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Road traffic injury mortality and its mechanisms in India: nationally representative mortality survey of 1.1 million homes.

Hsiao M, Malhotra A, Thakur JS, Sheth JK, Nathens AB, Dhingra N, Jha P, Million Death Study Collaborato - BMJ Open (2013)

Bottom Line: The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas, and was notably higher than that estimated from the national police records.Compared to non-pedestrian RTI deaths, about 55 000 (81%) of pedestrian deaths were associated with less education and living in poorer neighbourhoods.Improved prehospital transport and hospital trauma care might address just over a third of the RTI deaths.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Canada.

ABSTRACT

Objectives: To quantify and describe the mechanism of road traffic injury (RTI) deaths in India.

Design: We conducted a nationally representative mortality survey where at least two physicians coded each non-medical field staff's verbal autopsy reports. RTI mechanism data were extracted from the narrative section of these reports.

Setting: 1.1 million homes in India.

Participants: Over 122 000 deaths at all ages from 2001 to 2003.

Primary and secondary outcome measures: Age-specific and sex-specific mortality rates, place and timing of death, modes of transportation and injuries sustained.

Results: The 2299 RTI deaths in the survey correspond to an estimated 183 600 RTI deaths or about 2% of all deaths in 2005 nationally, of which 65% occurred in men between the ages 15 and 59 years. The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas, and was notably higher than that estimated from the national police records. Pedestrians (68 000), motorcyclists (36 000) and other vulnerable road users (20 000) constituted 68% of RTI deaths (124 000) nationally. Among the study sample, the majority of all RTI deaths occurred at the scene of collision (1005/1733, 58%), within minutes of collision (883/1596, 55%), and/or involved a head injury (691/1124, 62%). Compared to non-pedestrian RTI deaths, about 55 000 (81%) of pedestrian deaths were associated with less education and living in poorer neighbourhoods.

Conclusions: In India, RTIs cause a substantial number of deaths, particularly among pedestrians and other vulnerable road users. Interventions to prevent collisions and reduce injuries might address over half of the RTI deaths. Improved prehospital transport and hospital trauma care might address just over a third of the RTI deaths.

No MeSH data available.


Related in: MedlinePlus

Deceased mode of transportation, place of death and timing of death. (A) Deceased mode of transportation in the present study compared to the National Crime Records Bureau 2005 Report. Shaded line represents vulnerable road users (defined as road users without a rigid barrier protecting against traumatic forces, that is, pedestrians, bicyclists, motorcyclists and three-wheeler riders). Percentages from the present study are weighted by state and rural/urban residence. The estimated/reported number of deaths in 2005 (in thousands). (B) Place of death and (C) timing of death based on verbal autopsy narratives. Shaded lines represent deaths that are reported as occurring at the scene of collision or occurring instantly (defined as within 5 min).
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BMJOPEN2013002621F2: Deceased mode of transportation, place of death and timing of death. (A) Deceased mode of transportation in the present study compared to the National Crime Records Bureau 2005 Report. Shaded line represents vulnerable road users (defined as road users without a rigid barrier protecting against traumatic forces, that is, pedestrians, bicyclists, motorcyclists and three-wheeler riders). Percentages from the present study are weighted by state and rural/urban residence. The estimated/reported number of deaths in 2005 (in thousands). (B) Place of death and (C) timing of death based on verbal autopsy narratives. Shaded lines represent deaths that are reported as occurring at the scene of collision or occurring instantly (defined as within 5 min).

Mentions: The deceased mode of transportation was described in the narratives of 2105 (92%) of the RTI deaths. National estimates for the deceased mode of transportation were calculated, as those with unknown and known modes of transportation did not appear to differ with respect to the major sociodemographic traits (see online supplementary table S1). Vulnerable road users are those without a rigid barrier protecting against traumatic forces and include pedestrians, motorcyclists, bicyclists and three-wheelers. They constituted a majority (68%; n=124 000, 99% CI 115 000–131 000) of RTI deaths, led by pedestrians (37%; n=68 000, 62 000–73 000) and motorcyclists (20%; n=36 000, 31 000–40 000; figure 2). Drivers and passengers of motorised four-wheelers comprised 16% (n=31 000, 27 000–35 000) of RTI deaths. By contrast, the 2005 police reports, which use a different but compatible classification system to ICD-10, recorded only 33 000 vulnerable road user deaths and only 9000 pedestrian deaths.27 The most common types of vehicle to collide into the decedents were heavy transport vehicles and buses (37%; n=68 000, 61 000–74 000), followed by cars and vans (15%; n=28 000, 24 000–32 000). Single-vehicle incidents comprised 9% of deaths (n=17 000, 14 000–20 000). The most frequent combinations, resulting in 23% (n=42 000, 37 000–47 000) of RTI deaths, were collisions of heavy transport vehicles or buses with pedestrians and motorcyclists (data not shown).


Road traffic injury mortality and its mechanisms in India: nationally representative mortality survey of 1.1 million homes.

Hsiao M, Malhotra A, Thakur JS, Sheth JK, Nathens AB, Dhingra N, Jha P, Million Death Study Collaborato - BMJ Open (2013)

Deceased mode of transportation, place of death and timing of death. (A) Deceased mode of transportation in the present study compared to the National Crime Records Bureau 2005 Report. Shaded line represents vulnerable road users (defined as road users without a rigid barrier protecting against traumatic forces, that is, pedestrians, bicyclists, motorcyclists and three-wheeler riders). Percentages from the present study are weighted by state and rural/urban residence. The estimated/reported number of deaths in 2005 (in thousands). (B) Place of death and (C) timing of death based on verbal autopsy narratives. Shaded lines represent deaths that are reported as occurring at the scene of collision or occurring instantly (defined as within 5 min).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3753525&req=5

BMJOPEN2013002621F2: Deceased mode of transportation, place of death and timing of death. (A) Deceased mode of transportation in the present study compared to the National Crime Records Bureau 2005 Report. Shaded line represents vulnerable road users (defined as road users without a rigid barrier protecting against traumatic forces, that is, pedestrians, bicyclists, motorcyclists and three-wheeler riders). Percentages from the present study are weighted by state and rural/urban residence. The estimated/reported number of deaths in 2005 (in thousands). (B) Place of death and (C) timing of death based on verbal autopsy narratives. Shaded lines represent deaths that are reported as occurring at the scene of collision or occurring instantly (defined as within 5 min).
Mentions: The deceased mode of transportation was described in the narratives of 2105 (92%) of the RTI deaths. National estimates for the deceased mode of transportation were calculated, as those with unknown and known modes of transportation did not appear to differ with respect to the major sociodemographic traits (see online supplementary table S1). Vulnerable road users are those without a rigid barrier protecting against traumatic forces and include pedestrians, motorcyclists, bicyclists and three-wheelers. They constituted a majority (68%; n=124 000, 99% CI 115 000–131 000) of RTI deaths, led by pedestrians (37%; n=68 000, 62 000–73 000) and motorcyclists (20%; n=36 000, 31 000–40 000; figure 2). Drivers and passengers of motorised four-wheelers comprised 16% (n=31 000, 27 000–35 000) of RTI deaths. By contrast, the 2005 police reports, which use a different but compatible classification system to ICD-10, recorded only 33 000 vulnerable road user deaths and only 9000 pedestrian deaths.27 The most common types of vehicle to collide into the decedents were heavy transport vehicles and buses (37%; n=68 000, 61 000–74 000), followed by cars and vans (15%; n=28 000, 24 000–32 000). Single-vehicle incidents comprised 9% of deaths (n=17 000, 14 000–20 000). The most frequent combinations, resulting in 23% (n=42 000, 37 000–47 000) of RTI deaths, were collisions of heavy transport vehicles or buses with pedestrians and motorcyclists (data not shown).

Bottom Line: The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas, and was notably higher than that estimated from the national police records.Compared to non-pedestrian RTI deaths, about 55 000 (81%) of pedestrian deaths were associated with less education and living in poorer neighbourhoods.Improved prehospital transport and hospital trauma care might address just over a third of the RTI deaths.

View Article: PubMed Central - PubMed

Affiliation: Centre for Global Health Research, Li Ka Shing Knowledge Institute, St Michael's Hospital, University of Toronto, Toronto, Canada.

ABSTRACT

Objectives: To quantify and describe the mechanism of road traffic injury (RTI) deaths in India.

Design: We conducted a nationally representative mortality survey where at least two physicians coded each non-medical field staff's verbal autopsy reports. RTI mechanism data were extracted from the narrative section of these reports.

Setting: 1.1 million homes in India.

Participants: Over 122 000 deaths at all ages from 2001 to 2003.

Primary and secondary outcome measures: Age-specific and sex-specific mortality rates, place and timing of death, modes of transportation and injuries sustained.

Results: The 2299 RTI deaths in the survey correspond to an estimated 183 600 RTI deaths or about 2% of all deaths in 2005 nationally, of which 65% occurred in men between the ages 15 and 59 years. The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas, and was notably higher than that estimated from the national police records. Pedestrians (68 000), motorcyclists (36 000) and other vulnerable road users (20 000) constituted 68% of RTI deaths (124 000) nationally. Among the study sample, the majority of all RTI deaths occurred at the scene of collision (1005/1733, 58%), within minutes of collision (883/1596, 55%), and/or involved a head injury (691/1124, 62%). Compared to non-pedestrian RTI deaths, about 55 000 (81%) of pedestrian deaths were associated with less education and living in poorer neighbourhoods.

Conclusions: In India, RTIs cause a substantial number of deaths, particularly among pedestrians and other vulnerable road users. Interventions to prevent collisions and reduce injuries might address over half of the RTI deaths. Improved prehospital transport and hospital trauma care might address just over a third of the RTI deaths.

No MeSH data available.


Related in: MedlinePlus