Risk factors in urban road traffic accidents
Introduction
Motor-vehicle accidents are complex events resulting primarily from human, technical, and environmental contributing factors. Design of streets with traffic signals and stop-signs as well as overall organization of road traffic control by traffic police, are major factors that influence the frequency and severity of motor-vehicle collisions in urban area. Traffic police have the responsibility of collecting and analyzing crashes, and a review of motor-vehicle collisions can be compiled from their reports (Retting, Weinstein, Williams, & Preusser, 2001). Al-Ghamdi (2002) analyzed pedestrian–vehicle crashes in Riyadh, Saudi Arabia using data from traffic police reports. In addition, data on the type of injury, injury severity, costs, and length of hospital stay were collected from hospital records. Identification of the most probable factors that affect accident severity is the basis for effective road traffic accident prevention. The most complete information about causalties in road traffic crashes can be obtained from linked police, hospital, and death records (Rosman, 2001).
The data from Ministry of Interior's Road Traffic Accident (RTA) Surveillance for the Republic of Croatia shows that there were 701 killed (mortality 15.8/100,000) and 26,182 injured people (injury incidence 590.0/100,000) in RTA in Croatia in 2003. The number killed has been decreasing since 1990 (1,366) and the number of injured has been increasing since 1990 (19,791) – the highest was in 2003. There were 53 killed (mortality 6.8/100,000) and 3,270 injured persons in RTA (injury incidence 419.7/100,000) in Zagreb, the capital of Croatia, in 2003 (Fig. 1); 17.6% of the Croatian population were living in the city of Zagreb. The traffic density in Zagreb is increasing compared to other large Croatian cities. Although the percentage of killed in RTA in Zagreb is not high (7.5%), the percentage of injured is high (12.5%), and is still increasing. Therefore, it is important to investigate factors that most influence urban RTA mortality and morbidity.
The study used linked traffic police and hospital records in determining human and environmental risk factors, as well as calculating hospital cost and length of stay in hospital of RTA patients in the city of Zagreb during the 2-year period 1999–2000.
Three RTA outcome groups were included: (a) persons dead at the scene of the accident or who died during transportation; (b) severely injured (included deaths within 30 days); and (c) mildly injured persons (see definitions in the next section).
The aim of this paper is to determine circumstances and human and road traffic variables that most influence fatally, severely, and mildly injured urban road traffic users.
Section snippets
Material and method
A sample of 1,882 injured and killed persons in RTA in the city of Zagreb were hospitalized in three Zagreb hospitals: (a) Dubrava Clinic; (b) Clinic of Traumatology; and (c) Nun Clinic during the period January 1, 1999–December 31, 2000. These three hospitals receive about 75% of victims injured in RTA in the city of Zagreb.
A special form for those injured in RTA, as determined from hospital admission and discharge records (with length of stay data and costs of hospitalization) and death
Results
The study sample of 528 persons with linked hospital and traffic police data consists of 260 severely injured and 213 mildly injured persons in RTA in the city of Zagreb during 1999–2000. There were also 55 persons killed at the scene of the accident or during transportation. The analyzed sample consists of 372 men and 156 women.
The only risk-variables presented in Table 3 show significant differences (P < 0.05) between proportions of fatal and injured outcomes: 85.5% of those who died at the
Discussion
Information about road traffic crashes would be biased if the analyses were based solely on traffic police report data. They are less biased if they are derived from the hospital admissions linked database (Cryer et al., 2001). A high proportion of traffic police underreporting was found in this study, as in some other investigations, by trying to link hospital with police records. Aptel et al. (1999) found that only 37.3% of non-fatally traffic-injured hospital patients were recorded by the
Summary
On the basis of linked road traffic accident data of hospital records and traffic police reports, the study of urban RTA victims was performed. Sixteen personal characteristics and traffic variables were analyzed and for those variables that show statistically significant differences (P < 0.05) between proportions of fatal, severely, and mildly injured RTA victims, OR and CI were calculated. High risks for fatal road traffic accidents were found on urban links, during night hours, and with bad
Aknowledgement
The scientific project about road traffic accidents in the city of Zagreb was funded by The Zagreb City Institute of Health, Work and Social Care.
Ariana Vorko-Jović is Associated Professor, M.D. and a specialist in Epidemiology in the Medical School, University of Zagreb. Her doctoral thesis was The Elderly in road traffic and her main field of interest is accident prevention – Safe Communities; she was the head of two projects in Koprivnica county, Croatia. She also conducted a project about the road traffic injury registration in the city of Zagreb.
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Ariana Vorko-Jović is Associated Professor, M.D. and a specialist in Epidemiology in the Medical School, University of Zagreb. Her doctoral thesis was The Elderly in road traffic and her main field of interest is accident prevention – Safe Communities; she was the head of two projects in Koprivnica county, Croatia. She also conducted a project about the road traffic injury registration in the city of Zagreb.
Josipa Kern is Professor at the Zagreb University Medical School; she holds a Ph.D. from Faculty of Science, Zagreb University. She published more than 100 scientific papers dealing with methodology for data analysis in a wide variety of research areas.
Zrinka Biloglav M.D. is a research fellow at the Department of Medical Statistics, Epidemiology and Medical Informatics on the «A.Štampar» School of Public Health, Medical School, University of Zagreb. She participated in collection and analysis of the data on road traffic accident in the city of Zagreb, as well as in the scientific project of Safe Community in Koprivnica county.