Road traffic injury mortality and its mechanisms in India: nationally representative mortality survey of 1.1 million homes

Abstract

Objectives: To quantify and describe the mechanism of road traffic injury (RTI) deaths in India.

Design: We conducted a nationally representative mortality survey where at least two physicians coded each non-medical field staff's verbal autopsy reports. RTI mechanism data were extracted from the narrative section of these reports.

Setting: 1.1 million homes in India.

Participants: Over 122 000 deaths at all ages from 2001 to 2003.

Primary and secondary outcome measures: Age-specific and sex-specific mortality rates, place and timing of death, modes of transportation and injuries sustained.

Results: The 2299 RTI deaths in the survey correspond to an estimated 183 600 RTI deaths or about 2% of all deaths in 2005 nationally, of which 65% occurred in men between the ages 15 and 59 years. The age-adjusted mortality rate was greater in men than in women, in urban than in rural areas, and was notably higher than that estimated from the national police records. Pedestrians (68 000), motorcyclists (36 000) and other vulnerable road users (20 000) constituted 68% of RTI deaths (124 000) nationally. Among the study sample, the majority of all RTI deaths occurred at the scene of collision (1005/1733, 58%), within minutes of collision (883/1596, 55%), and/or involved a head injury (691/1124, 62%). Compared to non-pedestrian RTI deaths, about 55 000 (81%) of pedestrian deaths were associated with less education and living in poorer neighbourhoods.

Conclusions: In India, RTIs cause a substantial number of deaths, particularly among pedestrians and other vulnerable road users. Interventions to prevent collisions and reduce injuries might address over half of the RTI deaths. Improved prehospital transport and hospital trauma care might address just over a third of the RTI deaths.

Keywords: India; low- and middle-income countries; road traffic injury; verbal autopsy.

Figure 1

Road traffic injury deaths, age-standardised death rate and cumulative risk (age 0–69 years) across states and regions of India, by gender. Death rates are standardised to the 2005 United Nations estimated Indian population. Symbol size is proportional to sample size. Northeast states include Sikkim, Arunachal Pradesh, Nagaland, Manipur, Mizoram, Tripura and Meghalaya. Total estimates include the 80 male and 19 female deaths from Pondicherry, Chandigarh, Uttarakhand, Dadra & Nagar Haveli, A&N Islands, Daman & Diu, Lakshadweep and Goa. CHT=Chhatisgarh.

Figure 2

Deceased mode of transportation, place of death and timing of death. (A) Deceased mode of transportation in the present study compared to the National Crime Records Bureau 2005 Report. Shaded line represents vulnerable road users (defined as road users without a rigid barrier protecting against traumatic forces, that is, pedestrians, bicyclists, motorcyclists and three-wheeler riders). Percentages from the present study are weighted by state and rural/urban residence. The estimated/reported number of deaths in 2005 (in thousands). (B) Place of death and (C) timing of death based on verbal autopsy narratives. Shaded lines represent deaths that are reported as occurring at the scene of collision or occurring instantly (defined as within 5 min).

Figure 3

Reported injuries from 1124 verbal autopsy narratives (49% of all 2299 road traffic injury deaths). Percentages refer to those in each row with given injury (columns). *Values in bold denote two by two χ² tests with p<0.05 (excluding unknowns). Abdominal and spinal injuries were also reported but not shown due to small numbers (61 and 25 cases, respectively).