuries (RTIs) are recognized as one of the most important causes of morbidity and mortality throughout the world, especially in developing countries. Human behavior is reportedly one of the critical factors in the occurrence of such injuries. The purpose of this study is to evaluate the correlation of abnormal driving behaviors with the frequency and severity of RTIs among drivers in Hamadan, west of Iran.

Methods

The present cross-sectional study was conducted on 800 people driving, who were selected by multistage cluster sampling technique. Data were collected using a three-part self-administered questionnaire including demographic, social and driving characteristics; the Manchester driver behavior questionnaire (DBQ); as well as information on a history of the occurrence of the injuries caused by the crashes and the severity of them. Data were statistically analyzed using numerical indices, linear regression analysis, Pearson correlation, ordinal logistic regression model and multinomial logistic regression.

Results

The highest and lowest mean percentages of abnormal driving behavior were related to unintentional violations (19.13) and Lapses (16.44), respectively. "Changing radio stations and listening to music while driving", "overtaking a driver who drives slowly", and "unintentionally exceeding the speed limit" were the three highest behaviors associated with road traffic injuries, with the mean and standard deviation of (1.93 ± 1.4), (1.90±1.4), (1.58±1.3), respectively. Age, gender, educational level, driving experience and driving hours during the day were significantly associated with DBQ dimensions and severity of road traffic injuries.

Conclusions

The results of this study showed that socio-demographic characteristics were significantly correlated with driving behavior. In addition, driving behaviors were correlated with traffic crashes and the resulting injuries. The findings of this study can be utilized to develop driving behavior interventions among the drivers.

Economic Burden of Road Traffic Injuries in Nepal

The evidence of the economic burden of road traffic injuries (RTIs) in Nepal is limited. The most recent study, conducted in 2008, is now considered outdated because there has been a rapid increase in vehicle numbers and extensive road building over the last decade. This study estimated the current economic costs of RTIs in Nepal, including the direct costs, productivity costs, and valuation of pain, grief, and suffering. An incidence-based cost-of-illness analysis was conducted from a societal perspective, employing a bottom-up approach using secondary data. All costs incurred by the patients, their family members, and costs to society were estimated, with sensitivity analyses to consider uncertainty around the data estimates available. Productivity loss was valued using the human capital approach. The total costs of RTIs in 2017 were estimated at USD 122.88 million. Of these, the costs of productivity loss were USD 91.57 million (74.52%) and the pain, grief, and suffering costs were USD 18.31 million (14.90%). The direct non-medical costs were USD 11.50 million (9.36%) whereas the direct medical costs were USD 1.50 million (1.22%). The economic costs of RTIs increased by threefold since 2007 and are equivalent to 1.52% of the gross national product, indicating the growing national financial burden associated with preventable RTIs.

Cost Analysis of Accidents according to Demographic Factors in Iran

BACKGROUND

The first cause of death and disability constituting to the burden of disease in Iran has been accident and injury incidents. Young people are more at risk, these accidents have a negative effect on the national gross domestic product (GDP), on the one hand, and they increase the costs of the health system on the other hand. Therefore, this study aimed to analyze the costs and epidemiological pattern of accidents.

METHODS

The study variables in the first 8 months of 2016 included from Tehran Province, Iran; age, sex, how to transfer to the hospital, consequences of an accident, the injured area, and costs. Overall, 400 cases were investigated by referring to the patients' files and deriving the intended data. SPSS software used to analyze the data and statistical tests of t-test and ANOVA were applied.

RESULTS

Most accidents have happened in summer months of Jun, Jul and Aug. Most of the files (48%) were related to the age group of 16-30. The mean cost was 9024.82 dollar. In total, 39% of the road accidents had occurred by motorcycle and 90.8% of the patients discharged from the hospital.

CONCLUSION

Since about half of the traffic accidents were related to the age of 16 to 30 who were the active population of a community, therefore, any disability or death in these groups could cause an economic burden on the community and increase DALY. Thus, it appears essential to develop proper programs such as education for appropriate driving and strict rules for giving driving license to these ages.

Comparative Study of Stewardship of Road Traffic Injuries Prevention with a Focus on the Role of Health System; Three Pioneer Countries and Three Similar to Iran

OBJECTIVE

To compare the stewardship of road traffic accidents (RTIs) prevention in three pioneer countries and three similar ones to Iran.

METHODS

In this descriptive comparative study, the United States of America, Sweden, and Brazil as the pioneer countries in RTIs prevention were compared to the India, Pakistan, and Turkey as the countries socioeconomically similar to Iran. Embase, PubMed, Scopus, IranDoc, IranMedex, SID, and MagIran were searched. Also a hand search conducted on websites and search engines using related keywords.

RESULTS

In the pioneer countries in RTIs prevention there was a delegation to a particular organization. In the other three countries a part of the Ministry of Transportation had the overall responsibility of RTIs. In Iran there was uncertainty in the stewardship of RTIs prevention. There was little evidence on the role and activities of health systems in RTIs prevention.

CONCLUSION

It seems necessary to define a lead agency organization on RTIs prevention in Iran with sufficient authority and resources. This study also recommends conducting reliable studies to investigate the possible roles that the health system of a country can assume regarding the RTIs prevention.

The Cost Analysis of Patients with Traffic Traumatic Injuries Presenting to Emergency Department; a Cross-sectional Study

Introduction

Road traffic traumatic injuries are the leading cause of death especially among young men who are mostly vulnerable victims. This catastrophe is more complicated in low to middle-income countries.

Objective

This study assessed the financial costs of traffic casualties in a level-1 trauma university hospital.

Method

One thousand trauma patients presenting to the emergency department of Shohaday-e-Tajrish Hospital were included in the study. The prehospital and hospital costs as well as the expenses of physiotherapy, rehabilitation, outpatient visits and further surgical interventions were considered as direct expenses. The costs of productivity loss were estimated as indirect expenses.

Results

The direct and indirect costs were assessed 27.4% and 72.6% of total, respectively. The mean age of permanent disability was 43 years old. The average expenses of temporary and permanent disabilities were 2934.4 million rials, equal to 106 thousand $ (nearly 4.2 million rials or 153 $ per patient) and 23.9 billion rials, equal to 866.3 thousand $ (1.1 billion rials or 39.2 thousand $ per person), respectively.

Conclusion

The national burden of traffic injuries in Iran is significantly destructive as it consists of 2.19 % of Gross Domestic Product annually. Besides, young men are involved in most of the traffic accidents representing the need to establish rigorous preventive instructions and reduce human, and financial costs.

Cost of two-wheeler road accidents in India

Economic loss due to traffic accidents is noticeable in India; however, the country lacks research works to estimate the magnitude. This study is an attempt through a Stated Preference (SP) survey to know how users value safety and how much they are willing to pay (WTP) for a safer road facility to reduce the risk of their involvement in road traffic accidents. The survey was conducted for two-wheeler riders of selected roads in Calicut City. Attributes selected for SP experimental design includes travel time, travel cost and traffic accidents per year and Binary Logit model was used to determine the WTP values. It was observed that travel cost, accident rate of the route selected, age, occupation, personal income and number of household members have significant impact on the decision-making process. WTP value of a road accident for a two-wheeler user was found to be Rs 0.53/person/trip.

Epidemiological study of hospitalized road traffic injuries in Iran 2011

Background: In Iran, Road Traffic Injuries (RTIs) is the second-leading cause of deaths, and the first leading cause of disabilityadjusted life year, and has one of the highest rates of death (32.1 per 100 000 population) all over the world. This study's aim was to investigate the epidemiological pattern and underlying components of hospitalized RTIs in 31 provinces of Iran in 2011. Methods: This study conducted on all hospitalized RTIs during one-year period (March 21, 2011 to March 21, 2012). Data extracted from a hospital-based traffic injury registration system. According to a national law passed in 2005, all hospital expenses of traffic injuries should be covered by ministry of health based on governmental tariffs. The medical costs of eligible patients will be paid to the hospitals only if the patient data are sent to the above mentioned database. Statistical analysis was performed using SPSS v.16 (SPSS Inc., Chicago, USA), and spatial maps are provided using GIS 10.2. Descriptive statistics and t-test were used to compare means. World (WHO 2000-2025) standard population used to calculate age-adjusted incidence rate. All statistical tests were performed at the 5% level of statistical significance. Results: There were 322,064 injured cases recorded in the registration system during the study period. The national age-adjusted incidence rate of RTIs was 405 per 100,000 population. The highest incidence rates were in the age group of 15-29 years (643 per 100,000 population), followed by 30-44 year age groups (401 per 100,000 population). The incidence rate in men was 3.36 times more than women. Motorcyclist were the most frequent type of road users (39.2%) who involved in RTIs, followed by passengers (28.9%) and pedestrians (20.0%). Head injuries were among the most affected part of the body which occurred in 27.2% of the patients. The proportion of urban crashes was 60.7%. Conclusion: The results of this study indicated that the majority of RTI occurred on motorcyclists and head injuries was the most commonly affected body part. Therefore, in order to reduce motorcycle accidents and avoiding head injury among them, stricter law enforcement is urgently needed for helmet use and promotion of safety behaviors among motorcycle riders.

Transport injuries and deaths in the Eastern Mediterranean Region: findings from the Global Burden of Disease 2015 Study

OBJECTIVES

Transport injuries (TI) are ranked as one of the leading causes of death, disability, and property loss worldwide. This paper provides an overview of the burden of TI in the Eastern Mediterranean Region (EMR) by age and sex from 1990 to 2015.

METHODS

Transport injuries mortality in the EMR was estimated using the Global Burden of Disease mortality database, with corrections for ill-defined causes of death, using the cause of death ensemble modeling tool. Morbidity estimation was based on inpatient and outpatient datasets, 26 cause-of-injury and 47 nature-of-injury categories.

RESULTS

In 2015, 152,855 (95% uncertainty interval: 137,900-168,100) people died from TI in the EMR countries. Between 1990 and 2015, the years of life lost (YLL) rate per 100,000 due to TI decreased by 15.5%, while the years lived with disability (YLD) rate decreased by 10%, and the age-standardized disability-adjusted life years (DALYs) rate decreased by 16%.

CONCLUSIONS

Although the burden of TI mortality and morbidity decreased over the last two decades, there is still a considerable burden that needs to be addressed by increasing awareness, enforcing laws, and improving road conditions.

Effectiveness of Interventions for Prevention of Road Traffic Injuries in Iran and Some Methodological Issues: A Systematic Review

Objective

To review the effectiveness of Road Traffic Injuries (RTIs) interventions implemented for prevention of RTIs in Iran and to introduce some methodological issues.

Methods

Required data in this systematic review study were collected through searching the following key words: "Road Traffic Injuries", "Road Traffic accidents", "Road Traffic crashes", "prevention", and Iran in PubMed, Cochrane Library electronic databases, Google Scholar, Scopus, MagIran, SID and IranMedex. Some of the relevant journals and web sites searched manually. Reference lists of the selected articles were also checked. Gray literature search and expert contact was also conducted.

Results

Out of 569 retrieved articles, finally 8 articles included. Among the included studies the effectiveness of 10 interventions were assessed containing: seat belt, enforcements of laws and legislations, educational program, wearing helmet, Antilock Braking System (ABS), motorcyclists' penalty enforcement, pupil liaisons' education, provisional driver licensing, Road bumps and traffic improvement's plans. In 7 studies (9 interventions) reduction of RTIs rate were reported. Decreased rate of mortality from RTIs were reported in three studies. Only one study had mentioned financial issue (Anti-lock Brake System intervention). Inadequate data sources, inappropriate selection of statistical index and not mention about the control of Confounding Variables (CV), the most common methodological issues were.

Conclusion

The results of most interventional studies conducted in Iran supported the effect of the interventions on reduction of RTIs. However due to some methodological or reporting shortcoming the results of these studies should be interpreted cautiously.

Epidemiology of special incidents: Results from national mortality and morbidity registry and the associated factors in Iran in 2014

Background

Special incidents are harmful events that can result in people’s death or injury. Despite registering special incidents’ data in Iran, no study has yet been conducted to identify the types, rates, mortality and morbidity of such incidents and their associated factors. The present study was conducted to assess the epidemiology of incidents and their associated factors during 2014 in Iran.

Methods

In this cross-sectional study, all special incidents of 2014 were examined. Data were initially collected by universities of medical sciences nationwide and then sent to the Disaster and Emergency Management Center in the Ministry of Health and Medical Education. The collected data were analyzed in this study using statistical tests of Chi-square and Pearson’s correlation coefficient using SPSS ver. 14.5.

Results

Out of 6,892 special incidents that occurred during 2014 in Iran, 6,781 cases were included, of which, the most prevalent were traffic crashes (71%), carbon monoxide poisoning (14%), drowning (3.5%), and other cases (11.5%) (which included suspicious deaths, explosions, group poisoning, quarrels, fires, falls from height, and building collapses). The incidents led to 37,313 injuries and 3,259 deaths, of which 78% of injuries and 75% of deaths were due to road traffic incidents.

Conclusion

Given to relationship between occurrence of the incidents and special holidays; such incidents can be reduced through preventive planning and education. We recommend annual monitoring of special incidents and further studies on the associated factors.

Policy Analysis of Road Traffic Injury Prevention in Iran

Introduction

Due to the large number of Road Traffic Injuries (RTIs) in Iran, authorities have implemented a number of policies for the prevention of RTIs. However, a scientific analysis of these policies has thus far been neglected. Therefore, this study was conducted for policy analysis of RTIs prevention in Iran.

Methods

This qualitative study with a case study approach was conducted in Iran during 2016 in two phases: First, by reviewing literature and documents of the past ten years, policies that have been executed to prevent RTIs in Iran were identified. In the second phase of the study, the identified policies were ranked by prioritization matrices. The two policies with the highest scores were selected. ‘Policy triangle framework’ was used for Policy analyzing. Stakeholders of these policies (42 people) were interviewed. Data were analyzed manually by implementing Content-Analysis methods.

Results

The policies of “pupil liaisons” and “safety belt” were selected for analysis from thirteen potential identified polices. The results of some studies revealed that safety belts had not been properly used in Iran (less than 80%). There was an eight-year hiatus between the approval of the safety belts policy and implementation of this policy. Eight actors were identified for safety belts policy. Lack of diligence in implementation of the policy, failing to pay adequate attention to education and the culture of driving, and failing to select an organization for the implementation of the policy, were identified as the main weaknesses of this policy. For ‘pupil liaisons’ policy, five actors were identified. Following the implementation of this policy, the number of penalties was reduced (17.9%). Neglecting scientific findings and individual-based nature of the policy were identified as the primary weaknesses of this policy.

Conclusions

Taking serious measures to properly execute the policy, educating people, selecting an efficient organization that is responsible for the implementation of the policies, and using international experience are the measures that can be taken to reduce the number of RTIs in the country.

Predicting and analyzing the trend of traffic accidents deaths in Iran in 2014 and 2015

Background:

Predicting the trend in traffic accidents deaths and its analysis can be a useful tool for planning and policy-making, conducting interventions appropriate with death trend, and taking the necessary actions required for controlling and preventing future occurrences.

Objective:

Predicting and analyzing the trend of traffic accidents deaths in Iran in 2014 and 2015.

Settings and Design:

It was a cross-sectional study.

Materials and Methods:

All the information related to fatal traffic accidents available in the database of Iran Legal Medicine Organization from 2004 to the end of 2013 were used to determine the change points (multi-variable time series analysis). Using autoregressive integrated moving average (ARIMA) model, traffic accidents death rates were predicted for 2014 and 2015, and a comparison was made between this rate and the predicted value in order to determine the efficiency of the model.

Results:

From the results, the actual death rate in 2014 was almost similar to that recorded for this year, while in 2015 there was a decrease compared with the previous year (2014) for all the months. A maximum value of 41% was also predicted for the months of January and February, 2015.

Conclusion:

From the prediction and analysis of the death trends, proper application and continuous use of the intervention conducted in the previous years for road safety improvement, motor vehicle safety improvement, particularly training and culture-fostering interventions, as well as approval and execution of deterrent regulations for changing the organizational behaviors, can significantly decrease the loss caused by traffic accidents.

Temporal Patterns of Road Traffic Injuries in Iran

BACKGROUND

Road traffic injuries (RTIs) are the main causes of death and disability in Iran. However, very few studies about the temporal variations of RTIs have been published to date.

OBJECTIVES

This study was conducted to investigate the temporal pattern of RTIs in Iran in 2012.

MATERIALS AND METHODS

All road traffic accidents (RTAs) reported to traffic police during a one-year period (March 21, 2012 through March 21, 2013) were investigated after obtaining permission from the law enforcement force of the Islamic Republic of Iran. Distributions of RTAs were obtained for season, month, week, and hour scales, and for long holidays (more than one day) and the day prior to long holidays (DPLH). The final analysis was carried out using the Poisson regression model to calculate incidence rate ratios for RTIs. All analyses were conducted using STATA 13.1 and Excel software; statistical significance was set at P < 0.05.

RESULTS

A total of 452,192 RTAs were examined. The estimated rate of all accidents was 219 per 10,000 registered vehicles, or 595 per 100,000 people. About 28% of all RTAs, and more than one third of fatal RTAs, occurred during the summer months. The incidence rate for all traffic accidents on DPLH was 1.20, compared to workdays as a reference category, and it was 1.40 for fatal crashes. The rate of fatal road traffic accidents in outer cities was 3.2 times higher than in inner ones.

CONCLUSIONS

Our findings reveal that there are temporal variations in traffic accidents, and long holidays significantly influence accident rates. Traffic injuries have different patterns on outer/inner city roads, based on weekday and holiday status. Thus, these findings could be used to create effective initiatives aimed at traffic management.

Knowledge, attitudes, and practice of drivers towards traffic regulations in Bandar-Abbas, Iran

Introduction

Traffic injuries are among the leading causes of death and disability in many countries. The knowledge, attitudes, and practice of drivers towards traffic regulations are key factors in decreasing traffic injuries and deaths. The objectives of this research were to study the knowledge, attitudes, and practice of taxi drivers towards traffic regulations in Bandar-Abbas, Iran, and to determine the relationships between demographic features and knowledge, attitudes, and practice of taxi drivers towards traffic regulations.

Methods

This cross-sectional study was done in 2014 in Bandar-Abbas, Iran (Hormozgan Province). To study the knowledge, attitudes, and practice of 241 intra-city taxi drivers towards traffic regulations, researchers developed questionnaires and a checklist. The chi-squared test was performed to determine the relationships between knowledge, attitude, and practice of drivers towards traffic regulations and demographic features.

Results

Among the 241 drivers, 50 of them (20.7%) thought that the seat belt could cause discomfort while driving, and 107 (44.4%) did not wear a seat belt while driving. The study determined that there was a significant difference between the knowledge and work experience of the drivers (p = 0.014). The 94 drivers (43.5%) in the 31–40 year age group had positive attitudes towards traffic regulations (among 216 drivers expressed positive attitudes) and 92 (44.4%) of the drivers in this age group had safe practices towards traffic regulations (among 207 drivers with safe practice).

Conclusion

Many of the taxi drivers in Bandar-Abbas had inadequate knowledge, less positive attitudes, and risky practices towards traffic regulations. Implementation of effective intervention programs may increase the taxi drivers’ knowledge, attitudes, and practices towards traffic regulations.

Barriers of Pre-Hospital Services in Road Traffic Injuries in Tehran: The Viewpoint of Service Providers

BACKGROUND

Iran is one of the countries with considerable road traffic injuries. Pre-hospital interventions have an important role in preventing mortalities and disabilities caused by traffic accidents. The present study aimed to explore the barriers of pre-hospital care in traffic injuries in Tehran, Iran.

METHODS

A qualitative content analysis approach was conducted based on 21 semi-structured interviews with 18 participants. A purposeful sampling method was applied until reaching data saturation. Interviews were transcribed verbatim, and then data condensing, labeling, coding and defining categories were performed by qualitative content analysis.

RESULTS

Four main barriers including 4 main categories and 13 subcategories emerged; they included Barriers related to people, Barriers related to metropolitan infrastructure, Barriers related to the profession and Barriers related to managerial issues.

CONCLUSION

Based on the findings of this study, pre-hospital service barriers in traffic accidents have many dimensions including cultural, structural and managerial domains. Policy makers in health system can use these findings to promote the quality of pre-hospital services, especially in the field of traffic injuries.