The impact of environmental factors on traffic accidents in Iran

Identifying interactions among factors related to death occurred at the scene of traffic accidents: Application of "logic regression" method

Aim

Traffic accidents are caused by several interacting risk factors. This study aimed to investigate the interactions among risk factors associated with death at the accident scene (DATAS) as an indicator of the crash severity, for pedestrians, passengers, and drivers by adopting "Logic Regression" as a novel approach in the traffic field.

Method

A case-control study was designed based on the police data from the Road Traffic Injury Registry in northwest of Iran during 2014-2016. For each of the pedestrians, passengers, and drivers' datasets, logic regression with "logit" link function was fitted and interactions were identified using Annealing algorithm. Model selection was performed using the cross-validation and the null model randomization procedure.

Results

regarding pedestrians, "The occurrence of the accident outside a city in a situation where there was insufficient light" (OR = 6.87, P-value<0.001) and "the age over 65 years" (OR = 2.97, P-value<0.001) increased the chance of DATAS. "Accidents happening in residential inner-city areas with a light vehicle, and presence of the pedestrians in the safe zone or on the non-separate two-way road" combination lowered the chance of DATAS (OR = 0.14, P-value<0.001). For passengers, "Accidents happening in outside the city or overturn of the vehicle" combination (OR = 8.55, P-value<0.001), and "accidents happening on defective roads" (OR = 2.18, P-value<0.001) increased the odds of DATAS; When "driver was not injured or the vehicle was two-wheeled", chance of DATAS decreased for passengers (OR = 0.25, p-value<0.001). The odds of DATAS were higher for "drivers who had a head-on accident, or drove a two-wheeler vehicle, or overturned the vehicle" (OR = 4.03, P-value<0.001). "Accident on the roads other than runway or the absence of a multi-car accident or an accident in a non-residential area" (OR = 6.04, P-value<0.001), as well "the accident which occurred outside the city or on defective roads, and the drivers were male" had a higher risk of DATAS for drivers (OR = 5.40, P-value<0.001).

Conclusion

By focusing on identifying interaction effects among risk factors associated with DATAS through logic regression, this study contributes to the understanding of the complex nature of traffic accidents and the potential for reducing their occurrence rate or severity. According to the results, the simultaneous presence of some risk factors such as the quality of roads, skill of drivers, physical ability of pedestrians, and compliance with traffic rules play an important role in the severity of the accident. The revealed interactions have practical significance and can play a significant role in the problem-solving process and facilitate breaking the chain of combinations among the risk factors. Therefore, practical suggestions of this study are to control at least one of the risk factors present in each of the identified combinations in order to break the combination to reduce the severity of accidents. This may have, in turn, help the policy-makers, road users, and healthcare professionals to promote road safety through prioritizing interventions focusing on effect size of simultaneous coexistence of crash severity determinants and not just the main effects of single risk factors or their simple two-way interactions.

Modeling road traffic fatalities in Iran's six most populous provinces, 2015-2016

BACKGROUND

Prevention of road traffic injuries (RTIs) as a critical public health issue requires coordinated efforts. We aimed to model influential factors related to traffic safety.

METHODS

In this cross-sectional study, the information from 384,614 observations recorded in Integrated Road Traffic Injury Registry System (IRTIRS) in a one-year period (March 2015-March 2016) was analyzed. All registered crashes from Tehran, Isfan, Fras, Razavi Khorasan, Khuzestan, and East Azerbaijan provinces, the six most populated provinces in Iran, were included in this study. The variables significantly associated with road traffic fatality in the uni-variate analysis were included in the multiple logistic regression.

RESULTS

According to the multiple logistic regression, thirty-two out of seventy-one different variables were identified to be significantly associated with road traffic fatality. The results showed that the crash scene significantly related factors were passenger presence(OR = 4.95, 95%CI = (4.54-5.40)), pedestrians presence(OR = 2.60, 95%CI = (1.75-3.86)), night-time crashes (OR = 1.64, 95%CI = (1.52-1.76)), rainy weather (OR = 1.32, 95%CI = (1.06-1.64)), no intersection control (OR = 1.40, 95%CI = (1.29-1.51)), double solid line(OR = 2.21, 95%CI = (1.31-3.74)), asphalt roads(OR = 1.95, 95%CI = (1.39-2.73)), nonresidential areas(OR = 2.15, 95%CI = (1.93-2.40)), vulnerable-user presence(OR = 1.70, 95%CI = (1.50-1.92)), human factor (OR = 1.13, 95%CI = (1.03-1.23)), multiple first causes (OR = 2.81, 95%CI = (2.04-3.87)), fatigue as prior cause(OR = 1.48, 95%CI = (1.27-1.72)), irregulation as direct cause(OR = 1.35, 95%CI = (1.20-1.51)), head-on collision(OR = 3.35, 95%CI = (2.85-3.93)), tourist destination(OR = 1.95, 95%CI = (1.69-2.24)), suburban areas(OR = 3.26, 95%CI = (2.65-4.01)), expressway(OR = 1.84, 95%CI = (1.59-2.13)), unpaved shoulders(OR = 1.84, 95%CI = (1.63-2.07)), unseparated roads (OR = 1.40, 95%CI = (1.26-1.56)), multiple road defects(OR = 2.00, 95%CI = (1.67-2.39)). In addition, the vehicle-connected factors were heavy vehicle (OR = 1.40, 95%CI = (1.26-1.56)), dark color (OR = 1.26, 95%CI = (1.17-1.35)), old vehicle(OR = 1.46, 95%CI = (1.27-1.67)), not personal-regional plaques(OR = 2.73, 95%CI = (2.42-3.08)), illegal maneuver(OR = 3.84, 95%CI = (2.72-5.43)). And, driver related factors were non-academic education (OR = 1.58, 95%CI = (1.33-1.88)), low income(OR = 2.48, 95%CI = (1.95-3.15)), old age (OR = 1.67, 95%CI = (1.44-1.94)), unlicensed driving(OR = 3.93, 95%CI = (2.51-6.15)), not-wearing seat belt (OR = 1.55, 95%CI = (1.44-1.67)), unconsciousness (OR = 1.67, 95%CI = (1.44-1.94)), driver misconduct(OR = 2.51, 95%CI = (2.29-2.76)).

CONCLUSION

This study reveals that driving behavior, infrastructure design, and geometric road factors must be considered to avoid fatal crashes. Our results found that the above-mentioned factors had higher odds of a deadly outcome than their counterparts. Generally, addressing risk factors and considering the odds ratios would be beneficial for policy makers and road safety stakeholders to provide support for compulsory interventions to reduce the severity of RTIs.

Risk Factors for Road Traffic Injury-Related Mortality in Iran; a Systematic Review and Meta-Analysis

Introduction

Gathering information regarding the risk factors of mortality and disability due to road traffic injuries can provide evidence for adopting effective interventions to reduce the burden of the injury. Therefore, the present study intends to identify the most important risk factors of road accident-related mortality in Iran by conducting a systematic review and meta-analysis.

Methods

Search was done in English and Persian electronic databases, for articles published until the end of 2020. Cross-sectional, cohort and case-control studies were included. Risk factors were divided into age and sex, road related factors, exceeding speed limit, road user behaviors, vehicle related factors, weather condition, and light condition. Data were reported as adjusted odds ratio (OR) of death with 95% confidence interval (95% CI).

Results

20 studies were included (2,682,434 traffic accident victims and 23,272 deaths; mortality rate=1.28%). The risk of death in road traffic injuries in men was 1.66 times higher than women (OR = 1.66; 95% CI: 1.03, 2.68) and with each year increase in age, the risk increased by 1% (OR = 0.01; 95% CI: 1.00, 1.01). In addition, accident in urban streets (OR = 1.76; 95% CI: 1.08, 2.88), roadway defects (OR = 2.15, 95% CI: 1.59, 2.91), and not driving on a flat and straight road (OR = 1.60; 95% CI: 1.14, 2.24) were the most important road-related risk factors for mortality. Exceeding the speed limit was another risk factor of death (OR = 3.16; 95% CI: 2.83, 3.54). However, regarding exceeding safe speed, only three studies have been included, which greatly reduces the power of analysis. Not maintaining focus on the road (OR = 2.99; 95% CI: 1.49, 6.04), not fastening seatbelt (OR = 3.11; 95% CI: 1.08, 8.91), and reckless overtaking (OR = 4.04; 95% CI: 3.34, 4.89) were independent road user-related risk factors for mortality. Risk of pedestrian mortality in comparison with drivers and passengers is 2.07 times higher (OR = 2.07; 95% CI: 1.53, 2.58). In addition, risk of death in accidents occurring during daylight hours (OR = 0.26; 95% CI: 0.18, 0.37) is lower than that of other hours. No significant relationship was present between mortality and vehicle types (four-wheeled vehicle: OR = 0.99; 95% CI: 0.050, 1.97; two-wheeled vehicle: OR = 0.75; 95% CI: 0.48, 1.16). In the case of vehicle-related factors, only 2 studies were included, which also dealt only with the type of vehicle (two-wheeled/four-wheeled). Vehicle-related factors such as the car model, its safety rating, and safety standards were not mentioned in any study.

Conclusion

Low to very low-level evidence shows that there is a significant relationship between factors related to age, sex, road, road user, exceeding the speed limit, and light condition with the mortality of traffic accident victims. However, all studies included in the present study were retrospectively designed and the analyses were not adjusted for most of the key potential confounders. Therefore, it seems that despite years of effort by researchers in the field of traffic accidents in Iran, there is still no comprehensive and reliable picture of the most important risk factors for road accident mortalities in Iran.

Development, and Internal, and External Validation of a Scoring System to Predict 30-Day Mortality after Having a Traffic Accident Traveling by Private Car or Van: An Analysis of 164,790 Subjects and 79,664 Accidents

Predictive factors for fatal traffic accidents have been determined, but not addressed collectively through a predictive model to help determine the probability of mortality and thereby ascertain key points for intervening and decreasing that probability. Data on all road traffic accidents with victims involving a private car or van occurring in Spain in 2015 (164,790 subjects and 79,664 accidents) were analyzed, evaluating 30-day mortality following the accident. As candidate predictors of mortality, variables associated with the accident (weekend, time, number of vehicles, road, brightness, and weather) associated with the vehicle (type and age of vehicle, and other types of vehicles in the accident) and associated with individuals (gender, age, seat belt, and position in the vehicle) were examined. The sample was divided into two groups. In one group, a logistic regression model adapted to a points system was constructed and internally validated, and in the other group the model was externally validated. The points system obtained good discrimination and calibration in both the internal and the external validation. Consequently, a simple tool is available to determine the risk of mortality following a traffic accident, which could be validated in other countries.

Determinants of road traffic injuries in Iranian children; results from a National Representative Demographic- Health Survey 2010

Background

Road Traffic Injuries (RTIs) are a leading cause of disabilities and mortalities in Iran. The occurrence of RTIs among children is increasing. This study aims are to assess RTIs among Iranian children and to determine the main socio-economics determinants.

Methods

The National Institute of Health Research (NIHR) in collaboration with the Iran Ministry of Health (MoH) conducted a nationwide survey: The Multiple Indicator Demographic and Health Survey 2010 (IrMIDHS 2010). The Survey was undertaken by Medical Universities in Iran. Based on multistage clustered randomized sampling, 30,960 households were included in the survey. We performed a multivariate logistic regression to determine the main socio-economic factors associated with RTIs among children.

Results

Approximately 0.9% of the children received RTIs in 2010. Main socio-economics contributors to RTIs involving Iranian children included household size (Adjusted OR: 1.06 (CI 95% 1.01, 1.14), sex (Adjusted OR_female: 0.38 (CI 95% 0.29, 0.50), living with both parents (Adjusted OR: 0.55 (CI 95% 0.13, 0.95), being in the 2nd (Adjusted OR: 0.81 (CI 95%: 0.60, 0.90) or 4th income quartile (Adjusted OR: 0.13 (CI 95%: 0.02, 0.92) rather than the 1st income quartile, being aged five to nine (Adjusted OR: 1.39 (CI 95%: 1.10, 2.10), or aged 15 to 18 (Adjusted OR: 2.94 (CI 95%: 2.07, 4.97), and residency in a non- owned or non-tenancy house (Adjusted OR: 0.42 (CI 95%: 0.23 0.74).

Conclusions

Children need safe places for playing and doing their daily activities. Policy and regulation development aimed at protecting children from road traffic injuries needs to take into consideration the socio-economic factors associated with risk of road traffic injury among children.

Environmental Related Risk Factors to Road Traffic Accidents in Ilam, Iran

Introduction:

Road traffic injuries (RTIs) are the most serious health issue in the world and the main cause of death after the first year of birth. Environmental factors are among the most important and effective aspects of RTIs occurrences and their human consequences.

Aim:

This study aimed to identify the environmental factors associated with road traffic accidents (RTAs) in Ilam province.

Methods:

All crash data in Ilam province in 2012 were investigated. RTI’s data was collected using COM 114 form which included some human, environmental and vehicle related factors. Through Chi-Square test and logistic regression model, the association between environmental factors and RTIs was examined. For all statistical analyses we used the package Stata 13.1.

Results:

A total of 2314 traffic accidents were investigated. The highest 1659 (72.3%) and lowest 19 (0.83%) frequency of RTAs occurred during day and sunrise respectively. The majority of RTAs took place in July and September. The maximum number of RTAs was when the day was clear (91.7%) 2103 and the minimum when it was cloudy (3.5%) 81. A significant relationship was found between fatal RTAs and factors such as; the sort of the road, the hindered visibility, the location of the accident, the accidents’ place, the climate, and lighting of the day (P<0.05). The adjusted chance of traffic accidents causing death or injuries in main streets was 9.7 times more than in highways; in sidetracks it was 3.54 times more. And when it was cloudy, the chance was 2.60 times more than when was clear (P<0.05).

Conclusion:

Regarding the standards of road construction, development of the roads, and educating drivers how to adjust their driving behavior to the environment and road conditions could have a great role in decreasing RTAs causing death or injury.

Environmental and familial factors in drug use among commercial drivers in suburban public transport

Background:

A study was conducted in 2013 on the lack of accurate statistics on the environmental and family factors behind the use of drugs by drivers of public transport.

Materials and Methods:

Overall, 1176 drivers of buses, mini-buses, vans, all kinds of trucks, and cars were randomly selected proportionately according to the type of vehicles. The capture-recapture sampling method was used to determine the prevalence rate of drug use among commercial drivers. Trained experts collected data regarding the environmental and family factors behind the use of addictive drugs. Urinalysis was performed by the Rapid Test method (ACON, San Diego, USA). To providing descriptive and analytical statistics the Kruskal–Wallis and Mantel–Haenszel methods, logistic regression, and Chi-square tests were used.

Results:

The mean age of the drivers was 39.9 ± 9.7 years. The results of the experiment were positive in 14.1% of the drivers. A significant difference observed between addicted and nonaddicted drivers related to cold and heat (P < 0.001) and lack of facilities (P = 0.006) as the most influencing factors. The most important environmental factor was family poverty (P < 0.001), followed by marital status and its problems (P = 0.002), a large number of children (P = 0.006), and family disputes (P = 0.012). A family history of addiction was 2.5 times more among addicted drivers.

Conclusion:

Prevalence of addiction was 14.1%. Among the environmental factors, cold and heat, lack of facilities, family factors, and a family history of addiction greatly influenced addiction.

Exploring barriers and challenges in protecting residential fire-related injuries: a qualitative study

Background:

Building fires can be a great threat to the safety of residents, and can lead to economic and social damage. Exploring the views of stakeholders is a great source for understanding the factors that affect fires. The purpose of this study was to explore stakeholders’ experiences of unintentional fire-related injuries in residential buildings in Iran.

Methods:

This qualitative study was carried out using grounded theory. The study was conducted in Iran, in 2017. The study participants consisted of 25 people including stakeholders who had practical experience/or were knowledgeable in the field of preventing and fighting building fires. Purposeful and theoretical sampling were used for data collection. Data were analyzed based on constant comparative analysis and according to recommendations by Strauss and Corbin.

Results:

"Lack of a comprehensive approach to prevention of fire-related injury" emerged as a core variable which impacted on residents' safety against fires. The findings were classified into four groups of challenges related to the structure of building, socio-economic challenge, residents of the building and rescue services.

Conclusions:

Based on participants` experiences, unintentional fire-related injuries in residential buildings are affected by cultural context and economic, social and geographical factors. Improving the safety against unintentional fire-related injuries in residential buildings requires multidisciplinary operations including both change and improvement of the building construction and change in the beliefs and practices of residents to increase safety against fires.

Geospatial and environmental analysis of road traffic accidents in the city of Resistencia, Argentina

Traffic accidents are an emerging problem in cities with high mobility and little urban planning. Evidence is lacking in Argentina regarding the relationship between the environment and accident occurrence; we therefore conducted a geospatial analysis and estimated the risk of accidents and their possible association with the characteristics of the physical environment in the city of Resistencia, Argentina occurring in 2012. Kernel density estimates were used for the spatial distribution of accidents and in parallel an observational, analytical study was carried out to analyze the factors associated with accident occurrence. The results show three critical areas (in the northwest, center and south of the city) with greater accident frequency. Environmental factors that were associated with the occurrence of accidents were the presence of street lighting (23% greater), the presence of a tree close to the road (47% greater), the presence of a traffic light (28% greater), and if the road was a major avenue (122% greater) and had curves (129% greater). This study shows the city of Resistencia to be in a situation of urban vulnerability due not only to its socioeconomic status but also to the unequal development compared to neighboring cities, a reality that fosters an unfavorable environment.

Relationship between religion and school students' road behavior in southern Iran

PURPOSE

Unsafe behaviors are an important cause of accidents in adolescent age groups. This study was designed to examine the behaviors of adolescent pedestrians in southern Iran.

METHODS

This is a descriptive analytical cross-sectional study. The study population consisted of high school students in Shiraz, capital city of Fars Province, Iran. Five hundred and sixteen students were selected by multi-stage sampling. Data were collected by the use of three questionnaires, which included Persian copies of adolescent road user behavior questionnaire (ARBQ), Duke University Religious Index (DUREL), as well as the context and independent variables questionnaire.

RESULTS

The results showed that a decrease in dangerous behaviors on the road resulted in an increase in respondents' intrinsic religiosity. Also, engagement in unsafe crossing behavior in the road decreased with increasing respondents' intrinsic religiosity. Another finding showed that female students were less involved in dangerous play and planned protective behaviors on the road.

CONCLUSION

Findings clearly indicate that intrinsic religiosity has a significant role in reducing the risky road behaviors of students. Hence, religion may improve road safety in school students' road behavior in Iran.

The Pattern of Road Traffic Crashes in South East Iran

BACKGROUND

In the present study, the epidemiologic aspects of road traffic crashes in South East of Iran are described.

METHODS

This cross-sectional study included the profile of 2398 motor vehicle crashes recorded in the police office in one Year in South East of Iran. Data collected included: demographics, the type of crash, type of involved vehicle, location of crash and factors contributing to the crash. Descriptive statistics were used for data analysis.

RESULTS

Collisions with other vehicles or objects contributed the highest proportion (62.4%) of motor vehicle crashes. Human factors including careless driving, violating traffic laws, speeding, and sleep deprivation/fatigue were the most important causal factors accounting for 90% of road crashes. Data shows that 41% of drivers were not using a seat belt at the time of crash. One- third of the crashes resulted in injury (25%) or death (5%).

CONCLUSIONS

Reckless driving such as speeding and violation of traffic laws are major risk factors for crashes in the South East of Iran. This highlights the need for education along with traffic law enforcement to reduce motor vehicle crashes in future.

Epidemiological Patterns of Road Traffic Crashes During the Last Two Decades in Iran: A Review of the Literature from 1996 to 2014

Context

Despite considerable attention given to health statistics of road traffic crashes (RTCs), the epidemiological aspects of injuries resulting from RTCs are not fully understood in Iran and other developing countries. The aim of this review was to study the epidemiological pattern and issues arising due to RTCs in Iran.

Evidence Acquisition

The scope of this study involves data from a broad range of published literature on RTCs in Iran. Data collection for this study was conducted by searching for keywords such as traffic accidents, traffic crashes, motorcycle accidents, motorcycle crashes, motorcycle injury, motor vehicle injury, motor vehicle crashes and motor vehicle accidents, Iran and Iranian in various databases such as Embase, PubMed, Google Scholar, Scopus, Magiran, Iranian scientific information database (SID) and IranMedex.

Results

This study comprised of 95 articles. It is evident from this review that a large number of severe RTCs occur due to collision of two or more vehicles and most of the victims are males aged between 30 and 39 years. Male pedestrian, drivers and passengers are more likely to be severely injured in comparison to females. One of the most prevalent causes of death among adults involved in the RTCs are head injuries and the majority of deaths occur prior to hospitalization. Mortality rates for RTCs are higher in summer, especially during midnight among all age groups. The most common individual and environmental risk factors associated with RTCs include lack of attention, getting trapped in the car, listening to music, fatigue and sleepiness, duration and distance and negligence of seatbelt usage while driving.

Conclusions

The findings of the current study will be beneficial in prevention of RTCs and its associated complications and hence will be vital for policy makers, health service managers and stakeholders.

Application of an autoregressive integrated moving average model for predicting injury mortality in Xiamen, China

OBJECTIVE

Injury is currently an increasing public health problem in China. Reducing the loss due to injuries has become a main priority of public health policies. Early warning of injury mortality based on surveillance information is essential for reducing or controlling the disease burden of injuries. We conducted this study to find the possibility of applying autoregressive integrated moving average (ARIMA) models to predict mortality from injuries in Xiamen.

METHOD

The monthly mortality data on injuries in Xiamen (1 January 2002 to 31 December 2013) were used to fit the ARIMA model with the conditional least-squares method. The values p, q and d in the ARIMA (p, d, q) model refer to the numbers of autoregressive lags, moving average lags and differences, respectively. The Ljung-Box test was used to measure the 'white noise' and residuals. The mean absolute percentage error (MAPE) between observed and fitted values was used to evaluate the predicted accuracy of the constructed models.

RESULTS

A total of 8274 injury-related deaths in Xiamen were identified during the study period; the average annual mortality rate was 40.99/100,000 persons. Three models, ARIMA (0, 1, 1), ARIMA (4, 1, 0) and ARIMA (1, 1, (2)), passed the parameter (p<0.01) and residual (p>0.05) tests, with MAPE 11.91%, 11.96% and 11.90%, respectively. We chose ARIMA (0, 1, 1) as the optimum model, the MAPE value for which was similar to that of other models but with the fewest parameters. According to the model, there would be 54 persons dying from injuries each month in Xiamen in 2014.

CONCLUSION

The ARIMA (0, 1, 1) model could be applied to predict mortality from injuries in Xiamen.

Patterns of Road Traffic Accidents in North West of Iran during 2013 New Year Holidays: Complications and Casualties

OBJECTIVE

To determine the patterns,complications and casualties of road traffic accidents in North West of Iran during 2013 New Year holidays.

METHODS

One hundred and eighty one patients with trauma-related vehicle crashes were investigated in a cross sectional-descriptive study. We only included those road traffic accidents which were recorded during the 2013 Iranian New Year holidays. Severity of injury based on Glasgow Coma Scale (GCS) score, patient transmission type, damaged organ and the final diagnosis was determined. The mortality rate as well as complications were also recorded and reported. The pattern was analyzed and presented using descriptive statistics.

RESULTS

Overall we included 181 patients who were victims of road traffic accidents during the study period. Most cases of multiple traumas were from two car accident (49.2%). Of 181 cases, 71 (39.2%), 66 (36.5%), 16 (8.8%) and 11 (6.1%) subjects had limb, head and neck, abdominal, and spinal cord injuries respectively, while 16 cases (8.8%) did not have any organ damage. In final diagnosis, a limb fracture was noticed in 32 cases (17.7%) and skull fractures in 5 subjects (2.8%) as the first and second causes.

CONCLUSION

As head and neck were the most damaged organs after the limbs in patients with multiple traumas, it seems that there is a necessity for these patients in transmission and examination of head traumas. So there is a need for a proper referral system.