To evaluate preventive achievements and identify emerging trends and challenges regarding road traffic injuries (RTIs) in China from 1997 to 2023. Ecological trend study. Data on road traffic crashes, injuries, and deaths were extracted from China's National Bureau of Statistics. Joinpoint regression analysis was employed to identify significant temporal trends and compute the annual percentage change (APC) and average annual percentage change (AAPC). All outcome variables were log-transformed prior to analysis due to skewed distributions, as determined by normality assessment. Over the 27-year period, the number of road traffic crashes and associated casualties showed three distinct phases: a rapid increase until 2001, a significant decline until around 2011, and a subsequent stabilization or slight rebound. While motor vehicle-related incidents initially drove these trends, injuries (APC 2010-2023 = 12.88, P < 0.01; AAPC = 6.54, P < 0.01) and deaths (APC 2011-2019 = 13.57, P < 0.01; APC 2019-2023 = 5.06, P < 0.01) involving non-motor vehicles have risen sharply since around 2010. This surge has partially offset earlier gains in overall RTI prevention and now poses a substantial threat to national road safety. Notably, deaths exhibited a strong resurgence post-2011, exceeding 5000 in 2023. Despite commendable gains in reducing motor vehicle-related RTIs, China now faces the acute challenge of a rising injury burden involving non-motor vehicles. Consequently, future road safety initiatives must be formulated on a holistic approach that integrates enhanced vehicle safety, road infrastructure optimized for vulnerable users, and precise behavioral interventions targeting high-risk populations. The findings provide an evidence base for prioritizing non-motor vehicle safety in China's next phase of road safety strategy and offer methodological insights for similar trend analyses in other low- and middle-income countries experiencing rapid e-bike adoption.
This study examines the progress and current status of the "First National Injury Prevention and Control Plan (2026-2030)" and the annual Injury Implementation Plan established following the implementation of the Act on Injury Prevention and Control. It also highlights the importance and policy implications of this national plan within an evolving policy environment, addressing national injury-related issues such as traffic accidents, falls, and suicide. In the initial stages of plan development, the Korea Disease Control and Prevention Agency distributed guidelines and standardized forms to local governments and conducted written and oral consultations. In addition, it systematized existing injury prevention projects and analyzed regional injury incidence status and key response mechanisms, which were subsequently shared with stakeholders. The policy implementation process was reviewed using the Consolidated Framework for Implementation Research, a representative framework in action science. Relevant ministries and local governments established implementation plans under the Act on Injury Prevention and Control, reflecting their major programs and regional characteristics. At the central level, 44 detailed tasks were identified across 14 ministries. At the city/province level, implementation plans were established for all 17 local governments. Nationwide, the leading causes of injury-related deaths were self-harm/suicide, traffic accidents, and falls/slips. However, their distribution varied across regions. Accordingly, effective plans were formulated through consultations to ensure that the injury status of each local government was reflected in the implementation plans. These implementation plans play a critical role in translating the comprehensive strategy into practice and strengthening central-local cooperation. Continuous improvement and a self-monitoring framework are essential for the system's success.
Road traffic crashes are a major cause of traumatic brain injury (TBI), particularly among vulnerable road users (VRUs). However, current injury prevention strategies often overlook the heterogeneity of TBI-which include various injury types and severities-leading to an oversimplified approach to evaluating helmets and safety systems in regulations and ratings. To identify priority TBI types and severities in VRUs and to inform targeted prevention strategies, the German In-Depth Accident Study database was analyzed and a pathoanatomic classification system, i.e., Abbreviated Injury Scale, was employed. AIS 2 (moderate) TBIs account for 70-80% of all brain injuries across VRU groups, nearly half of which are concussions. For helmeted cyclists, milder TBIs are at a greater percentage than for unhelmeted cyclists. These findings highlight the need for expanding prevention efforts to include AIS 2+ injuries. Key injury types observed include concussion (with and without loss of consciousness), skull base fracture, subdural hemorrhage, contusion and laceration. New mechanism-specific injury criteria may be needed to address these injuries. The strong similarity in injury type ranking among different road users (the Kendall's tau values ranged from 0.90 to 0.93) suggests similar needs for injury prevention. A new brain injury assessment criterion may serve all road user types.
Road traffic injuries are a global public-health challenge, causing substantial morbidity and mortality, especially among children in low- and middle-income countries such as Ethiopia. Despite this impact, research on child road traffic injuries is often under-represented and often masked within the general population. Effective injury prevention requires context-specific evidence to support implementation and scale-up interventions. This study aimed to address these gaps by investigating epidemiological evidence and injury patterns among paediatric populations. A systematic literature search was conducted across major databases, including Medline, Embase, Scopus, PubMed, CINAHL Complete, and Ovid Transport to identify published studies reporting on child traffic injuries. Data were extracted using a standard Microsoft Excel format, and the quality of the included studies was assessed using the JBI checklists. Statistical analysis was conducted using Stata version 18. Random-effects models were used to estimate the pooled prevalence of child traffic injuries and fatalities. A total of 36 articles were included in this review. The random-effects models indicated that the pooled prevalence of child traffic injuries and fatalities was estimated at 23% (95% CI: 21%-25%) and 17% (95% CI: 11%-24%), respectively. Regarding the pattern of injuries, 81.5% of all reported injuries involved pedestrians; 40.6% of injury cases involved individuals aged between 13 and 18 years; 37% of injuries were classified as serious; nearly 50% of incidents occurred on streets or highways; and 34.1% of incidents occurred in school-zone areas. Head trauma was the most frequently injured region and a leading contributor to death. The key causes of incidents were failure to prioritise pedestrians, speeding, incorrect lane use, alcohol impairment, and unsafe following distances. This study highlights child road traffic injury as a substantial public health burden in Ethiopia, with disproportionate impacts on school-aged children, males, adolescents, and those living in urban areas. These findings underscore the need for targeted public health strategies for child injury prevention. Enhancing community-level road safety education, strengthening enforcement of traffic laws, and promoting effective child supervision are essential for evidence-informed policy interventions. Implementation of these measures could meaningfully reduce child injuries and fatalities.
This study aimed to examine the independent and combined impacts of diabetes mellitus (DM), and substance use on the risk of accidental injuries in a nationwide population-based cohort in Taiwan. Using Taiwan's National Health Insurance Research Database (NHIRD), two retrospective cohorts were analyzed. The DM cohort (2000-2013) included 31,424 patients with DM and 94,272 age-, sex-, and index-year-matched controls. The substance uses cohort (2013-2022) included 324,648 substance users and an equal number of matched controls. Injury outcomes were classified as traffic accidents, falls, burns and fires, brain injuries, suicide, and drowning. Cox proportional hazards models were applied to estimate adjusted hazard ratios (aHRs) with 95% confidence intervals (CIs), and Kaplan-Meier analyses were used for descriptive visualization of cumulative injury risk, and interaction was formally assessed using Cox regression models. Patients with DM exhibited a 1.702-fold higher risk of injury compared to non-DM individuals, while substance users demonstrated a 1.444-fold higher risk compared to non-users. Among substance users, the highest risks were found for suicide (aHR = 10.287), intentional injury (aHR = 2.453), and falls (aHR = 1.742). Female sex, low income, major illness, and comorbidities (stroke, hypertension, hyperlipidemia) further amplified injury risk. Both DM and substance use were independently associated with increased injury risk. In joint-effects analyses, individuals with both DM and substance use had the highest injury risk among the four exposure groups (non-DM/non-user, DM only, substance use only, and DM + substance use). The multiplicative interaction between DM and substance use was statistically significant. Results were consistent in sensitivity analyses restricted to unintentional injuries. DM and substance use independently elevate the risk of accidental and intentional injuries; their coexistence is associated with the highest injury risk that markedly increases injury susceptibility. Integrating chronic disease management with substance use prevention and behavioral interventions may reduce injury-related morbidity and mortality in high-risk populations.
Trauma-related mortality exhibits a marked social gradient, driven by access barriers and health inequities worldwide. These barriers jeopardize progress toward Sustainable Development Goals 3 and 4. This study aimed to investigate the prehospital and in-hospital barriers to timely injury care as perceived by frontline trainee physicians and traffic law enforcement professionals during real-time treatment execution in Uganda. Additionally, we aimed to highlight the potential impact of these barriers on trauma outcomes. This study used a convergent mixed methods approach. Qualitative data were collected through structured interviews and face-to-face focus groups with diverse teams of 500 frontline trainee physicians, including surgical residents, interns, medical students, and traffic law enforcement professionals. Directed content analyses for structured interviews and focus groups were conducted in NVivo (version 14, release 2023; QSR International). Quantitative data were concurrently collected using a survey questionnaire from the Motorcycle Trauma Outcome Registry, which included 1003 patients with trauma. We categorized barriers as prehospital or in-hospital barriers and as trauma team-related, patient-related, or health system-related barriers. Multilevel restricted maximum likelihood logistic regression analyses of factors associated with barriers to injury care were analyzed using Stata (version 15.0; StataCorp LLC). Odds ratios (ORs) and 95% CIs were reported; statistical significance was defined as P<.05. Qualitative analyses identified key prehospital barriers, including delays in emergency medical services activation, ambulance arrival, and transportation. In-hospital barriers were primarily shortage of supplies, delays in identifying life-threatening injuries, and insufficient critical care services. Quantitatively, among the 1003 audited patients with trauma, 42% (416/1003) faced barriers during treatment. The most common obstacles were delays in treatment decisions (232/1003, 23%) and securing necessary supplies (180/1003, 18%). The presence of barriers was independently associated with a 3-fold increased likelihood of unfavorable Glasgow Outcome Scale scores (OR 3.15, 95% CI 2.23-4.66; P<.001) for neurological injuries and was linked to a 4-fold increase in odds of 90-day mortality (OR 4.20, 95% CI 2.25-6.94; P<.001). After adjusting for injury severity and clustering effects by hospital teams and resources, the presence of barriers was associated with arrival by public means (adjusted OR [aOR] 1.62, 95% CI 1.09-2.41; P=.02), increasing age (aOR 1.01, 95% CI 1.00-1.03; P=.01), sustaining 1 or more injuries requiring admission (aOR 1.92, 95% CI 1.18-3.14; P=.01 vs aOR 3.69, 95% CI 1.95-6.98; P<.001), and a severe Kampala Trauma Score of ≤6 (aOR 2.71, 95% CI 1.37-5.37; P=.004). Multiple barriers to trauma care are more frequent for severe injuries and are associated with poorer neurological outcomes and higher mortality. These findings indicate the need for targeted, multifaceted interventions that incorporate frontline health workers' perspectives to improve trauma care delivery in low-resource settings facing both prehospital and in-hospital barriers.
Fabry disease (FD) is a lysosomal storage disorder leading to α-galactosidase A deficiency and glycosphingolipid accumulation. Neurological manifestations of FD, such as central nervous system involvement, peripheral neuropathy, and vestibular dysfunction that results in postural and cognitive impairment, may predispose individuals to injuries. However, the associations between the risk of injury and FD remains underexplored. Using the Taiwanese National Health Insurance Research Database, we conducted a nationwide cohort study of adult FD patients (International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code 272.7)) who were diagnosed between 2001 and 2015. The comparison group was matched at a 1:4 ratio by age, sex, and index date. Injuries were identified via ICD-9-CM codes 800-999. Multivariate Cox proportional hazards models were applied to study the risk of injury, adjusting for sociodemographic factors and comorbidities. The injury incidence rate was higher in the FD cohort (32.97/1,000 person-years) than in the control cohort (22.52/1,000 person-years). FD was significantly related to an increased risk of injury (adjusted hazard ratio: 1.642; 95% CI: 1.375-1.980; p < 0.001). FD patients had an 86% greater risk of motor vehicle traffic accidents and a 56% greater risk of falls than the control group. Higher risks of injury were also associated with the winter season, more complicated comorbidities, greater urbanization, and treatment at higher-level hospitals. This is the first large-scale study to demonstrate a significantly increased risk of injury among FD patients. These findings highlight the need for proactive injury risk assessments and tailored prevention strategies for this population. Future research should investigate the role of FD-related clinical phenotypes in injury susceptibility to enhance personalized care and improve outcomes.
Traumatic spinal cord injury (TSCI) imposes a substantial clinical and public health burden, yet contemporary epidemiological data from northern China are limited. This study aimed to describe the epidemiological characteristics of TSCI in Jinan, an urban-rural integrated city in northern China. We conducted a hospital-based retrospective observational study of patients with TSCI admitted to the 960th Hospital of the PLA and Qilu Hospital of Shandong University between 2015 and 2024. Medical records of 1134 patients were reviewed. Collected variables included sex, age, marital status, occupation, time of injury, etiology, neurological level of injury, American Spinal Injury Association grade, complications, concomitant injuries, treatments received, and length of hospital stay. Descriptive statistics were used to summarize the data. The mean (standard deviation) age was 62.0 (18.6) years (95% confidence interval, 60.9-63.1), and the male-to-female ratio was 3.69:1. Falls were the leading cause of injury (46.0%), including low-level falls (25.8%) and high-level falls (20.2%), followed by traffic accidents (40.7%). The cervical spine was the most frequently injured region. During hospitalization, 500 of 1134 patients (44.1%) developed complications, most commonly pulmonary infections (16.5%) and urinary tract infections (13.6%). Surgical intervention was performed in 88.9% (1009/1134) of patients. In this 10-year hospital-based series from Jinan, most patients with TSCI were older men, with 61 to 75 years being the most common age group. Falls and traffic accidents were the predominant etiologies. Farmers represented the highest-risk occupational group. Prevention strategies should particularly target fall risk among older adults and electric bicycle-related injuries among young men. These findings highlight the need for tailored injury-prevention measures and underscore the crucial role of rehabilitation in the long-term management of TSCI.
As the number of geriatric populations increases in the aging era, the injury of the older adults is also increasing. This study aimed to investigate the epidemiologic trends and injury characteristics of geriatric patients with severe injuries by age groups and mechanism, using a nationwide database in Korea. A cross-sectional observational study was conducted for all emergency medical service (EMS) treated geriatric (≥65 years) patients with severe injuries in Korea between 2016 and 2023. Patients who met the criteria for a field-based injury triage scheme or had a prehospital physiologic abnormality were defined as severe injury. Exposure was age group: young old (65-74), middle old (75-84), and oldest old (≥85 years) groups. The distribution of age groups was investigated by year. Injury characteristics and outcomes were compared by age group and mechanism. A Multivariable logistic regression analysis was used to investigate the predictors of mortality of geriatric patients with severe injuries. Among 319,567 patients with severe injuries transferred by EMS over 8 years, 92,085 (28.8%) were over 65 years of age. The proportion of older adults increased from 25.7% in 2016 to 32.0% in 2023. Among older adults, young old was 46.4% (42,742), middle old was 39.3% (36,182), and oldest old was 14.3% (13,161). The proportion of oldest old increased from 11.8% in 2016 to 16.6% in 2023. Most common mechanisms were slip/fall (35.9%), traffic accident (TA) (30.1%), and poisoning (17.4%) and 17.0% were suicidal attempts. Overall hospital mortality was 27.9% and the older the age, the higher mortality (young 25.2%, middle 30.0%, and oldest 31.0%). As age group increased, slip/fall increased (33.2% to 46.4%) and TA decreased (34.3% to 15.3%). Older age groups, male, suicidal attempts, and TA and asphyxia (compared with slip/fall) were associated with higher risk of hospital mortality. The geriatric patients, especially the oldest old with high mortality are increasing among patients with severe injuries. It is necessary to plan target-specific geriatric injury prevention program based on age distribution and common injury mechanism.
Commercial motorcycle riders are among the most vulnerable road users in low- and middle-income countries, with poor visibility contributing significantly to road traffic injuries, particularly under low-light conditions. While visibility materials such as reflective jackets and functional lighting systems are effective, low-cost safety measures, their use remains inconsistent in many settings. In addition to individual behaviors, structural factors such as enforcement, access to safety equipment, and road conditions may influence their uptake. This study assessed the use of visibility materials and factors associated with their uptake among commercial motorcycle riders in the Limbe and Tiko Health Districts of Cameroon. A community-based cross-sectional study was conducted among 499 commercial motorcycle riders aged 18 years and above in the Limbe and Tiko Health Districts. Riders were recruited at selected motorcycle pick-up points using a multistage sampling approach. Data were collected using structured interviewer-administered questionnaires and an observational checklist. Descriptive statistics were used to summarize the uptake of visibility materials. Multivariable logistic regression analysis was performed to identify factors independently associated with reflective jacket use, guided by theoretical and contextual relevance. Adjusted odds ratios (AORs) with 95% confidence intervals (CIs) were reported. The mean age of riders was 32.2 ± 7.6 years, and all participants were male. The most commonly observed visibility feature was a functional headlamp (85.8%), followed by backlights (57.3%) and brake lights (57.3%). Approximately half of the riders were observed wearing reflective jackets (50.9%), while reflective strips were present on only 19.0% of motorcycles. In adjusted analysis, riders who reported obeying traffic regulations were more likely to wear reflective jackets (AOR = 1.52; 95% CI: 1.10-2.30), as were those willing to allocate a budget for visibility materials (AOR = 2.20; 95% CI: 1.30-3.60). Knowledge and attitudes toward visibility materials were also positively associated with reflective jacket use. Each one-point increase in knowledge score was associated with an 18% increase in the odds of reflective jacket use (AOR = 1.18; 95% CI: 1.10-1.26), while each one-point increase in attitude score increased the odds by 14% (AOR = 1.14; 95% CI: 1.07-1.21). Riders reporting safer visibility-related practices were also more likely to wear reflective jackets (AOR = 2.16; 95% CI: 1.36-3.44). The uptake of visibility materials, particularly reflective jackets and reflective strips, remains suboptimal among commercial motorcycle riders despite widespread availability of basic lighting systems. Both behavioral and contextual factors appear to influence their use. Interventions that combine improved awareness with strategies addressing structural barriers-such as affordability, accessibility, and enforcement-may enhance rider visibility and contribute to reducing road traffic injuries in this population.
Road traffic injuries (RTIs) remain a major global public health burden and a leading cause of mortality, particularly among individuals aged 5-29 years. While environmental and infrastructural determinants have been widely studied, the role of individual behavioral predispositions, including personality traits, remains underexplored. This study examines the association between the Big Five personality traits and RTI risk within a behavioral and injury prevention framework. A hospital-based cross-sectional study with a case-control analytical framework was conducted in two tertiary centers in Kelantan, Malaysia. Adults aged 18-60 years with RTIs were recruited from emergency departments, while controls were randomly selected from outpatient populations. Personality traits were assessed using the validated Bahasa Malaysia version of the Revised NEO Personality Inventory. A multivariable logistic regression analysis was performed to evaluate the associations between personality traits and RTI risk, adjusting for relevant confounders. A total of 425 participants were included (229 RTI cases and 196 controls) in the study. The RTI group demonstrated marked male predominance. The distribution of personality traits was comparable between the groups. In adjusted analyses, agreeableness and neuroticism were significantly associated with an increased risk of RTIs [OR 1.12, 95% CI (1.03-1.21); OR 1.10, 95% CI (1.03-1.18), respectively]. Personality traits may contribute to RTI risk through behavioral mechanisms involving emotional regulation, attention control, and decision-making. These findings support an integrated model of RTI risk incorporating both behavioral and environmental factors, with implications for targeted road safety and public health interventions.
Urban road traffic exhibits complex and highly dynamic flow patterns, making real-time risk probability assessment challenging. Existing measures such as Time to Collision (TTC) rely on full sample vehicle trajectory data, which are difficult to obtain at large urban scales. To address this limitation, this study adopts a spatiotemporal grid representation and utilizes floating vehicle trajectory data to characterize traffic operational states and develop a real-time urban traffic risk probability assessment framework. This study proposes an integrated spatiotemporal framework for urban traffic risk probability estimation. A Graph Attention Network Long Short Term Memory (GAT-LSTM)-based Spatiotemporal Autoencoder Neural Network (GL-SANN) is developed to extract latent risk features from vehicle operational parameters. These features are further incorporated into a Deep Clustering Spatiotemporal Network (DCSN) with K-means clustering to assess traffic risk levels. A LightGBM model is then constructed for real-time risk identification. Finally, a Spatiotemporal Graph Convolutional Risk Prediction (SGCRP) model is designed to predict future vehicle operational parameters and infer short-term risk states. Experiments using ride-hailing vehicle trajectory data from Xi'an demonstrate that traffic risk probability patterns can be classified into five levels, with risk probability levels increasing significantly during peak periods and decreasing during off-peak periods. Specifically, the proportion of high-risk grids reaches approximately 50%-60% during peak periods, while during off-peak periods, this proportion decreases to about 37%. Intersections and traffic-intensive grids consistently exhibit higher risk probability levels than ordinary grids. The DCSN model consistently outperforms benchmark methods. The LightGBM-based risk identification model achieves a precision of 0.984. The proposed risk prediction model improves training speed by 33.1% over the Transformer model and yields a prediction precision of 0.974. These findings provide a method for proactive urban traffic risk prevention and contribute to the development of intelligent transportation systems.
While previous research suggests that e-scooter riders and pedestrians may exhibit similar injury patterns due to a shared standing posture, direct comparisons using unified datasets are lacking. This study aims to identify the distinctive injury characteristics of e-scooter riders by comparing them directly with pedestrians in motor vehicle collisions, with a particular focus on head-related injury risk. Using traffic accident statistics from the National Police Agency of Japan (January 2024-June 2025), I analyzed 165 injured e-scooter riders and 23,599 injured pedestrians ranging in age from 18 to 59 years. I statistically compared demographic, accident and injury characteristics (e.g., sex, injury source, primary injury region). To ensure a focused analysis, the primary injury region was collapsed into a binary outcome (Head/Face/Neck vs. Other). A logistic regression model was performed to estimate the adjusted odds ratio for head-related (Head/Face/Neck) injuries, adjusting for demographics and accident characteristics. E-scooter riders were significantly younger than pedestrians (p < 0.001). Although no significant difference was observed in injury severity, e-scooter riders had a significantly higher proportion of head-related (Head/Face/Neck) injuries (41.8% vs. 23.1%; p < 0.001). Multivariable analysis revealed that unhelmeted e-scooter riders exhibited a significantly higher risk of head-related injuries compared with pedestrians (adjusted odds ratio 2.15, 95% confidence interval 1.53-3.00). This study suggests that a shared standing posture does not necessarily result in similar injury outcomes. The results indicate that e-scooter injury profiles, particularly for head-related injuries, differ from those of pedestrians. These findings suggest that it may be appropriate for traffic safety policies to consider e-scooter riders as a distinct category and prioritize the promotion of helmet use to mitigate head-related injury risks.
Road traffic injuries remain a leading cause of death and serious harm among children, and a substantial proportion of this burden occurs among child passengers. Despite clear safety recommendations, incorrect installation and suboptimal child restraint system (CRS) selection remain widespread, representing a persistent public health implementation gap. Against this backdrop, the present study examined determinants of CRS selection decisions and self-reported installation and use practices, with a particular focus on how selection and retail-support experiences relate to intention to choose the same CRS again. A cross-sectional online survey (Google Forms) was conducted from February to December 2024, yielding 3,750 questionnaires, of which 1,150 complete cases were included in analysis. Descriptive statistics were supplemented with chi-square tests (Cramér's V) and multivariable logistic regression (odds ratios, 95% CI) for top-box intention to choose the same CRS again ("yes/probably yes"). Price (58.1%), seat weight (48.2%), and installation method (46.1%) were the most frequently reported selection determinants, while safety tests (28.3%) and comfort (26.4%) were less commonly cited. ISOFIX solutions predominated (74.6%), with installation most often behind the driver (45.0%) and a notable share on the front seat (25.4%). Intention to choose the same CRS again was low (27.4% top-box; 62.3% negative). Seller installation demonstration was associated with intention to choose the same CRS again (χ2 = 22.82, p = 0.0036; V = 0.100), whereas reported child discomfort was not (p = 0.9378). In logistic regression, only age 26-35 years (vs. 18-25) predicted top-box intention to choose the same CRS again (OR = 1.42, 95% CI 1.05-1.91), with overall low explanatory power (McFadden pseudo-R2 = 0.0167). The findings suggest that economic and usability considerations outweigh explicitly stated safety criteria, and that closing the implementation gap requires stronger, scalable support for correct CRS selection and installation.
Driver distraction from smartphones is a growing but difficult-to-study contributor to traffic fatalities. We investigated whether major music album releases-events that trigger sharp surges in smartphone-based streaming-are associated with increases in traffic fatalities in Chile, and whether the increase is driven by driver inattention. We used 1,145,932 individual-level traffic accident records from Chile's Comisión Nacional de Seguridad de Tránsito (CONASET) for 2009-2023. We conducted a quasi-experimental event study around the release dates of 15 major music albums (2017-2023). We estimated the release-day effect on daily fatalities using OLS with album, day-of-week, and holiday fixed effects, with standard errors clustered at the album level. We exploited two unique features of the Chilean data-police-classified accident causes and detailed accident typologies-to test the distraction mechanism directly. On album release days, daily traffic fatalities increased by 1.80 (95% CI: 0.27-3.34; p = .022), a 40.3% increase. Fatalities in crashes officially classified as caused by driver inattention nearly doubled on release days (+90%; p = .017); vehicle-vehicle collision fatalities rose by 55% (p = .040), while rollover fatalities-a built-in negative control-showed no change (p = .896). The overall effect was concentrated in daytime, non-alcohol, urban crashes. A permutation-based placebo test (p = .007) and five alternative specifications confirmed robustness. Music album releases are associated with significant increases in traffic fatalities in Chile, with cause-specific and accident-type evidence directly implicating driver inattention as the mechanism. These findings contribute novel quasi-experimental evidence on smartphone-enabled distraction and road safety from a high-streaming Latin American setting.
Motor vehicle protective equipment, such as seatbelts and airbags, has improved occupant safety. However, while seatbelts reduce facial and abdominal injuries, they may not significantly prevent head, neck, or thoracic trauma. Limited data exist on blunt cardiac injury (BCI). This study evaluated patterns of BCI, associated thoracic injuries, and hospital outcomes in adult trauma patients following motor vehicle collisions (MVCs). We analyzed the 2023 American College of Surgeons Trauma Quality Improvement Program (ACS-TQIP) database for adult MVC occupants. Abbreviated Injury Scale codes 4208xx.x, 4404xx.x, 4410xx.x, 4412xx.x, 4413xx.x, and 4416xx.x identified patients with BCI. Those without BCI formed the reference cohort. A 1:1 propensity score match (PSM) on Injury Severity Score (ISS) was performed using RStudio to balance collision severity. In the overall cohort, the incidence of BCI was 1.2% (1,914/161,446). After PSM, 1,914 patients remained in each cohort with a mean ISS of 22.7. Both seatbelt plus airbag use and airbag use alone were independently associated with increased odds of BCI. BCI was strongly associated with thoracic injuries, including sternum fracture (odds ratio [OR] 3.492; 95% CI 2.95-4.14), hemothorax (OR 2.928; 95% CI 2.29-3.75), thoracic aortic injury (OR 1.773; 95% CI 1.29-2.44), and pulmonary contusion (OR 1.382; 95% CI 1.18-1.62). In multivariable analysis with BCI as the outcome, mortality (OR 2.325; 95% CI 1.93-2.79) and cardiac arrest (OR 1.827; 95% CI 1.29-2.59) were independently associated with BCI. Protective equipment use correlates with BCI and thoracic trauma. In MVC patients using seatbelts and airbags, concomitant chest injuries should heighten suspicion for BCI and prompt further evaluation.
Road traffic injuries (RTIs) represent a significant global public health issue, particularly in low- and middle-income countries like Brazil. Despite the high mortality rates and associated costs, there is limited comprehensive literature addressing long-term mortality resulting from RTIs. Most research tends to focus on rates and hospitalization figures while neglecting the connection between hospitalizations and causes of death, partly due to the challenges of follow-up studies. This study employed record-linkage methodology to create a database that includes both hospitalization and mortality records. The aim was to estimate all-cause and cause-specific relative risks (RR) of death among inpatients due to road traffic accidents, compared to those hospitalized for other reasons, over a time span of three months to ten years. A retrospective cohort study examined hospitalization data for RTIs and mortality from 2000 to 2015 using Brazil's Unified Health System (Sistema Único de Saúde - SUS in Portuguese), excluding any obstetrics-related admissions and deaths, and calculated RR stratified by sex and age over 15 years old. The findings indicated a significantly higher mortality risk of 3.23 (95% Uncertainty Interval: 3.08- 3.39) for individuals previously hospitalized for RTIs compared to others during follow-up. Males aged 15- 29 and 30- 59, especially those with motorcycle, vehicle, or pedestrian injuries, exhibited an elevated mortality risk compared to other inpatients. Furthermore, individuals with prior RTIs experienced increased mortality risks from substance use disorders, violence, and suicide. This research may enhance our understanding of the complex factors associated with road traffic injuries, underscoring the importance of recognizing how RTIs contribute to long-term mortality to inform better prevention strategies and policies.
Road Traffic Injuries are a major problem in Sub-Saharan Africa. Recidivism after road traffic infraction has not previously been studied in this setting. This study evaluated a novel elementary school based program to reduce repeat minor traffic offenses near schools by having children serve as "judges" to rhetorically interrogate offenders. Offenders were randomly allocated into standard penalties or participation in Kids' Court (412 total) and followed via quarterly interrogation of a traffic police database for 1 year. While the number of repeat offenders was similar in both groups (88 vs. 85, p = 0.84), the total number of offenses was improved in the Kids' Court group and approached significance but did not achieve it (344 vs. 404, p = 0.065). The average time to first repeat offense was significantly decreased in the Kids' Court group (127 vs. 154 days, p = 0.0019). This program reduces the number of repeat offenses and lengthens the time to repeat offense. It likely has a yet unquantifiable long-term effect on the children that participate as "judges" in the program.
Road crashes continue to be one of the leading causes of death and injury around the globe. Yet, despite decades of studying the problem, safety surveillance is still largely dependent on crash reports that are at best incomplete and at worst outdated, leaving daily risk in critical blind spots. This systematic review synthesizes 89 peer-reviewed studies published between 1995 and 2024. We grouped these studies into five categories: (a) crash databases, (b) automated imagery, (c) onboard and mobile sensors, (d) naturalistic and simulated studies, and (e) AI-augmented approaches. They measured each method on four major axes: monetary cost, scale-up cost, data granularity, and ethics. The findings show a clear space of trade-off between traditional databases, which are still relevant and used for long-term monitoring in the field, but lack detail on behavior, and sensors and AI-based approaches, which provide more detailed and real-time information on individual-level data but are plagued by cost, privacy, and accessibility issues. Some gaps remain, such as underreporting in police statistics, privacy concerns in naturalistic research, and technological inequalities in low- and middle-income countries. This review, therefore, brings together methodological considerations and outlines steps for identifying a contextualized approach. Together, these findings highlight the importance of creating scalable and ethical paradigms that shift traffic safety research from a response-based to a risk-based framework. To facilitate the systematic comparison of these various approaches, we compile evidence within a Strengths-Weaknesses-Opportunities-Threats (SWOT) based framework that highlights the trade-offs among methods. These review results are intended to inform future research and eventual outcomes related to road safety and reduced traffic crashes.
To characterize the prevalence and patterns of psychoactive substance use among fatal traffic crash victims across four Brazilian metropolitan areas and to identify the demographic and temporal factors independently associated with substance positivity. Cross-sectional study of 524 fatal traffic crash victims from Recife (n = 272), Curitiba (n = 96), Vitória (n = 93), and Belém (n = 63), March 2022-June 2024. Standardized blood toxicological screening for alcohol, cocaine (benzoylecgonine), benzodiazepines, amphetamines, and cannabis was performed at a single reference laboratory. Multivariable logistic regression identified independent predictors of alcohol and any substance positivity. Overall, 46.0% of victims tested positive for at least one substance. Alcohol was detected in 38.0%, with mean blood alcohol concentration (BAC) of 1.83 g/L (SD = 0.88); no significant difference across cities (p = 0.095). Cocaine or metabolites were detected in 9.9%, with uniform regional distribution (p = 0.392). Vitória showed markedly higher benzodiazepine positivity (9.7% vs. 1.0-4.4%; p = 0.019). Cannabis was not detected. Night time (OR = 2.45, 95%CI 1.63-3.67) and weekend crashes (OR = 2.05, 95%CI 1.38-3.04) were the strongest independent predictors of alcohol positivity. After adjustment, Vitória showed significantly higher odds of any substance positivity compared to Recife (OR = 1.73, 95%CI 1.01-2.98, p = 0.046). Psychoactive substances were involved in nearly half of fatal traffic crashes across four Brazilian cities. Temporal factors-night time and weekend crashes-were the primary independent predictors of substance involvement. Vitória's elevated benzodiazepine positivity persisted after adjustment, suggesting distinct regional prescribing patterns. These findings support temporally targeted enforcement strategies and region-specific pharmaceutical interventions.