Epidemiology of bicycle injuries in 13 health divisions, Islamic Republic of Iran 2003
Introduction
Unintentional injuries are the second leading cause of death in Iran (Naghavi, 2004). In 2000 and 2001, the rates of fatal injuries were 58.9/105 persons (Naghavi, 2001) and 57/105 (Naghavi, 2004), respectively. Among these the leading mechanism of death was road traffic collisions (38/105) (Naghavi, 2004). In 1999, medico-legal documents (Coroner's office or Medical Examiners’ documents) revealed that the crude mortality rate for road traffic collisions was 25.8/105, with males demonstrating a higher rate than females (39.1/105 versus 10.5/105) (Montazeri, 2004). Compared to the world estimates in 2000, traffic-related mortality in Iran was higher (31.3/105 versus 19.5/105) and also higher than the rate estimated for Eastern Mediterranean (EMRO)1 countries (27.7/105) (WHO, 2003). Finally, traffic collisions were also the main cause of death among children <14 in rural areas of Iran (37%) (Soori and Naghavi, 1998).
While much is known about traffic deaths and injury, the country-wide rate of bicycle injuries has not been examined in detail. Despite the importance of this problem, extensive searches for other databases revealed limited published evidence. A 1-year study in an Iranian province in 1999 revealed that 4.9% of injured children in urban and sub-urban areas referred to emergency departments were pedal cyclists, of whom, 55% had head injuries (Soori, 2002). In another provincial study in 1994, of 2304 traffic-related injuries which referred to ED, 191 (8.2%) were in bicyclists and 37 (21%) of these suffered from head injuries (representing 6.7% of all traffic-related head injuries) (Foroudnia and Janghorbani, 1996).
The rate and severity of bicycle injuries has decreased in many countries in the past 25 years (Nixon et al., 1987, Cushman et al., 1992, Vulcan et al., 1992, Thompson et al., 1995, Linn et al., 1998, Wesson et al., 2000, Cook and Sheikh, 2003). To prevent cycling casualties, methods of protection such as bicycle helmets (Lardelli et al., 2003), designated cycling paths, (Staunton et al., 2003, Boarnet et al., 2005) and visibility aids (Kwan and Mapstone, 2004) have been employed. Some jurisdictions have also introduced social interventions such as helmet legislation, (Cameron et al., 1994, Macknin and Medendorp, 1994, Ni et al., 1997, Kanny et al., 2001, Lee et al., 2005) and promotional programs (Dannenberg et al., 1993, Rivara et al., 1994, Abularrage et al., 1997, Farley et al., 2003) to increase helmet use. Conversely, many countries, such as Iran, have not implemented any of these efforts to reduce bicycling injuries.
Given the various and practical interventions for injury prevention, it is important to explore the causes of cycling injuries in Iran in order to prioritize interventions. The current study was designed to examine the circumstances and nature of cycling injuries in 13 health divisions in Iran and describe the risk factors for serious injuries.
Section snippets
Data procedure
This is a secondary analysis of a data set provided by the Ministry of Health and Medical Education of the Islamic Republic of Iran. Permission to use this data-set was provided by the Deputy Minister for Health Affairs (Dr. M.E. Akbari). The Health Research Ethics Board at the University of Alberta also approved this analysis.
In 2003, a comprehensive survey, addressing ten categories of injuries including traffic-related injuries, was conducted in 13 health divisions located in 11 provinces of
Reliability results
Of the 26 hospitalized patients, 8 died. Simple agreement was excellent for the following categories: age, sex, residence, education (all 100%), injury sustained in cases that died (n = 8; 100%), location of collisions (96%), and rider/passenger status (85%). Agreement was lower for the exact injury sustained in those surviving their injuries (66%). Disagreements were minor and did not influence the ISS scoring.
Study sample
During the study period in 13 health divisions, 8817 persons were hospitalized and/or
Discussion
This prospective study examined traffic-related injuries resulting in hospitalization or death in 13 health divisions in Iran. Of the total number of traffic-related injuries (8817) in this study, 5% (440) were in bicyclists. This proportion was similar to two previous smaller provincial studies in Iran (Foroudnia and Janghorbani, 1996, Soori, 2002), and also comparable to proportions in other countries (Kennedy, 1996, Jacobson et al., 1998, Klimentopoulou et al., 2004). The male/female ratio
Conclusion
From this evaluation two conclusions can be made:
- 1.
Bicyclists, particularly males and young children in Iran are vulnerable to severe injury and death. The risk of serious injury or death is higher when the mechanism of injury is striking a moving vehicle on a highway.
- 2.
The head is the most frequent site of severe injury with or without subsequent death.
More population-based studies are needed to explore the actual number of injured pedal cyclists presenting to the EDs, including those with minor
Acknowledgements
The authors wish to thank an anonymous reviewer for his/her recommendations. The authors would also like to thank Dr. Ali Rashidy-pour and Dr. Mohammad Forozesh-fard for proving access to patients charts in Amir-al-Momenin hospital in Semnan. Dr. Karkhaneh's PHD training is supported by the Government of Iran and Semnan University of Medical Sciences. Dr. Rowe is supported by the Government of Canada through the 21st Century Canada Research Chair Program. Dr. Hagel holds the recently appointed
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