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Abstract
Background Road safety for older adults should receive more attention in low-income and middle-income countries with rapidly ageing populations.
Methods Using injury surveillance data from Khon Kaen Regional Hospital in northeastern Thailand, we calculated the proportion of older adults in the total number of patients who were fatally and non-fatally injured in road traffic crashes in each year from 2001 to 2020 and the proportion of road user type in the fatal and non-fatal patients by age groups for the entire study period to examine the extent to which older adults were involved in the crashes and with what mode of transportation.
Results During the 20-year period, there were 5046 fatal and 180 353 non-fatal patients of whom 509 (10%) and 6087 (3%) were aged 65 years or older, respectively. From 2001 to 2020, this proportion increased from 3% to 20% among the fatal patients and from 1% to 6% among the non-fatal patients. Of the fatal and non-fatal patients aged 65 years or older, 50% and 54% were involved in road traffic crashes while driving motorcycles and 28% and 22% while riding bicycles or walking, respectively. Compared with patients aged 65–74 years, those aged 75 years or older tended to be bicyclists or pedestrians in the crashes, though as high as 40% of them were motorcycle drivers.
Conclusion Older adults are increasingly injured in road traffic crashes as vulnerable road users in Thailand. Therefore, road safety efforts should consider their presence on the road.
- Older People
- Motor vehicle � Occupant
- Motorcycle
- Public Health
- Descriptive Epidemiology
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WHAT IS ALREADY KNOWN ON THIS TOPIC
Globally, road traffic crashes cause approximately 1.3 million fatal injuries and 50 million non-fatal injuries, with more than 90% of these injuries occurring in low-income and middle-income countries.
Thailand is one of the most affected countries, with over 20 000 road traffic deaths or approximately 33 deaths per 100 000 population annually.
The road safety of older adults will be a public health concern due to the rapid population ageing phenomenon in Thailand, though this issue has not been well addressed.
WHAT THIS STUDY ADDS
The proportion of older adults in road traffic victims is increasing in northeastern Thailand.
Approximately 20% of road traffic deaths have occurred in older adults in recent years.
Older adults were often involved in road traffic crashes when they rode motorcycles, but they were also victimised as pedestrians and bicyclists.
HOW THIS STUDY MIGHT AFFECT RESEARCH, PRACTICE OR POLICY
The safety of older road users should be addressed in road safety efforts in Thailand.
Guidelines are needed on older motorcyclists’ fitness to drive and safety.
Introduction
Globally, approximately 1.3 million are killed and 50 million are injured in road traffic crashes each year.1 As the world’s population ages and road traffic injuries among older adults increase, ensuring road safety for this age group is important. Thailand is one of the countries most affected by both road traffic injuries and population ageing: over 20 000 road traffic deaths or approximately 33 deaths per 100 000 population annually2; the proportion of people aged 65 years or older was 9% in 2010, and this is projected to be 20% in 2030 and 30% in 2050.3 Under such circumstances, older adults’ share in road traffic injuries will rise, even though road safety measures lower their crash risk. Therefore, road safety for this age group will be a more prominent concern in Thailand and many other countries with ageing populations. However, detailed information on road traffic injuries among older adults is limited, though aggregated data are available. For example, over 70% of road traffic deaths occur in motorcycle drivers and passengers in Thailand2; however, what has not been well examined is the extent to which older adults are involved, and the type of road user and mode of transportation. To highlight this issue, we describe the trend of road traffic injuries among older adults in northeastern Thailand.
Methods
Study setting
This study was conducted using data from Khon Kaen Regional Hospital (KKH) in Khon Kaen Province, the centre of northeastern Thailand, with a population of approximately 1.8 million. KKH is a tertiary hospital with around 1000 beds, and it is the only hospital equipped with a trauma and critical care centre in the province. Approximately 20 000 trauma patients are treated at this centre every year, and 80% of them are residents of Khon Kaen Province. Notably, KKH is the first hospital in Southeast Asia to initiate hospital-based injury surveillance in 1989.4
Data
We obtained data on patients injured in road traffic crashes between 2001 and 2020 from KKH’s injury surveillance with ethical approval. The data included life outcomes, age, road user type and vehicle of the injured person.
Analysis
First, we calculated the proportion of people aged 65–74 years and 75 years or older in the total number of patients who were fatally and non-fatally injured in road traffic crashes in each year from 2001 to 2020 to examine an increase in older adults among these patients over the study period. Then, we calculated the proportion of each road user (car drivers/passengers, motorcycle drivers/passengers, bicyclists, pedestrians and others) in the patients aged 0–14 years, 15–64 years, 65–74 years and 75 years or older for the entire study period to examine what type of road user older adults tended to be when they were involved in the crashes. The proportion of the patients in each age group by road user was also calculated to examine the age distribution of each road user.
Patient and public involvement
Our research did not involve the patients or the general public of Thailand. We do not plan to involve them in disseminating the research findings beyond usual media coverage.
Results
During the 20-year study period, there were 5046 and 180 353 patients who were fatally and non-fatally injured in road traffic crashes among those transported to KKH. Of the fatal patients, 342 (6.8%) and 167 (3.3%) were aged 65–74 years and 75 years or older, respectively; of the non-fatal patients, 4729 (2.6%) and 1358 (0.8%) were aged 65–74 years and 75 years or older, respectively.
Figures 1 and 2 show the trend in the annual number of fatal and non-fatal patients and the proportions of those aged 65–74 years and 75 years or older from 2001 to 2020. In the fatal patients, the proportion of those aged 65–74 years and 75 years or older increased from 2.4% and 1.0% in 2001 to 10.6% and 9.0% in 2020, with 13.3% and 9.0% at a peak, respectively. Likewise, in the non-fatal patients, the proportion of those aged 65–74 years and 75 years or older increased from 1.1% and 0.3% in 2001 to 4.7% and 1.5% in 2020, with 4.9% and 1.8% at a peak, respectively.
Total number of fatal patients injured in road traffic crashes and proportions of those aged 65–74 years and those aged 75 years in the total number of the fatally injured patients in Khon Kaen Province, Thailand, 2001–2020.
Total number of non-fatal patients injured in road traffic crashes and proportions of those aged 65–74 years and those aged 75 years in the total number of the non-fatally injured patients in Khon Kaen Province, Thailand, 2001–2020.
Table 1 shows the proportion of each road user in the fatal and non-fatal patients by age group, along with the proportion of the patients in each age group by road user, for the 20-year study period. Across the age groups, motorcycle drivers shared the largest proportion in both fatal and non-fatal patients (except for the non-fatal patients aged <15 years in whom motorcycle passengers shared the largest proportion). The proportions of motorcycle drivers in the patients aged 65–74 years and 75 years or older were 54% and 42% for fatal injuries and 58% and 43% for non-fatal injuries, respectively. Unlike the patients aged 15–64 years, older adults were also largely involved in the crashes as other vulnerable road users. In the fatal patients aged 65–74 years and 75 years or older, 15% and 25% were pedestrians and 9% and 11% were bicyclists, respectively. In the non-fatal patients aged 65–74 years and 75 years or older, 9% and 16% were pedestrians and 10% and 15% were bicyclists, respectively. Similar results were seen in the patients aged <15 years. By road users, a large majority of the patients were aged 15–64 years except for bicyclists and pedestrians. Among fatal patients, 43% of bicyclists and 27% of pedestrians were aged 65 years or older; among non-fatal patients, 54% of bicyclists and 34% of pedestrians were aged <15 years.
Proportion of each road user in fatal and non-fatal patients injured in road traffic crashes by age group, and the proportion of the patients in each age group by road user in Khon Kaen Province, Thailand, 2001–2020
Discussion
We observed a constant increase in the proportion of older adults among road traffic victims over the past 20 years in northeastern Thailand. Today, approximately 20% of road traffic deaths occur in older adults. They were often involved in crashes when they rode motorcycles as in other age groups. However, older adults were more likely to be victimised as pedestrians and bicyclists than the working-age population.
An increasing pace in the proportion of older adults among road traffic victims is not negligible. In Khon Kaen Province, the proportion of people aged 65 years or older in the total population increased from 7% in 2001 to 12% in 2020,5 whereas the proportions of people in the same age group among road traffic victims increased from 3% to 20% for fatal injuries and from 1% to 6% for non-fatal injuries. To our knowledge, there has been no discussion on road safety specifically for older adults in Thailand’s road safety efforts. Given their fragility and the fact that many older adults as well as children are victimised as pedestrians and bicyclists, we need to take a step further to protect them on the road. Effective interventions for that purpose, such as area-wide traffic calming,6 7 should be adoptable in Thailand.
Notably, many older adults were involved in crashes while driving motorcycles, which may be related to age-related physical decline. Unlike car drivers, motorcyclists need to stay balanced while riding, which requires a higher level of physical strength and coordination than that required for car drivers. Besides, motorcyclists are not physically protected. Nevertheless, there are no guidelines on older motorcyclists’ fitness to drive and their safety.
Methods of protecting motorcyclists are limited. Today, helmet wearing is only an established method for motorcyclists to alleviate injury severity,8–10 and it has been mandatory in Thailand for drivers since 1996 and for passengers since 2007.11 Some studies suggest that protective clothing can exert such effects,12–14 but it may not be practical in tropical countries.15 Considering their fragility, we assume that the safety of older motorcyclists will not be ensured by wearing a helmet and protective clothing. Therefore, older motorcyclists may consider driving cessation when their driving ability decreases, and mobility support for older adults will be a social issue.
The major limitation of this study was the lack of data on the population at risk. Therefore, we are unsure whether the crash or fatal risk of older people has increased in the past 20 years. The proportional mortality of older people shown in this study could be inflated if fewer people in other age groups or more older people happened to be involved in crashes. Another concern was the representativeness of our findings. In Khon Kaen Province, road traffic victims who need tertiary care are transported to KKH or Khon Kaen University Hospital. If older victims were disproportionately transported to either hospital and the extent of disproportion changed over the study period, the estimated proportion of older adults in road traffic victims and its temporal trend were possibly biased, however unlikely. Additionally, we did not identify whether those referred to another hospital survived. However, they are usually not severe cases, and the number of such referrals is small; thus, the incidence of road traffic deaths should not be underestimated.
In conclusion, older adults are increasingly injured in road traffic crashes in Thailand. Road safety efforts should consider their presence on the road.
Ethics statements
Patient consent for publication
Ethics approval
This study was approved by Khon Kaen Regional Hospital’s institutional review board.
Footnotes
Contributors MI conceived the study. RB, MI and SN designed the study. RB obtained the data. RB and MI analysed the data. MI drafted the manuscript. RB, RP and SN made comments that led to substantial revisions of the manuscript, and all the authors approved its final version. MI is the guarantor.
Funding This work was supported by JSPS KAKENHI (grant number 21H03195).
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.