Comparing road traffic mortality rates from police-reported data and death registration data in China

Police and hospital data linkage for traffic injury surveillance: A systematic review

This systematic review examines studies of traffic injury that involved linkage of police crash data and hospital data and were published from 1994 to 2023 worldwide in English. Inclusion and exclusion criteria were the basis for selecting papers from PubMed, Web of Science, and Scopus, and for identifying additional relevant papers using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) and supplementary snowballing (n = 60). The selected papers were reviewed in terms of research objectives, data items and sample size included, temporal and spatial coverage, linkage methods and software tools, as well as linkage rates and most significant findings. Many studies found that the number of clinically significant road injury cases was much higher according to hospital data than crash data. Under-estimation of cases in crash data differs by road user type, pedestrian cases commonly being highly under-counted. A limited number of the papers were from low- and middle-income countries. The papers reviewed lack consistency in what was reported and how, which limited comparability.

Traffic safety and public health in China - Past knowledge, current status, and future directions

Transportation-related harms have developed into a social disease, threatening public safety and health in China. We aimed to increase the global understanding of traffic safety and public health in China from past knowledge, current status, and future directions by collecting, collating, and analyzing the Chinese traffic incidents reported in the published literature. A systematic search of China National Knowledge Infrastructure, Weipu, and published articles referenced in PubMed, Web of Science and ProQuest between January 1, 1988 and April 30, 2023 was performed. China encountered the first recorded traffic accident as early as three thousand years ago in the Shang Dynasty. An increase in vehicle capacity and velocity increased the traffic risks during the transition from rickshaws and livestock to motor vehicles in varying traffic environments. Humans are not only the decisive factor of a large number of vehicles, traffic routes, and environmental variables, but also the victims at the end and starting point of traffic accidents. Injuries (mechanical force, burns) and diseases (traffic-related air pollution, noise) caused by traffic activities not only threaten public health, but also cause risks to safe driving. Analysis of traffic activities and biomarkers promotes the treatment of traffic injuries in ethology and medicine. China prepared for the construction of healthy transportation in the "decade of road safety" toward an estimation of worldwide road traffic injuries in 2030. Improvement of traffic safety concerning public health under the "Outline of the National Comprehensive Three-dimensional Transportation Network Planning" in China will propel the realization of worldwide traffic environmental advancement.

Evaluating the effectiveness of implementing a more severe law on prevention of road traffic injury mortality in mainland China: an interrupted time series study based on national mortality surveillance

BACKGROUND

In China, road traffic injury (RTI) is the seventh-leading cause of death More than 1.5 million adults in China live with permanent disabilities due to road traffic accidents. In 2011, the Chinese government implemented a more severe law that increased the penalty points and fines for persons charged with drink-driving as a criminal offence.

OBJECTIVES

This study evaluated the short-term and long-term effects of the drink-driving law. It also aimed to establish whether punishments of increased severity resulted in greater reductions in RTI mortality.

METHODS

RTI mortality data was obtained from the Disease Surveillance Points System. A two-level interrupted time series model was used to analyse daily and monthly road traffic mortality rates, accounting for the varying trends among counties.

RESULTS

The overall RTI mortality rate showed a decreasing trend from 2007 to 2015 in mainland China, especially after 2011, and similarly decreasing trends were noted among males and females and in urban and rural areas. After the Criminal Law and Road Traffic Law amendment was implemented in 2011, charging drink-driving as a criminal offence, the immediate daily RTI mortality rate reduced by 1.57% (RR=0.9843, 95% CI: 0.9444 to 1.0259), while the slope change significantly decreased by 0.04% (RR=0.9996, 95% CI: 0.9994 to 0.9997) compared with the period before the Law was revised. Stratified analysis showed that the effect size of the law was higher for males in urban and high socioeconomic circumstances (SEC) than females in rural and low and moderate SEC. Meanwhile, the increase in penalty points for dangerous driving behaviours showed no significant effects.

CONCLUSION

Evidence was found that charging criminal responsibility for drink-driving is associated with reducing RTI deaths in China.

Evaluating automated emergency braking performance in simulated car-to-two-wheeler crashes in China: A comparison between C-NCAP tests and in-depth crash data

Automated Emergency Braking (AEB) is an effective way to prevent crashes from happening or mitigate their severity. Because riders of two-wheelers (TWs) are among the most vulnerable road users, New Car Assessment Programs, like the China New Car Assessment Program (C-NCAP), have recently introduced test scenarios for the assessment of AEB for cars encountering TWs (TW-AEB). The main aim of this study was to determine how well two different C-NCAP test scenario datasets reflect real-world crash scenarios for the purpose of assessing TW-AEB performance. We used virtual counterfactual simulations to determine whether the hypothetical TW-AEB's performance, when applied to the two C-NCAP datasets, was similar to its performance when applied to a set of reconstructed car-to-TW crashes representing real-world crashes. The test datasets were the current C-NCAP scenario set and a proposed C-NCAP scenario set; the real-world crash dataset comprised 113 reconstructed crashes from the Shanghai United Road Traffic Safety Scientific Research Center database (SHUFO). The performances were compared with respect to crash avoidance rate and the characteristics of the remaining crashes. A substantially higher proportion of crashes was avoided in the current C-NCAP scenario set than in the other two (with the sensor field of view (FoV) set to 70° and the activation time to 1.1 s TTC). In fact, with these parameter settings, no crashes remained in the current C-NCAP scenarios, while only 37% and 46% of the crashes in the proposed C-NCAP scenario set and SHUFO crash set were avoided, respectively. Our findings show that TW-AEB systems which are optimized for the current C-NCAP test scenarios are likely to provide benefits in real-world crashes. However, including additional test scenarios which reflect real-world crash situations more accurately would likely lead to a higher correlation between C-NCAP scores and real-world TW-AEB performance. In particular, we recommend the introduction of longitudinal same-direction scenarios with the car or TW turning and perpendicular scenarios with high TW traveling speed, in future C-NCAP releases. Inclusion of these scenarios in C-NCAP might reward improvements of future TW-AEBs toward systems that can save more lives. Furthermore, our study shows that there is likely to be a substantial number of crashes with an impact speed higher than 40 km/h still remaining even after the widespread application of TW-AEB. Therefore, passive safety for TW riders on Chinese roads will be still needed.

Road traffic injury mortality and morbidity by country development status, 2011-2017

PURPOSE

This research examined road traffic injury mortality and morbidity disparities across of country development status, and discussed the possibility of reducing country disparities by various actions to accelerate the pace of achieving Sustainable Development Goals target 3.6 - to halve the number of global deaths and injuries from road traffic accidents by 2020.

METHODS

Data for road traffic mortality, morbidity, and socio-demographic index (SDI) were extracted by country from the estimates of the Global Burden of Disease study, and the implementation of the three types of national actions (legislation, prioritized vehicle safety standards, and trauma-related post-crash care service) were extracted from the Global Status Report on Road Safety by World Health Organization. We fitted joinpoint regression analysis to identify and quantify the significant rate changes from 2011 to 2017.

RESULTS

Age-adjusted road traffic mortality decreased substantially for all the five SDI categories from 2011 to 2017 (by 7.52%-16.08%). Age-adjusted road traffic mortality decreased significantly as SDI increased in the study time period, while age-adjusted morbidity generally increased as SDI increased. Subgroup analysis by road user yielded similar results, but with two major differences during the study period of 2011 to 2017: (1) pedestrians in the high SDI countries experienced the lowest mortality (1.68-1.90 per 100,000 population) and morbidity (110.45-112.72 per 100,000 population for incidence and 487.48-491.24 per 100,000 population for prevalence), and (2) motor vehicle occupants in the high SDI countries had the lowest mortality (4.07-4.50 per 100,000 population) but the highest morbidity (428.74-467.78 per 100,000 population for incidence and 1025.70-1116.60 per 100,000 population for prevalence). Implementation of the three types of national actions remained nearly unchanged in all five SDI categories from 2011 to 2017 and was consistently stronger in the higher SDI countries than in the lower SDI countries. Lower income nations comprise the heaviest burden of global road traffic injuries and deaths.

CONCLUSION

Global road traffic deaths would decrease substantially if the large mortality disparities across country development status were reduced through full implementation of proven national actions including legislation and law enforcement, prioritized vehicle safety standards and trauma-related post-crash care services.

World Health Organization's estimates of death related to road traffic crashes and their discrepancy with other countries' national report

BACKGROUND

Due to a lack of effective registry system for road traffic deaths, some international organizations like the World Health Organization provide the estimated number of road traffic deaths. It was shown that there are differences in the number of road traffic deaths between the WHO estimates and national reports even in High-Income Countries. This study aimed to an investigation of reasons for differences between the national reports and world health organization estimates about road traffic deaths.

METHODS

This study focus to investigate the World Health Organization reports of Global Status Report for Road Safety in years of 2009, 2013, 2015 and 2018 and related articles about the estimates of deaths related to road traffic crashes and the observed differences between the WHO estimates and national reports.

RESULTS

The findings showed that the observed differences between the WHO estimates and national reports could be due to errors in the road traffic death registration system, errors in the regression model which was used for estimation, proposed variables for estimations, or all of them.

CONCLUSIONS

The estimations of WHO about road traffic deaths can be useful for countries especially for those which don't have the road traffic registry system or the registry system does not meet the quality criteria. These estimates may not be sufficiently robust if disregard for spatial differences, the epidemiological pattern of risk factors among the countries, and the type of regression model which was used for estimation.

Estimating the burden of road traffic crashes in Uganda using police and health sector data sources

BACKGROUND

In many low-income countries, estimates of road injury burden are derived from police reports, and may not represent the complete picture of the burden in these countries. As a result, WHO and the Global Burden of Diseases, Injuries and Risk Factors Project often use complex models to generate country-specific estimates. Although such estimates inform prevention targets, they may be limited by the incompleteness of the data and the assumptions used in the models. In this cross-sectional study, we provide an alternative approach to estimating road traffic injury burden for Uganda for the year 2016 using data from multiple data sources (the police, health facilities and mortuaries).

METHODS

A digitised data collection tool was used to extract crash and injury information from files in 32 police stations, 31 health facilities and 4 mortuaries in Uganda. We estimated crash and injury burden using weights generated as inverse of the product of the probabilities of selection of police regions and stations.

RESULTS

We estimated that 25 729 crashes occurred on Ugandan roads in 2016, involving 59 077 individuals with 7558 fatalities. This is more than twice the number of fatalities reported by the police for 2016 (3502) but lower than the estimate from the 2018 Global Status Report (12 036). Pedestrians accounted for the greatest proportion of the fatalities 2455 (32.5%), followed by motorcyclists 1357 (18%).

CONCLUSIONS

Using both police and health sector data gives more robust estimates for the road traffic burden in Uganda than using either source alone.

Trends in mortality from road traffic injuries in South Korea, 1983-2017: Joinpoint regression and age-period-cohort analyses

Although mortality trends can be influenced by different ages, periods, and cohorts, few studies have demonstrated the age-period-cohort (APC) effect on road traffic injury (RTI) mortality. Moreover, APC effects in Korea have never been documented despite the high mortality rates from RTIs. This study aimed to describe the trends in mortality from RTIs and examine APC effects on RTI mortality in Korea. Using the national death certificate and census mid-year population estimates data during 1983-2017, trends in age-standardized mortality rates from RTIs were analyzed using Joinpoint regression. Intrinsic estimator regression models were used to estimate APC effects on RTI mortality. Consistent with the trend in period effects, RTI mortality increased sharply with the economic growth in the 1980s, decelerated after the implementation of road safety policies in the early 1990s, plummeted owing to the 1997-1998 financial crisis, and gradually decreased from the early 2000s. A J-shaped age effect indicated that the relative risk of road traffic death surged in people aged ≥65 years. Educational expansion from the mid-1950s turned an increasing birth cohort effect into a continuously decreasing trend after peaking around the 1938-1943 birth cohorts. The risk of road traffic death was relatively high among the Korean Generation Y, i.e., those born in 1978-1983. RTI mortality trends in Korea have been affected by diverse socioeconomic changes through cohort and period effects. Despite the recent favorable trend, RTI mortality remains high, especially among older people. Road safety policies to address the burden of RTIs require further improvement.

Analysis of the burden and trend of injury in Sichuan, China, from 2006 to 2015: results from the national injury surveillance system

OBJECTIVE

This study investigates the distribution, burden and trends of injuries in Sichuan, China.

DESIGN

A surveillance study using injury data collected by the National Injury Surveillance System.

SETTING AND PARTICIPANTS

312 511 injury cases reported in the National Injury Surveillance System in Sichuan, China, from 2006 to 2015.

PRIMARY OUTCOME MEASURES

Years of potential life lost (YPLL) were calculated to determine the disease burden from injuries. Trend analysis was performed to assess the trends in specific injuries over time.

RESULTS

A total of 312 511 injury cases were reported in the last 10 years in Sichuan with 192 904 (men: 58.58%) and 119 607 (men: 67.11%) cases from the urban and rural surveillance hospitals, respectively. The annual number of injury cases increased from 21 257 in 2006 to 44 112 in 2015 with an average annual increase of 8.45%. The top three common causes of injury were fall (29.3%), animal-related injury (19.1%) and road-related injury (14.6%) in the urban area and fall (38.4%), road-related injury (17.2%) and blunt injuries (16.0%) in the rural area. YPLLs from injuries accounted for 13% of the total YPLLs in the urban area.

CONCLUSIONS

The number of injury cases varied according to rural/urban areas and gender and increased sharply in Sichuan over the last decade. It is necessary to develop targeted prevention and control measures to reduce the disease burden of injuries.

Sistema de indicadores de morbilidad y mortalidad por accidentes de tráfico: una revisión sistemática

Objetivo Elaborar un sistema de indicadores de morbilidad y mortalidad por accidentes de tráfico, con el fin de mejorar los procesos de recopilación y registro de la información de seguridad vial en el país.Materiales y Métodos Revisión sistemática cualitativa de artículos científicos publicados en revistas indexadas en las principales bases de datos (Scopus, PubMed, Lilacs, SciELO, Google Scholar), sobre accidentes de tráfico desde el año 1995 hasta el año 2015. La información recolectada pasó por 4 fases de revisión.Resultados Se seleccionaron 84 indicadores, agrupados en nueve dimensiones: accidentalidad, morbilidad, mortalidad, temporalidad, geoespacial, sociodemográfica, parque vehicular, impacto en salud pública, tipos y causas.Conclusiones Una gestión eficaz sobre seguridad vial exige que cada país cuente con un sistema de indicadores efectivo e institucionalizado que permita recolectar, analizar y gestionar la información de forma rápida y oportuna, enmarcada en el campo de la investigación científica, para difundir a la comunidad y organismos responsables de la seguridad vial, con miras a la adopción de medidas preventivas y correctivas. Por lo que, se recomienda a los organismos competentes de seguridad vial del país incorporar el sistema de indicadores elaborado en la presente investigación, lo cual permitirá contar con un sistema de registro da datos confiables.

Errors in accident data, its types, causes and methods of rectification-analysis of the literature

Most of the decisions taken to improve road safety are based on accident data, which makes it the back bone of any country's road safety system. Errors in this data will lead to misidentification of black spots and hazardous road segments, projection of false estimates pertinent to accidents and fatality rates, and detection of wrong parameters responsible for accident occurrence, thereby making the entire road safety exercise ineffective. Its extent varies from country to country depending upon various factors. Knowing the type of error in the accident data and the factors causing it enables the application of the correct method for its rectification. Therefore there is a need for a systematic literature review that addresses the topic at a global level. This paper fulfils the above research gap by providing a synthesis of literature for the different types of errors found in the accident data of 46 countries across the six regions of the world. The errors are classified and discussed with respect to each type and analysed with respect to income level; assessment with regard to the magnitude for each type is provided; followed by the different causes that result in their occurrence, and the various methods used to address each type of error. Among high-income countries the extent of error in reporting slight, severe, non-fatal and fatal injury accidents varied between 39-82%, 16-52%, 12-84%, and 0-31% respectively. For middle-income countries the error for the same categories varied between 93-98%, 32.5-96%, 34-99% and 0.5-89.5% respectively. The only four studies available for low-income countries showed that the error in reporting non-fatal and fatal accidents varied between 69-80% and 0-61% respectively. The logistic relation of error in accident data reporting, dichotomised at 50%, indicated that as the income level of a country increases the probability of having less error in accident data also increases. Average error in recording information related to the variables in the categories of location, victim's information, vehicle's information, and environment was 27%, 37%, 16% and 19% respectively. Among the causes identified for errors in accident data reporting, Policing System was found to be the most important. Overall 26 causes of errors in accident data were discussed out of which 12 were related to reporting and 14 were related to recording. "Capture-Recapture" was the most widely used method among the 11 different methods: that can be used for the rectification of under-reporting. There were 12 studies pertinent to the rectification of accident location and almost all of them utilised a Geographical Information System (GIS) platform coupled with a matching algorithm to estimate the correct location. It is recommended that the policing system should be reformed and public awareness should be created to help reduce errors in accident data.

The burden of injury in China, 1990-2017: findings from the Global Burden of Disease Study 2017

BACKGROUND

A comprehensive evaluation of the burden of injury is an important foundation for selecting and formulating strategies of injury prevention. We present results from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2017 of non-fatal and fatal outcomes of injury at the national and subnational level, and the changes in burden for key causes of injury over time in China.

METHODS

Using the methods and results from GBD 2017, we describe the burden of total injury and the key causes of injury based on the rates of incidence, cause-specific mortality, and disability-adjusted life years (DALYs) in China estimated using DisMod-MR 2.1. We additionally evaluated these results at the provincial level for the 34 subnational locations of China in 2017, measured the change of injury burden from 1990 to 2017, and compared age-standardised DALYs due to injuries at the provincial level against the expected rates based on the Socio-demographic Index (SDI), a composite measure of development of income per capita, years of education, and total fertility rate.

FINDINGS

In 2017, in China, there were 77·1 million (95% uncertainty interval [UI] 72·5-81·6) new cases of injury severe enough to warrant health care and 733 517 deaths (681 254-767 006) due to injuries. Injuries accounted for 7·0% (95% UI 6·6-7·2) of total deaths and 10·0% (9·5-10·5) of all-cause DALYs in China. In 2017, there was a three-times variation in age-standardised injury DALY rates between provinces of China, with the lowest value in Macao and the highest in Yunnan. Between 1990 and 2017, the age-standardised incidence rate of all injuries increased by 50·6% (95% UI 46·6-54·6) in China, whereas the age-standardised mortality and DALY rates decreased by 44·3% (41·1-48·9) and 48·1% (44·6-51·8), respectively. Between 1990 and 2017, all provinces of China experienced a substantial decline in DALY rates from all injuries ranging from 16·3% (3·1-28·6) in Shanghai and 60·4% (53·7-66·1) in Jiangxi. Age-standardised DALY rates for drowning; injuries from fire, heat and hot substances; adverse effects of medical treatments; animal contact; environmental heat and cold exposure; self-harm; and executions and police conflict each declined by more than 60% between 1990 and 2017.

INTERPRETATION

Between 1990 and 2017, China experienced a decrease in the age-standardised DALY and mortality rates due to injury, despite an increase in the age-standardised incidence rate. These trends occurred in all provinces. The divergent trends in terms of incidence and mortality indicate that with rapid sociodemographic improvements, the case fatality of injuries has declined, which could be attributed to an improving health-care system but also to a decreasing severity of injuries over this time period.

FUNDING

Bill & Melinda Gates Foundation.

Road traffic injuries in China from 2007 to 2016: the epidemiological characteristics, trends and influencing factors

Background

Road traffic accidents are one of the serious disasters that cause public injury, fatality and great economic loss. They are a growing public health problem around the world.

Objectives

The aim of this study was to determine epidemiological characteristics, tendency and possible influencing factors of road traffic injuries (RTIs) in China, so as to give target suggestions on preventative measures.

Methods

Road traffic accident data were obtained from National Bureau of Statistics of China and Ministry of Transport of the People’s Republic of China. Descriptive statistic such as RTIs frequency, trends of different accident types from 2007 to 2016; the RTIs difference between different regions and road surfaces were compared; and the possible influencing factors of RTIs were also explored.

Results

Over the past decade, with the mileage of constructed highway increased, the frequency of road traffic accidents have declined substantially in China, and the death toll from road traffic accidents with motor vehicles has declined from 2007 to 2015, Conversely, the number of deaths from non-motor vehicle accidents has risen rapidly since 2012. Our study showed that the traffic accident related mortality in Guizhou province was different from the level of the whole nation, and the Eastern, Central and Western areas of China were all significantly different (P < 0.001). Linear regression suggested a significant affected of gross domestic product (GDP)-per-capita, education level, the number of health institutions, populations, and car ownership status on traffic accident death tolls (P < 0.001). Moreover, cement concrete pavement roads were associated with the highest occurrence rates of RTI, and RTIs was statistically significant (P < 0.001) on different road surfaces.

Conclusion

Even though the frequency of road traffic accidents has declined, RTIs remain an urgent public health problem in China. Thus, the government should give some target preventative measures to reduce RTIs, aiming at different regions, the increasing trend of the death toll related to non-motor vehicles and the highest occurrence on cement concrete pavement roads.

Road injury prevention in China: current state and future challenges

In just a few decades, China has undergone probably the fastest motorization of a transportation system in history. Now possessing the longest roadway network and the highest volume of car sales in the world, China has also faced major public health impacts from adopting automobiles, including air pollution and traffic fatalities. This paper synthesizes various sources to present the challenges to road safety in China. The country's rapid development expresses many patterns and features familiar to developed nations, such as declining urban density, increased use of sport utility vehicles, and strict drunk-driving laws. It also mirrors patterns familiar to developing nations-high-fatality rates for pedestrians and nondrivers, low salaries and corruption among police officers, and infrequent seat-belt use. Despite these similarities, China also exhibits particular attributes, such as a nationwide cadre evaluation system and tightly controlled media organization, which influence the traffic risks that receive national attention.

Health System in China

The health of China’s population improved dramatically during the first 30 years of the People’s Republic, established in 1949. By the mid-1970s, China was already undergoing the epidemiologic transition, years ahead of other nations of similar economic status, and by 1980, life expectancy (67 years) exceeded that of most similarly low-income nations by 7 years. Almost 30 years later, China’s 2009 health reforms were a response to deep inequity in access to affordable, quality healthcare resulting from three decades of marketization, including de facto privatization of the health sector, along with decentralized accountability and, to a large degree, financing of public health services. The reforms are built on earlier, equity-enhancing initiatives, particularly the reintroduction of social health insurance since 2003, and are planned to continue until 2020, with gradual achievement of overarching objectives on universal and equitable access to health services. The second phase of reform commenced in early 2012. China’s health reforms remain encouragingly specific but not prescriptive on strategy; set in the decentralized governance structure, they avoid the issue of reliance on local government support for the national equity objective, leaving the detailed design of health service financing, human resource distribution and accountability, essential drug lists and application of clinical care pathways, etc. to local health authorities answerable to local government, not the Ministry of Health. Community engagement in government processes, including in provision of healthcare, remains limited. This chapter uses the documentation and literature on health reform in China to provide a comprehensive overview of the current situation of the health sector and its reform in the People’s Republic.

Featured Article: Evaluating Smartphone-Based Virtual Reality to Improve Chinese Schoolchildren's Pedestrian Safety: A Nonrandomized Trial

Objective

This nonrandomized trial evaluated whether classroom-based training in a smartphone-based virtual reality (VR) pedestrian environment (a) teaches schoolchildren to cross streets safely, and (b) increases their self-efficacy for street-crossing.

Methods

Fifty-six children, aged 8-10 years, attending primary school in Changsha, China participated. Baseline pedestrian safety assessment occurred in the VR environment and through unobtrusive observation of a subsample crossing a street for 11 days outside school. Self-efficacy was assessed through both self-report and observation. Following baseline, children engaged in the VR for 12 days in their classrooms, honing complex cognitive-perceptual skills required to engage safely in traffic. Follow-up assessment replicated baseline.

Results

Probability of crash in the VR decreased posttraining (0.40 vs. 0.09), and observational data found the odds of looking at oncoming traffic while crossing the first lane of traffic increased (odds ratio [OR] = 2.4). Self-efficacy increases occurred in self-report (proportional OR = 4.7 crossing busy streets) and observation of following crossing-guard signals (OR = 0.2, first lane).

Conclusions

Pedestrian safety training via smartphone-based VR provides children the repeated practice needed to learn the complex skills required to cross streets safely, and also helps them improve self-efficacy to cross streets. Given rapid motorization and global smartphone penetration, plus epidemiological findings that about 75,000 children die annually worldwide in pedestrian crashes, smartphone-based VR could supplement existing policy and prevention efforts to improve global child pedestrian safety.

A social change perspective on injury prevention in China

INTRODUCTION

China has undergone massive social change over the past four decades. Since national estimates became available in 1987, the overall fatal injury rate has decreased. This paper investigates targeted interventions and sociodemographic factors that may have contributed to fatal injury rate changes particularly for road traffic fatality (RTF), suicide and drowning.

AIMS

(1) To review the recent epidemiology of injury in China.(2)To investigate factors influencing trends in overall and specific cause injury mortality rates.

METHODS

Published injury mortality statistics and related literature were reviewed. Factors potentially influencing trends were investigated in the context of rapid development based on literature reviews of targeted interventions, macrolevel and microlevel contextual factors and changes specific to RTF, suicide and drowning.

RESULTS

Overall estimated national injury mortality rates in China decreased between 1987 and 2015, despite a rapid rise in RTF. Suicide and drowning rates decreased significantly and falls displaced drowning among the leading causes. The higher female to male suicide ratio reversed. Differences were observed in frequencies and proportions of deaths by major cause by age group and over time.

DISCUSSION

Economic and structural development and related social change in this period include: urbanisation, changes in demographics, life choices (eg, internal migration), education, poverty alleviation, health insurance and relevant regulations/legislation. These factors potentially explain much of the change in fatal injury rates in China. Data limitations persist. Increased investment in data and research would provide realistic opportunities for accelerated progress in implementing effective targeted interventions to further reduce China's injury burden.

Global road fatality trends' estimations based on country-wise micro level data

The global road crash deaths during the past 35 years are estimated and analysed considering micro-level data for 215 countries. The data were gathered from Governmental records, international databases, and personal contacts. The data are adjusted for underreporting, death definition differences and missing data. The study models both reported and adjusted death to forecast future crash trends for each continent. The developed models employed curve fitting regression technique. It took over five years to build-up the database. The global sum of crash deaths showed firm increasing trends between 1980 and 2008. Subsequently, the global deaths tend to slow down. The adjusted death during 2014 ranged between 792,000 and 905,000. The high range showed 40% lesser death than World Health Organization (WHO) estimate. The developed models presented a plateauing transition stage of global road deaths before descending. This is contradicting WHO and The World Bank (TWB) forecasts. The global adjusted death for 2020 and 2030, differed substantially from WHO and TWB forecasts. The results showed inconsistencies in road deaths between various WHO sectors. The trend of crash fatalities in Asia followed closely with that for global trend, and that in Africa it showed fluctuated trend with steep increasing tendency after 1999. In South America, it showed continuous ascending trends, and that in Europe and Oceanic countries showed clear descending patterns. The trend in North and Central America did not change much during the period between 1980 and 2007. While the developed models indicated drops of 33% in North and Central America, 18% in Oceania and 13% in Asia by 2025 compared with 2014, they increase by over 44% in Africa and 32% in South America. The poor safety records in several continents, require careful reading, proper interpretation of the results and extensive research.

Availability and consistency of health and non-health data for road traffic fatality: Analysis of data from 195 countries, 1985-2013

High-quality data are critical for validly monitoring progress toward global initiatives related to road traffic crash prevention. We assessed the availability and consistency of road traffic mortality data from health and non-health departments in national governments, plus changes in data consistency over time from 1985 to 2013. Using freely accessible data, we systematically assessed availability and consistency of health and non-health data from 1985 to 2013 in 195 countries. Data availability was reflected by the presence of data on motor vehicle mortality rates in that country at any points between 1985 and 2013. The ratio of 'health data divided by non-health data' was calculated to measure the consistency of the two types of data sources. We found that 77 of the 195 countries in the world (39%) had both health and non-health data sources available from 1985 to 2013. None of the 34 low-income countries had both kinds of data sources simultaneously available, while 41 of 55 high-income countries had both kinds of data sources. Of the 71 countries having both kinds of data for five years or more, 33 countries demonstrated high consistency between data sources, 25 countries showed moderate data consistency, and 13 countries displayed low consistency. Jamaica, Mexico, and China had the largest data inconsistencies. 26 of the 71 countries witnessed improved data consistency between 1985 and 2013, but nine experienced decreasing data consistency, in a few cases to a large degree. Efforts are needed to identify reasons leading to data quality changes, and to develop approaches to improve data quality in those nations where it is inadequate.

Transport and public health in China: the road to a healthy future

Transportation-related risk factors are a major source of morbidity and mortality in China, where the expansion of road networks and surges in personal vehicle ownership are having profound effects on public health. Road traffic injuries and fatalities have increased alongside increased use of motorised transport in China, and accident injury risk is aggravated by inadequate emergency response systems and trauma care. National air quality standards and emission control technologies are having a positive effect on air quality, but persistent air pollution is increasingly attributable to a growing and outdated vehicle fleet and to famously congested roads. Urban design favours motorised transport, and physical activity and its associated health benefits are hindered by poor urban infrastructure. Transport emissions of greenhouse gases contribute substantially to regional and global climate change, which compound public health risks from multiple factors. Despite these complex challenges, technological advances and innovations in planning and policy stand to make China a leader in sustainable, healthy transportation.

Demographic and regional characteristics of road traffic injury deaths in Jiangsu Province, China

Background

The study investigates the magnitude and distribution of fatal road traffic injuries (RTIs) in the Chinese province of Jiangsu by road user.

Method

The 13 694 RTI deaths and years of potential life lost (YPLL) that occurred in 2012 were analysed; vulnerable and non-vulnerable road users were considered separately. Age-adjusted mortality and YPLL were compiled and the association between demographic characteristics and RTI mortality rate was analysed using negative binomial regression.

Results

The age-adjusted RTI mortality and YPLL in Jiangsu in 2012 were 18.14 (95% CI: 17.84-18.45) and 494.3 (95% CI: 492.7-496.0) per 100 000 population. Half of the deaths were among pedestrians and for vulnerable road users as a whole, male fatalities were over three times that of female (adjusted incidence rate ratio = 3.26, 95% CI: 1.89-3.77). Fatalities in the oldest age group (80+ years) were over 14 times that of the youngest one (0-9 years) (adjusted incidence rate ratio = 14.13, 95% CI: 9.49-21.01). Fatality rates in the central and northern regions surpassed that of the south.

Conclusion

As in the rest of the country, RTIs are a considerable public health problem in Jiangsu where fatality and YPLL rates fall heavily on pedestrians, men, and older persons and are more pronounced in the less developed regions.

Evaluating the Effectiveness of Implementing a More Severe Drunk-Driving Law in China: Findings from Two Open Access Data Sources

In 2011, China implemented a more severe drunk-driving law. This study evaluated the effectiveness of the law on road traffic morbidity and mortality attributed to alcohol use. Data were from two open-access data sources, the Global Burden of Disease (GBD) 2015 update and police data. Poisson regression examined the significance of changes in morbidity and mortality. Large gaps in crude death estimates from road traffic crashes attributed to alcohol use emerged between the two data sources. For the GBD 2015 update, crude and age-standardized mortality displayed consistent trends between 1990 and 2015; age-standardized mortality per 100,000 persons increased from 5.71 in 1990 to 7.48 in 2005 and then continuously decreased down to 5.94 in 2015. Police data showed a decrease for crude mortality per 100,000 persons from 0.29 in 2006 to 0.15 in 2010 and then an increase to 0.19 in 2015. We conclude available data are inadequate to determine the effectiveness of the implementation of the more severe drunk-driving law in China since the two data sources present highly inconsistent results. Further effort is needed to tackle data inconsistencies and obtain reliable and accurate data on road traffic injury attributable to alcohol use in China.

Trends in traumatic brain injury mortality in China, 2006-2013: A population-based longitudinal study

BACKGROUND

Traumatic brain injury (TBI) is a significant global public health problem, but has received minimal attention from researchers and policy-makers in low- and middle-income countries (LMICs). Epidemiological evidence of TBI morbidity and mortality is absent at the national level for most LMICs, including China. Using data from China's Disease Surveillance Points (DSPs) system, we conducted a population-based longitudinal analysis to examine TBI mortality, and mortality differences by sex, age group, location (urban/rural), and external cause of injury, from 1 January 2006 to 31 December 2013 in China.

METHOD AND FINDINGS

Mortality data came from the national DSPs system of China, which has coded deaths using the International Classification of Diseases-10th Revision (ICD-10) since 2004. Crude and age-standardized mortality with 95% CIs were estimated using the census population in 2010 as a reference population. The Cochran-Armitage trend test was used to examine the significance of trends in mortality from 2006 to 2013. Negative binomial models were used to examine the associations of TBI mortality with location, sex, and age group. Subgroup analysis was performed by external cause of TBI. We found the following: (1) Age-adjusted TBI mortality increased from 13.23 per 100,000 population in 2006 to 17.06 per 100,000 population in 2008 and then began to fall slightly. In 2013, age-adjusted TBI mortality was 12.99 per 100,000 population (SE = 0.13). (2) Compared to females and urban residents, males and rural residents had higher TBI mortality risk, with adjusted mortality rate ratios of 2.57 and 1.71, respectively. TBI mortality increased substantially with older age. (3) Motor vehicle crashes and falls were the 2 leading causes of TBI mortality between 2006 and 2013. TBI deaths from motor vehicle crashes in children aged 0-14 years and adults aged 65 years and older were most often in pedestrians, and motorcyclists were the first or second leading category of road user for the other age groups. (4) TBI mortality attributed to motor vehicle crashes increased for pedestrians and motorcyclists in all 7 age groups from 2006 to 2013. Our analysis was limited by the availability and quality of data in the DSPs dataset, including lack of injury-related socio-economic factors, policy factors, and individual and behavioral factors. The dataset also may be incomplete in TBI death recording or contain misclassification of mortality data.

CONCLUSIONS

TBI constitutes a serious public health threat in China. Further studies should explore the reasons for the particularly high risk of TBI mortality among particular populations, as well as the reasons for recent increases in certain subgroups, and should develop solutions to address these challenges. Interventions proven to work in other cultures should be introduced and implemented nationwide. Examples of these in the domain of motor vehicle crashes include policy change and enforcement of laws concerning helmet use for motorcyclists and bicyclists, car seat and booster seat use for child motor vehicle passengers, speed limit and drunk driving laws, and alcohol ignition interlock use. Examples to prevent falls, especially among elderly individuals, include exercise programs, home modification to reduce fall risk, and multifaceted interventions to prevent falls in all age groups.

Misuse of booster cushions among children and adults in Shanghai-an observational and attitude study during buckling up

OBJECTIVE

Traffic crashes are one of the leading causes of fatalities among Chinese children. Booster cushion usage in China is low, and there are no studies showing how a population with limited experience handles booster cushions during buckling up. The purpose of this study was to evaluate the handling of and explore the attitudes toward booster cushions among children, parents, and grandparents in Shanghai.

METHODS

An observational study including a convenience sample of 254 children aged 4-12 years was conducted in 2 passenger cars at a shopping center in Shanghai. Parents, grandparents, or the children themselves buckled up the child on 2 types of booster cushions, a 2-stage integrated booster cushion (IBC) and an aftermarket booster cushion (BC). The test participants were observed during buckling up, first without and then with instructions. The test leaders conducted structured interviews.

RESULTS

Ninety-eight percent of the uninstructed participants failed to buckle up without identified misuse on the aftermarket booster cushion and 31% of those uninstructed on the integrated booster cushion. The majority of misuse was severe, including placing the belt behind the arm and the lap belt routing above the guiding loops. Instruction reduced misuse to 58% (BC) and 12% (IBC), respectively, and, in particular, severe misuse. Some misuse was related to limited knowledge of how to buckle up on the booster cushion, and some misuse was intentional in order to reduce discomfort. The participants, both children and adults, reported that they preferred the IBC due to good comfort and convenience. Safety was reported as the main reason for adults using booster cushions in general, whereas children reported comfort as the most important motivation.

CONCLUSIONS

Education is needed to ensure frequent and correct use of booster cushions in China and to raise safety awareness among children and adults. Furthermore, it is important that the booster cushions offer intuitively correct usage to a population with limited experience of booster cushions. This is the first study published on the handling of and attitude toward booster cushions after child restraints laws were introduced in Shanghai 2014.

Assessing Chinese coach drivers' fitness to drive: The development of a toolkit based on cognition measurements

Road traffic accidents resulting in group deaths and injuries are often related to coach drivers' inappropriate operations and behaviors. Thus, the evaluation of coach drivers' fitness to drive is an important measure for improving the safety of public transportation. Previous related research focused on drivers' age and health condition. Comprehensive studies about commercial drivers' cognitive capacities are limited. This study developed a toolkit consisting of nine cognition measurements across driver perception/sensation, attention, and reaction. A total of 1413 licensed coach drivers in Jiangsu Province, China were investigated and tested. Results indicated that drivers with accident history within three years performed overwhelmingly worse (p<0.001) on dark adaptation, dynamic visual acuity, depth perception, attention concentration, attention span, and significantly worse (p<0.05) on reaction to complex tasks compared with drivers with clear accident records. These findings supported that in the assessment of fitness to drive, cognitive capacities are sensitive to the detection of drivers with accident proneness. We first developed a simple evaluation model based on the percentile distribution of all single measurements, which defined the normal range of "fit-to-drive" by eliminating a 5% tail of each measurement. A comprehensive evaluation model was later constructed based on the kernel principal component analysis, in which the eliminated 5% tail was calculated from on integrated index. Methods to categorizing qualified, good, and excellent coach drivers and criteria for evaluating and training Chinese coach drivers' fitness to drive were also proposed.

One Outcome, Many Trends: Understanding National Data Sources for Road Traffic Fatalities in China

OBJECTIVES

To better understand national data sources and evaluate time trends in road traffic fatalities (RTF) in China.

METHODS

We reviewed national sources on RTF data. These included population-based report from the Ministry of Public Security (MPS), sample-based estimates from the Ministry of Health (MOH) and the Disease Surveillance Points System (DSP), as well as model-based estimates from the World Health Organization (WHO), and the Global Burden of Disease Study (GBD).

RESULTS

All data sources have limitations in coverage, representativeness or overreliance on model specifications. Despite the discrepancies in methodologies and estimates, all sources indicated an increase in RTF before 2005. Since then, MPS and GBD indicated a decrease, DSP showed plateauing, and MOH and WHO suggested increasing fatalities. However, despite any recent decline, RTF remain high.

CONCLUSIONS

The divergent trends in RTF across data sets in China implies a challenge to understanding China's experience with addressing RTF. China needs to reconcile data sources and further improve road safety.

Examining Road Traffic Mortality Status in China: A Simulation Study

Background

Data from the Chinese police service suggest substantial reductions in road traffic injuries since 2002, but critics have questioned the accuracy of those data, especially considering conflicting data reported by the health department.

Methods

To address the gap between police and health department data and to determine which may be more accurate, we conducted a simulation study based on the modified Smeed equation, which delineates a non-linear relation between road traffic mortality and the level of motorization in a country or region. Our goal was to simulate trends in road traffic mortality in China and compare performances in road traffic safety management between China and 13 other countries.

Results

Chinese police data indicate a peak in road traffic mortalities in 2002 and a significant and a gradual decrease in population-based road traffic mortality since 2002. Health department data show the road traffic mortality peaked in 2012. In addition, police data suggest China’s road traffic mortality peaked at a much lower motorization level (0.061 motor vehicles per person) in 2002, followed by a reduction in mortality to a level comparable to that of developed countries. Simulation results based on health department data suggest high road traffic mortality, with a mortality peak in 2012 at a moderate motorization level (0.174 motor vehicles per person). Comparisons to the other 13 countries suggest the health data from China may be more valid than the police data.

Conclusion

Our simulation data indicate China is still at a stage of high road traffic mortality, as suggested by health data, rather than a stage of low road traffic mortality, as suggested by police data. More efforts are needed to integrate safety into road design, improve road traffic management, improve data quality, and alter unsafe behaviors of pedestrians, drivers and passengers in China.

Evaluating the Impact of Criminalizing Drunk Driving on Road-Traffic Injuries in Guangzhou, China: A Time-Series Study

BACKGROUND

Road-traffic injury (RTI) is a major public-health concern worldwide. However, the effectiveness of laws criminalizing drunk driving on the improvement of road safety in China is not known.

METHODS

We collected daily aggregate data on RTIs from the Guangzhou First-Aid Service Command Center from 2009 to 2012. We performed an interrupted time-series analysis to evaluate the change in daily RTIs before (January 1, 2009, to April 30, 2011) and after (May 1, 2011, to December 31, 2012) the criminalization of drunk driving. We evaluated the impact of the intervention on RTIs using the overdispersed generalized additive model after adjusting for temporal trends, seasonality, day of the week, and holidays. Daytime/Nighttime RTIs, alcoholism, and non-traffic injuries were analyzed as comparison groups using the same model.

RESULTS

From January 1, 2009, to December 31, 2012, we identified a total of 54 887 RTIs. The standardized daily number of RTIs was almost stable in the pre-intervention period but decreased gradually in the post-intervention period. After the intervention, the standardized daily RTIs decreased 9.6% (95% confidence interval [CI], 6.5%-12.8%). There were similar decreases for the daily daytime and nighttime RTIs. In contrast, the standardized daily cases of alcoholism increased 38.8% (95% CI, 35.1%-42.4%), and daily non-traffic injuries increased 3.6% (95% CI, 1.4%-5.8%).

CONCLUSIONS

This time-series study provides scientific evidence suggesting that the criminalization of drunk driving from May 1, 2011, may have led to moderate reductions in RTIs in Guangzhou, China.

Cause-specific mortality for 240 causes in China during 1990-2013: a systematic subnational analysis for the Global Burden of Disease Study 2013

BACKGROUND

China has experienced a remarkable epidemiological and demographic transition during the past three decades. Far less is known about this transition at the subnational level. Timely and accurate assessment of the provincial burden of disease is needed for evidence-based priority setting at the local level in China.

METHODS

Following the methods of the Global Burden of Disease Study 2013 (GBD 2013), we have systematically analysed all available demographic and epidemiological data sources for China at the provincial level. We developed methods to aggregate county-level surveillance data to inform provincial-level analysis, and we used local data to develop specific garbage code redistribution procedures for China. We assessed levels of and trends in all-cause mortality, causes of death, and years of life lost (YLL) in all 33 province-level administrative units in mainland China, all of which we refer to as provinces, for the years between 1990 and 2013.

FINDINGS

All provinces in mainland China have made substantial strides to improve life expectancy at birth between 1990 and 2013. Increases ranged from 4.0 years in Hebei province to 14.2 years in Tibet. Improvements in female life expectancy exceeded those in male life expectancy in all provinces except Shanghai, Macao, and Hong Kong. We saw significant heterogeneity among provinces in life expectancy at birth and probability of death at ages 0-14, 15-49, and 50-74 years. Such heterogeneity is also present in cause of death structures between sexes and provinces. From 1990 to 2013, leading causes of YLLs changed substantially. In 1990, 16 of 33 provinces had lower respiratory infections or preterm birth complications as the leading causes of YLLs. 15 provinces had cerebrovascular disease and two (Hong Kong and Macao) had ischaemic heart disease. By 2013, 27 provinces had cerebrovascular disease as the leading cause, five had ischaemic heart disease, and one had lung cancer (Hong Kong). Road injuries have become a top ten cause of death in all provinces in mainland China. The most common non-communicable diseases, including ischaemic heart disease, stroke, chronic obstructive pulmonary disease, and cancers (liver, stomach, and lung), contributed much more to YLLs in 2013 compared with 1990.

INTERPRETATION

Rapid transitions are occurring across China, but the leading health problems and the challenges imposed on the health system by epidemiological and demographic change differ between groups of Chinese provinces. Localised health policies need to be implemented to tackle the diverse challenges faced by local health-care systems.

FUNDING

China National Science & Technology Pillar Program 2013 (2013BAI04B02) and Bill & Melinda Gates Foundation.

Estimated trends and patterns of road traffic fatalities in China, 2002-2012

OBJECTIVE

This study examined the time trends and age distribution patterns of estimated road traffic fatalities (RTFs) in China over the period 2002-2012.

METHODS

Data on age-, sex-, and region-specific RTF rates were provided by the Chinese Ministry of Health. The crude rates were standardized and the Mann-Kendall test was used to test the significance of time trends. Annual number of RTFs was calculated. To minimize the effect of yearly variations, magnitude of changes in and age distribution patterns of the RTFs were examined using mean values of 2 years.

RESULTS

RTFs increased significantly in China during the study period. Several features were identified for the RTFs in China. First, RTF rates skyrocketed in rural areas including towns and counties. Second, a significant increase in RTFs was also observed in cities even though the change in RTF rates was not statistically significant there. Third, individuals aged 20-24, 40-49, and 55-64, especially in rural areas, were particularly at risk for RTFs in recent years. Finally, RTFs became more common among middle-aged and older adults than young Chinese, with roughly 57% of all RTFs occurring among individuals aged 45 and above during 2011-2012.

CONCLUSIONS

RTFs increased dramatically in China during the past decade, especially in rural areas. Age distribution patterns of RTFs have changed there. Community-based public health education and intervention programs are warranted.

Prevalence and factors associated with road traffic crash among taxi drivers in Mekelle town, northern Ethiopia, 2014: a cross sectional study

Objectives

The 2013 World Health Organization Status Report on Road Safety estimated that approximately 1.24 million deaths occur annually due to road traffic crashes with most of the burden falling on low- and middle-income countries. The objective of this research is to study the prevalence of road traffic crashes in Mekelle, Tigray, Northern Ethiopia and to identify risk factors with the ultimate goal of informing prevention activities and policies.

Methods

This study used a cross-sectional design to measure the prevalence and factors associated with road traffic crashes among 4-wheeled minibus (n = 130) and 3-wheeled Bajaj (n = 582) taxi drivers in Mekelle, Ethiopia. Bivariate and multivariate logistic regression were used to evaluate the association between risk factors and drivers’ involvement in a road traffic crash within the 3 years prior to the survey.

Findings

Among the 712 taxi drivers, 26.4% (n = 188) of them reported involvement in a road traffic crash within the past 3 years. Drivers who listened to mass media had decreased likelihood of road traffic crash involvement (AOR = 0.51, 0.33–0.78), while speedy driving (AOR = 4.57, 3.05–7.44), receipt of a prior traffic punishment (AOR = 4.57, 2.67–7.85), and driving a mechanically faulty taxi (AOR = 4.91, 2.81–8.61) were strongly associated with road traffic crash involvement. Receiving mobile phone calls while driving (AOR = 1.91, 1.24–2.92) and history of alcohol use (AOR = 1.51, 1.00–2.28) were also associated with higher odds of road traffic crash involvement.

Conclusion

The results of this study show that taxi drivers in Mekelle habitually place themselves at increased risk of road traffic crashes by violating traffic laws, especially related to speedy driving, mobile phone use, and taxi maintenance. This research can be used to support re-evaluation of the type, severity, and enforcement of traffic violation penalties.

The underestimated drink driving situation and the effects of zero tolerance laws in China

BACKGROUND

China has a competing situation in that the increase of alcohol consumption and the lowering rates of traffic injuries caused by drink driving coexist. In addition, the zero tolerance law was announced in January 2013. Under the above complex background, this study aims to unveil the truth about drink driving and the effects of the related policies in China.

METHODS

This research was a retrospective examination of the data from the National Disease Surveillance System in Shandong Province of China from 2011 to 2013. Descriptive statistics were used to find the summary of mortality caused by drink driving and the traits of the deceased subjects.

RESULTS

The drink driving situation in China was found to be much more alarming than the initial official prediction. In this research, the rate should be around 18.45% to 26.61%, compared to only 4.02% to 4.80% from the Ministry of Public Security. However, with the introduction of the zero tolerance law at the beginning of 2013, a significant change was observed; that is, a sharp decrease in traffic fatalities caused by drink driving between 2012 and 2013, with a drop of 6.81% (from 25.26% to 18.45%). According to the data, more attention should be paid to young adults, male drivers, those with low education, and the unemployed because the drink driving deaths increased for these populations during 2011 to 2013.

CONCLUSION

In reality, the drink driving situation in China is much more serious than official prediction and the laws were efficient.

Chinese traffic fatalities and injuries in police reports, hospital records, and in-depth records from one city

OBJECTIVES

Claims of sharp reductions in Chinese traffic casualties after 2002 based on police-reported data have been questioned in the literature. The objective of this study is to determine whether a decline in casualties occurred and to better understand the police data.

METHODS

The first of 2 unrelated studies analyzed data from 210 military hospitals throughout China providing records for inpatients injured in traffic accidents (2001-2007). The second compared in-depth crash records (2000-2006) from one city to officially released data.

RESULTS

Hospital data showed that casualties increased from 2002 to 2007. The city investigation showed consistently far more fatalities and injuries in the in-depth data than officially released. For example, in-depth data showed 1,720 fatalities. Only 557 of these were reported officially (data loss = 68%). Disaggregating into 3 regions showed a data loss of 41% in urban areas, 63% in rural areas, and 90% in rural-urban fringe zones. For injuries, data losses were even greater.

CONCLUSIONS

Traffic fatalities and injuries did not decrease from 2002 to 2006. The in-depth city data contained 3 times as many fatalities and 5 times as many injuries as reported by police. Reasons why this occurred and suggestions to improve data collection and reduce casualties are given.

A health impact assessment of a proposed bill to decrease speed limits on local roads in Massachusetts (U.S.A.)

Decreasing traffic speeds increases the amount of time drivers have to react to road hazards, potentially averting collisions, and makes crashes that do happen less severe. Boston’s regional planning agency, the Metropolitan Area Planning Council (MAPC), in partnership with the Massachusetts Department of Public Health (MDPH), conducted a Health Impact Assessment (HIA) that examined the potential health impacts of a proposed bill in the state legislature to lower the default speed limits on local roads from 30 miles per hour (mph) to 25 mph. The aim was to reduce vehicle speeds on local roads to a limit that is safer for pedestrians, cyclists, and children. The passage of this proposed legislation could have had far-reaching and potentially important public health impacts. Lower default speed limits may prevent around 18 fatalities and 1200 serious injuries to motorists, cyclists and pedestrians each year, as well as promote active transportation by making local roads feel more hospitable to cyclists and pedestrians. While a lower speed limit would increase congestion and slightly worsen air quality, the benefits outweigh the costs from both a health and economic perspective and would save the state approximately $62 million annually from prevented fatalities and injuries.

Can China diminish its burden of non-communicable diseases and injuries by promoting health in its policies, practices, and incentives?

China has rapidly progressed through epidemiological and demographic transitions and is now confronting an increasing burden from non-communicable diseases and injuries. China could take advantage of what has been learnt about prevention and control of non-communicable diseases and injuries, which is well summarised in the WHO best buys (a set of affordable, feasible, and cost-effective intervention strategies in any resource setting), to improve individual and population health. Implementation of these strategies could allow China to exceed the incremental gains in decreasing non-communicable diseases and injury burdens of high-income countries, and greatly shorten the interval needed to achieve decreased morbidity and mortality in its population. With the lessons learnt from other countries and its own programmes and policies, China could provide a health model for the world.

Incidence of road traffic disabilities trending upwards in transitional China: a retrospective analysis from 1980 to 2005

OBJECTIVE

To evaluate the change in incidence rates of road traffic disabilities from 1980 to 2005 in China.

METHODS

We employed the 2006 China National Sample Survey on Disability to derive weighted number of persons with disabilities resulting from road crashes and weighted age-gender-specific population at risk by disability occurrence year. The annual incidence rate of road traffic disabilities and corresponding 95% CI were estimated. We used the World Population Prospects (WPP) and the death rate of people with disabilities (PWD) to estimate potential earlier loss of lives before 2006. Both WPP-adjusted and PWD-adjusted incidence rates of road traffic disabilities were further adjusted using the life table analysis.

RESULTS

The WPP-adjusted incidence rate for road traffic disabilities increased over time from 1.50 (95% CI 1.47 to 1.52) in 1980 to 11.19 (95% CI 11.13 to 11.25) per 100 000 persons in 2005. The PWD-adjusted incidence rate also increased from 1.71 (95% CI 1.68 to 1.73) to 11.51 (95% CI 11.45 to 11.57) per 100 000 persons.

CONCLUSIONS

Road crashes disable thousands of Chinese and remain a significant population health and development problem. The increasing burden of road traffic disabilities calls for more efforts and specific strategies to improve road safety in China.

The quality of police data on RTC fatalities in India

BACKGROUND

Police records are the major source of data on road traffic collision (RTC) deaths in India.

OBJECTIVE

To examine the utility and quality of police data on RTC deaths available from two sources.

METHODS

Police data on RTC deaths available from National Crime Records Bureau (NCRB) and Ministry of Road Transport and Highways (MoRTH) were accessed. The utility of these data for surveillance and consistency of data reported by the two organisations was examined. Data completeness was assessed for India, its six geographic regions and for the mode of travel using cause of death estimates from the Sample Registration System (SRS) and Global Burden of Disease (GBD) as a reference.

RESULTS

Data imperative for surveillance including deaths by age and sex for each state, the counterpart vehicle or object and use of safety equipment were not available. The total number of deaths reported by NCRB and MoRTH was similar across states but showed large differences by mode of travel categories. Compared with GBD, completeness of the number of fatalities reported by both sources in 2010 was approximately 50%. Completeness for the geographic regions ranged from 26.4% to 76.4%, using SRS data, in 2001-2003.

CONCLUSIONS

This detailed examination of police data on RTC fatalities from two sources has raised several questions about the validity of these data and has highlighted a number of gaps that limit the usefulness of these data for surveillance and informing road safety policies. Unless these are addressed, significant reductions in RTC fatalities cannot be achieved in India.

A population-based study on road traffic injuries in Pune City, India

OBJECTIVE

The annual mortality of road traffic injuries (RTIs) is estimated to be over 80,000 in India; however, there is not enough information about the magnitude, pattern, and factors associated with RTIs in a population-based scenario, where the police and hospital records suffer from severe underreporting. This study was conducted with the aim of identifying the burden, pattern, and risk factors of RTIs in the population of Pune City.

METHOD

A population-based cross-sectional study was conducted among 9014 individuals in a randomly selected and representative sample of the population from 14 administrative wards of the city from March 2008 to April 2009.

RESULTS

The annual incidence rate of RTIs was 93.2 (95% confidence interval [CI], 83.2-103.2) per 1000 individuals and after adjustment for age it was 76.4 per 1000 individuals. Injury occurrence was significantly more among the age group 15-30, males, and students and workers. Univariate analysis showed a significant association between RTIs and age, gender, occupation, mode of transport, driving a vehicle, and alcohol abuse. Multivariate analysis showed that only age, driving a vehicle, and alcohol abuse were the factors associated with RTIs.

CONCLUSION

The magnitude of RTIs in India is very high, which is not reflected in police registration reports.

The prevalence of speeding and drunk driving in two cities in China: a mid project evaluation of ongoing road safety interventions

Road traffic crashes in China kill in excess of 250,000 people annually, more than any other country in the world. They are the fourth leading cause of premature death in the country and are responsible for 2.4% of the burden of non-fatal health loss in the country. Interventions to curb speeding and drunk driving are being implemented in the cities of Suzhou and Dalian since late 2010. We evaluated the ongoing effect of these activities through five roadside surveys, seven rounds of observational studies, and analysis of crash statistics in the two cities. We find that thus far, the prevalence of speeding has not reduced in either city with the notable exception of one site in Dalian, where the percentage of speeding vehicles declined from nearly 70% to below 10% after an interval-based speed enforcement system was installed. The broader deployment of such speed control technologies across China and other countries should be explored. Roadside alcohol testing suggests that prevalence of drunk driving (i.e. BAC >20 mg%) declined from 6.4% to 0.5% in Suzhou and from 1.7% to 0.7% in Dalian during the monitored time period. However, the measured prevalence rates are very low and should be validated against estimates based on hospital studies. Roadside interviews suggest that the population of both cities is already highly sensitized to the risks associated with drunk driving and speeding. Crash statistics from the two cities do not show appreciable declines in injuries and fatalities as yet. However, the possibility of substantial underreporting in crash statistics sourced from traffic police poses a severe threat to monitoring progress towards road safety in Suzhou, Dalian and across China. There is an urgent need for China to invest in a reliable road traffic injury surveillance system that can provide information for describing key risk factors, evaluating the impact of safety policies, and benchmarking achievements.

Bicyclist mortality between 2006 and 2010 in China: findings from national Disease Surveillance Points (DSP) data

CONTEXT

While road traffic mortality has been reported to be seriously undercounted by the police in China, non-police-reported data have not been explored previously to examine vulnerable road user mortality.

OBJECTIVE

To examine changes in bicyclist mortality between 2006 and 2010 in China, using the Disease Surveillance Points (DSP) data of China.

DESIGN, SETTING AND DATA SOURCE

Mortality data of 2006-2010 from DSP data, covering 73 million population, was analysed. Poisson regression was used to examine the significance of year after controlling for sex, age and urban/rural location.

MAIN OUTCOME MEASURE(S)

Mortality rate and mortality rate ratio (MRR).

RESULTS

Between 2006 and 2010, the mortality rate for bicyclists increased from 1.1 to 1.6 per 100 000 population according to DSP data. Between 2006 and 2010, more than 90% of bicyclist deaths were undercounted by the police compared to the findings from DSP data. Contrary to the 34% increase between 2006 and 2010 reflected by DSP data (adjusted MRR: 1.34, 95% CI 1.23 to 1.46), police data revealed a 64% decrease in bicyclist mortality (unadjusted MRR: 0.36, 95% CI 0.32 to 0.40) in the study time period.

CONCLUSIONS

Health data should be used to assess the road traffic injuries in China. The recent increase in bicyclist mortality merits attention from policy makers and researchers.