Background Road traffic injuries (RTIs) are a priority public health problem in the Republic of North Macedonia (Macedonia). The main objective is to analyze the burden and trend of RTIs in Macedonia before and through the period of the Decade of action for road safety 2011–2020.

Methods The burden and trend of RTIs on a national level have been estimated in a retrospective study of available data in the last 12 years, applying the WHO standard method and software application. Data from the Ministry of Internal affairs, State Statistical Office, and Institute for Health Metrics and Evaluations have been used.

Results The estimated burden of RTIs in 2017 is 4.894 DALYs (3.157 YLLs and 1.737 YLDs) which is lower than in 2009 with 5.391 DALYs (3.201 YLLs and 2.190 YLDs), with a strong correlation with sex and age. The burden is significantly higher in males, with three times more DALYs lost than in females (χ2 = 28, df = 1, p < 0,01). The most vulnerable are the young at 15–29 years age group with over 40% of RTIs DALYs lost.

Conclusion There is decreasing in the burden of RTIs in 2017 compared with the burden before the Decade of action for road safety 2011–2020 started. Cooperation among all relevant sectors for preventive activities implementation is essential. Macedonia has comprehensive laws which address all RTIs risk factors, but the legislation enforcement is not on a satisfactory level.