Ali Khorshidi ( Safety Promotion and Injury Prevention Research Center of Shahid Beheshti University of Medical Sciences, 1Ilam University of Medical Sciences, Iran. )
Elaheh Ainy ( Safety Promotion and Injury Prevention Research Center of Shahid Beheshti University of Medical Sciences, 1Ilam University of Medical Sciences, Iran. )
Hamid Soori ( Safety Promotion and Injury Prevention Research Center of Shahid Beheshti University of Medical Sciences, 1Ilam University of Medical Sciences, Iran. )
Mohammad Mahdi Sabbagh ( Traffic Police of Iran, FAVA of NAJA, Iran. )
Objective: To assess the status of road traffic injuries in Iran.
Methods: The retrospective study was conducted in Iran and comprised all reported traffic accidents from March 2011 to March 2012 that were recorded in the national traffic accident database. The information collected included demographic data specific to road traffic accidents and injuries. The data was summarised and presented using frequencies and percentages.
Results: There were a total of 452192 road traffic accidents with 252246 victims in the one-year period. The highest number of accidents, 110348(47%), involved individuals in the 15-30 year age group. Among the gender-identified injured, 206171(78.4%) were male and 56639 (21.6%) were female. Besides, 298750(73.2%) accidents took place between 6am and 6pm. In terms of location, the province of Semnan had the highest rates of injury and death (913 per 100000 and 41per 100000, respectively), while the lowest rate of injury was in Alborz (131 per 100000) and lowest rate of death was in Tehran (5 per 100000). The majority of accidents 301516(66.7%) occurred on inner city roads. Although the total number of victims in inner city roads (180893) was higher than outer the city roads (2.2:1), the number of deaths (8615) on outer roads was higher (3:1).
Conclusion: Road traffic injuries placed a heavy burden on the Iranian population, especially on young men. Comprehensive strategies and policies must be implemented for effective prevention of road accidents in Iran.
Keywords: Road traffic, Injuries, Inner and outer city roads. (JPMA 66: 517; 2016)
Road traffic injuries (RTIs) are the eighth leading cause of death globally, and are the most common cause of mortality in people aged 12-29 years, causing a major economic burden worldwide.1-3 Each year, more than one million people die in traffic accidents, accounting for 2.2% deaths worldwide.4 RTI deaths have been steadily increasing in low- and middle-income countries, where it is estimated that by 2030 it will rank as the second and third leading causes of death, respectively.5,6
RTIs are the leading cause of death in Iran. RTIs are the second largest cause of mortality in Iran after adjusting for the effect of disease as represented by the disability adjusted life years (DALYs).7 The DALYs resulting from RTIs in Iran are higher than those estimated for the eastern Mediterranean region and worldwide.8,9 In developing countries, such as Iran, RTIs are estimated to cost 6.46% of the gross national product (US$39billion) per year.10
There is a lack of precise information to determine priorities for the prevention of RTIs by knowing the magnitude of the problem. As such, the current study was planned to identify the underlying components of road traffic accidents (RTAs) in Iran. This is the first national study on road traffic injuries and its findings form part of body of findings relating to RTAs.
Materials and Methods
The retrospective study was conducted in Iran and comprised all RTAs from March 2011 to March 2012 that were recorded in the national traffic accident database. Iran is divided into 31 provinces and the provinces are further divided into counties. All police records for RTIs were investigated. In Iran, RTI data is collected daily by the police at accident scenes using an advanced data registry system developed at the request of the traffic police, rural police, Ministry of Road and Urban Development and as requested by municipalities. The forms are based on those in use in other countries and are adapted to meet the needs of the organisations.
The database collected data on the characteristics of the people involved in traffic accidents and the time, date and location of the accidents. The locations of the accidents were classified as occurring on inner or outer city roads based on municipal boundaries.
While collecting data, the serial numbers, dates and locations of the accidents were precisely checked to remove duplicate records. Since data collected for different aspects of RTAs were registered in four separate datasets, it was therefore necessary to merge and link related data for each accident. The country accident data processing (CADP) software was designed to merge the data. This programme was designed to be compatible with other statistical software. Statistical analysis was performed using STATA 12.
A total of 452192 RTAs occurred in Iran during the study period. There were 10203(2.3%) fatal accidents and injury was caused in 220169 (49.8%). Besides, 301516 (66.7%) RTAs occurred on inner city roads. Of the 408198 RTAs for which the time of day was available, 298750 (73.2%) occurred between 6am and 6pm). There were 263781 RTA victims, 252246(95%) of whom were injured and 11535(4.3%) were killed. Of the 262810 victims in whom gender was identified, 206171(78.4%) were male and 56639(21.6%) were female. The male:female ratio for injury was 3.6:1, and for death it was 5.1:1. The mean age for all casualties was 31.2±13.4 years with only a slight difference between men and women (p>0.05).
The highest number of RTIs occurred in the 15-29 year age group and the lowest occurred in the 1-4 year age group (Table-1).
The maximum number of injuries and deaths occurred in August (26383; 10.5% and 1289; 11.2%, respectively) and lowest number was observed in March for injuries (17876; 7.1%) and in December for deaths (660; 5.7%) (Figure).
Overall, 301516(66.7%) RTAs occurred on inner city roads. Although the total number of victims in inner city roads (180893) was higher than outer city roads (2.2:1), the number of deaths (8615) on outer the city roads was higher (3:1). The largest proportion of victims both inner and outer the city roads had completed 12 or fewer years of education (Table-2).
In most provinces, the number of injured was higher on the inner city roads than the outer ones (Table-3).
Conversely, in all provinces, mortality caused by RTAs was higher on the outer city roads than the inner ones. The Semnan province had the highest rates of injury and death (913 per 100000 and 41per 100000, respectively). The lowest rate of injury was for Alborz (131 per 100000) and for death it was Tehran (5 per 100000).
The study used a recent dataset for one year of RTA results to highlight aspects of RTIs in Iran. It also compared the characteristics of RTIs on inner and outer city roads. The findings are in line with the results of previous studies. Our study showed that the majority of RTIs in Iran were males, and the finding agrees with those of previous studies.11-15 While the distribution by gender in the Iranian population was almost equal, males were at greater risk of traffic injury probably because of their increased presence on the roads.
Our study revealed that the age group most greatly affected by RTIs was the most productive age group: 15-44 years (n=170136; 72.4%). Prior studies in Iran and other countries have found similar results.13,16,17 The reason may be that this is the most active period of life, which increases the chance of exposure to and risk of injury or death. Since this age group comprises the most economically active strata of society, traffic collisions are a source of great economic loss to communities.
There was a decrease in RTIs in people older and younger than the 15-44 age groups. This is probably because fewer children are present in vehicles during school hours and the safety of children who are passengers is controlled by the adults present. In addition, seniors over aged 60 tend to be less mobile than other age groups. The number of RTIs was the highest among people who had completed 12 or fewer years of education. Previous studies have also shown that a higher proportion of RTI victims are less well-educated.13,18
In the present study, the highest number of RTIs occurred in the month of August followed by June. This may be because in Iran, the summer months of June, July and August are when many families travel on vacation; this is particularly true for the month of August. Moreover, as other researchers have found, seasonal factors for summer such as length of day and good weather conditions encourage increased use of motor vehicles and increased speed as well.19-21
The current study revealed that although the predominant proportion of RTAs occurred on inner city roads, but most fatal injuries occurred on outer city roads. This could be explained by the fact that the severity of collisions on outer city roads was greater than that on the inner city roads. The lack of rapid and timely access to emergency healthcare services may have contributed to the result.
More than 70% of traffic collisions took place during the daytime (6am to 6pm). Similar results have been reported elsewhere;13,22 this is the time of day experiencing increased activity and mobility. The present study showed that the annual incidence of RTIs per 100000 people was the highest in Semnan province. It appears that because Semnan is located in central Iran, the roads in inner and outer city roads are more heavily used by road users.
The study relied on traffic police data collected at the sites of the collisions and does not include information about the fates of victims transferred to hospitals or after discharge from hospital. Considering this limitation, the mortality estimates reported in our study are likely underestimated. Other studies have also found under-reporting of RTI data by police.23
The status of road traffic injuries in Iran is alarming. It requires comprehensive planning and coordination of sectors involved in road safety to prevent injury and death by RTAs, especially during the daytime and among urban drivers having 12 or fewer years of education.
We are grateful to Traffic Police (Rahvar Research Centre) for providing relevant information. Thanks are also due to all the colleagues in Safety Promotion and Injury Prevention Research Centre for their cooperation.
1. Lozano R, Naghavi M, Foreman K, Lim S, Shibuya K, Aboyans V, et al. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012, 380: 2095-128.
2. Global burden of disease, 2008. Geneva, World Health Organization, 2011. [online] [cited 2013 Feb 22]. Available from: URL: http://www.who.int/healthinfo/global_burden_disease/estimates_regional/en/index.html
3. World Health Organization. Injury and Violence: The Facts. Geneva: WHO; 2010.
4. Jacobs G, Aeron-Thomas A, Astrop A. Estimating global road fatalities. Crowthorne, Transport Research Laboratory, 2000.
5. Peden M, Scurfield R, Sleet D, Mohon D, Hyder AA, Jarawan E, et al, eds. World report on road traffic injury prevention. Geneva,World Health Organization, 2004. [online] [cited 2013 Feb 22]. Available from: URL: www.who.int/violence_injury_prevention/publications/road_traffic/world_report/en/index.html
6. Global Plan for the Decade of Action for Road Safety, 2011-2020. Geneva, World Health Organization, 2011. [online] [cited 2013 Jan 24]. Available from: URL: www.who.int/Road safety/decadeof_action /plan/plan_english.pdf.
7. Parsaeian M, Farzadfar F, Zeraati H, Mahmoudi M, Rahimighazikalyeh G, Navidi I. Application of spatio-temporal model to estimate burden of diseases, injuries and risk factors in Iran 1990-2013. Arch Iranian Med 2014; 17: 28-33.
8. Ministry of Health, treatment and Medical Education. Death profile in 18 provinces 2001, The WHO representative in Islamic Republic of Iran, Tehran. 2002.
9. Ainy E, Soori H, Mahfozphoor S, Movahedinejad A. Presenting a practical model for governmental political mapping on road traffic injuries in Iran in 2008: a qualitative study. JRSM short reports 2011; 2:79.
10. Ainy E, Soori H, Ganjali M, Le H, Baghfalaki T. Estimating cost of road traffic injuries in iran using willingness to pay (WTP) method. PLoS One 2014; 9: e112721.
11. Henriksson EM, Ostrom M, Eriksson A. Preventability of vehicle-related fatalities. Accid Ann Prev 2001; 33: 467-75.
12. Sharma BR, Harish D, Sharma V, Vij K. Road Traffic accidents a demographic and topographic analysis. Med Sci Law 2001; 41: 266-74.
13. Jha N, Agrawal CS, Epidemiological Study of Road Traffic Accident Cases: A Study from Eastern Nepal. Regional Health Forum WHO South-East Asia Region, 2004; 8: 15-22.
14. Arvind K, Lalwani S, Agrawal D, Rautji R, Dogra TD. Fatal road traffic accidents and their relationship with head injuries: An epidemiological survey of five years. Indian J Neurotrauma 2008; 5: 63-7.
15. Mohammadi G. Road traffic fatalities among pedestrians, bicyclists and motorvehicle occupants in Sirjan, Kerman, Iran. Chin J Traumatol 2009; 12: 200-2.
16. Ghorbanali M, Road traffic fatalities among pedestrians, bicyclists and motorvehicle occupants in Sirjan, Kerman, Iran. Chinese Journal of Traumatology 2009;12(4):200-202. [same as ref 15]
17. Meel BL. Trends in fatal motor vehicle accidents in Transkei region of South Africa. Med Sci Law 2007; 47: 64-8.
18. Verma PK, Tiwar KN. Epidemiology of Road Traffic injuries in Delhi: Result of a survey. Reg Health Forum 2004; 8: 6-14.
19. Radun I, Radun JE. Seasonal variation of falling asleep while driving: An examination of fatal road accidents. Chronobiol Int 2006; 23: 1053-64.
20. Sivak M. During which month is it riskiest to drive in the United States? Traffic Inj Prev 2009; 10: 348-9.
21. Farmer CM, Williams AF. Temporal factors in motor vehicle crash deaths. Inj Prev 2005; 11: 18-23.
22. Ranganthan N, Gupta S, Raju MP. Spatial and temporal characteristics of accidents in a Metropolitan city 1991. Proceedings of International Conference on Traffic Safety 27-30 January 1991; New Delhi, India.
23. Miranda JJ, Lopez-Rivera LA, Quistberg DA, Rosales-Mayor E, Gianella C, Paca-Palao A, et al. Epidemiology of Road Traffic Incidents in Peru 1973-2008: incidence, mortality, and fatality. Plos One 2014; 9: e99662.