Discussion

The PMRTI in Qatar is 12.5%. One in eight deaths, from all causes, is due to a road traffic injury. RTIs are the leading cause of death in Qatar. When analysing the data for all age groups, the PMRTI for males is higher than females and for non-Qatari populations when compared to Qatari populations, of both genders and all ages. When age and nationality are taken into the analysis, young Qatari men (aged 20–29) have the highest PMRTI of 76.9%. The ASDRRTI for Qatari males, from the age of 10 onwards was from 2.76–10.1 times that of the general population. Using the risk for RTI death of the general population as a reference, Qatari males from the age of 10 onwards are at a significantly increased risk for RTI death. Non-Qatari men older than 50 years are the only other subpopulation that shares this significantly increased relative risk for RTI death with the aforementioned group.

This is an analysis of the most recent and complete national mortality dataset from the QSA, compiled and used for health policy planning by the Supreme Council of Health. This study reports the differential risks for death from a road traffic injury among this country's diverse populations by taking into account available age and nationality data. It is intended as a supplementary tool that will guide the prioritisation of preventive and research programmes for road safety in Qatar.

This study shares its limitations with other analyses of RTI deaths from a large or national dataset. For example, the potential for miscoding the cause of death due to late deaths happening beyond 30 days and for underreporting of deaths in RTI victims directly attributable to ‘other causes’, such as pneumonia or sepsis, cannot be overlooked. In 2010 there were no recorded MVC deaths among Qatari females; this is not a yearly occurrence, potentially making the data on female MVC deaths for this year an outlier. Qatar does not have a national trauma registry that links ambulance service, emergency room and trauma centre data with national mortuary and traffic police data to serve as a cross-reference for the mortality data of the QSA.

There have been reports of reductions in the number of road deaths in Qatar as the result of various initiatives, such as the installation of speed cameras, increased issuance of traffic citations and improvements in trauma care.6 ,8 ,9 However, there is a need for better and unified data on motor vehicle crash injuries and mortalities.10 ,11

This study analyses mortality outcomes from RTIs, identifies high-risk groups that need targeted interventions and adds to the existent data on risk factors for RTIs.3–5 Its findings are in agreement with global data that consistently show the disproportionate risk for RTI deaths borne by males.11 As there are no laws that restrict females from driving in Qatar, the gender discrepancy that exists should be studied further in the light of the potential differential road exposures and driving behaviours between the genders. Burgut et al5 reported that 26.6% of all Qatari drivers they surveyed were involved in a crash and that being young (aged 25–34 years) and male predisposed to higher involvement in a crash. This study demonstrates that the disproportionate mortality (not only crash) burden is also borne by a young population of Qatari males, aged 10–29, who have a 5–10 times higher RTI mortality rates when compared to the general population.

Given that 92% of pedestrians injured are non-Qataris12 and 32% of RTI deaths are pedestrians13 ,14 then most of the deaths among the Qatari are young male passengers or drivers. If their ASDRRTI is compared with that of their counterparts in the US, 26.7 deaths per 100 000 population of 20–29-year-old men in 2010,15 it can be observed that young Qatari males have 5.4 times their death rate. If this same rate were applied to this US population, it would result in 25 633 more deaths from RTIs every year and urgent calls for immediate action from government agencies to tackle such a deadly issue. This is further evidence of the need to target interventions to this high-risk group in the form of proven road safety initiatives such as graduated driver licensing programmes16 ,17 and the enforcement of laws to reduce known risk factors such as distracted driving as declared in the Qatar National Development Strategy 2011–2016.13 ,14

While risky behaviours have been previously identified as predisposing to RTM,3–5 it is still unclear from our study why there is such a high rate of death in this particular segment of the population. An analysis of the road risk exposure (ie, vehicle km travelled) of the diverse populations in Qatar can further describe and explain the differential burden of each subpopulation. If anything, this study under-reports the true magnitude of the problem, as we have not studied the disabilities that result from non-fatal MVCs, the numerous lives permanently affected and dollars spent on rehabilitation and long-term care. There is a need for further studies in this high-risk population to inform the creation of targeted injury prevention programmes.

Expatriates, that is, non-Qataris, are not at a significantly increased risk for death from an RTI when compared to the general population. This can be partially explained by the findings from the study of Bener et al18 who found that Qatari drivers were significantly more likely to engage in ‘careless driving or excessive speeding’ when compared to drivers from Jordan, India or the Philippines. The fact that many non-Qataris are vulnerable (ie, non-motorised) road users can explain why they comprise a great majority of the pedestrian victims presenting to the country's level 1 trauma centre.12

We conducted this study because the diverse and transitory nature of the population of Qatar makes the description of the epidemiology of road traffic deaths difficult to report and challenging to address from an injury prevention standpoint. Conventional public health indicators, such as death rates, are reported for the entire population, despite the fact that Qatar's subpopulations do not share the same exposures, risk factors or epidemiological characteristics. This ‘lumping’ of data may lead to erroneous conclusions as the real effect of RTI deaths in high-risk populations may be reduced or diluted. Our findings highlight the fact that, despite reported improvements in road fatality rates in Qatar, there are still subpopulations at a disproportionately high risk for RTI death. These high-risk groups need a proportionate response in terms of injury prevention programmes, public education and law enforcement measures in order to reduce the unnecessary RTI deaths in this very young population.