Background Risky driving and unsafe vehicles are two areas receiving increased global attention as priorities for road traffic injury prevention. However, the attendant risks have not been quantified in low- and middle-income Pacific nations using controlled epidemiological studies.

Methods A population-based case-control study was designed to include all four-wheeled motor vehicles involved in crashes where at least one occupant died or was hospitalised (case vehicles) and a random sample of vehicles driven on roads in Viti Levu, Fiji (control vehicles). The drivers or their proxies were administered structured questionnaires eliciting self-reported data on risky driving and vehicle factors, including crash involvement and traffic convictions in the previous five years.

Results Drivers of 154 case and 752 control vehicles participated in this study. Multivariable models of the main effects of interest found significant excess in the odds of injury-involved motor vehicle crashes (MVCs) with vehicles older than 10 years (OR 1.99; 95% CI: 1.27–3.12); vehicles with seat belts only in the front seats (OR 2.03; 95% CI: 1.19–3.46) and speeding up when someone tries to pass (OR 3.40; 95% CI: 1.51–7.65). The odds of MVC were significantly less if drivers had experienced a traffic conviction or crash in the previous 5 years (OR 0.43; 95% CI: 0.24–0.78 and OR 0.45; 95% CI: 0.22, 0.95, respectively).

Conclusions Speeding in some contexts and driving vehicles older than 10 years or without a full complement of seatbelts were associated with a 2–3 fold increase in the odds of serious injury-involved MVCs. In contrast to some other studies, previous traffic convictions and crash involvement appeared protective, which may signify a greater deterrent effect. However, it is unclear if the apparent risk reduction will be long-lasting and we cannot exclude the possibility that this finding may reflect biases relating to social desirability or concerns relating to risk of prosecution.