Road Traffic Accidents - Epidemiology



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Road traffic accidents (RTAs) are a major public health concern causing thousands of injuries and premature deaths each year. Globally, RTAs result in an estimated 1.2 million deaths and a further 50 million injuries per year (World Health Organization, 2004). In 1990, RTAs were the ninth leading cause of the global burden of disease1 and they are predicted to rise to the third leading cause by 2020 (World Health Organization, 2004). In the United Kingdom (UK), police recorded 280,840 casualties due to RTAs in 2004 of which 3,221 were fatal; equivalent to nine deaths every day (Department of Transport, 2005a). Children and older adults are particularly vulnerable to injury through RTAs with data illustrating higher rates in the 0 to 19 and 60 plus age groups (Department of Transport, 2005a; Department of Transport, 2004). The government in its aim to reduce RTAs by 2010 has set the following targets: • Reduce the number of people killed or seriously injured in Great Britain in road traffic accidents by 40% compared with the average for 1994-98. • Reduce the number of children killed or seriously injured by 50% compared with the average for 1994-98. • Reduce the slight casualty rate, expressed as the number of people slightly injured per 100 million vehicle kilometres by 10% compared with the average for 1994-98. Nationally, fatalities and injuries due to RTAs are decreasing and these targets appear achievable. In 2004 the overall number of people killed or seriously injured due to RTAs was 28% below the 1994-98 average. The number of children killed or seriously injured and the slight casualty rate were 43% and 20% below the 1994-98 average respectively. 1.1 Data sources Currently six Accident and Emergency (A&E) departments provide data to the TIIG Injury Surveillance System. A&E data sources used for this report are: • Aintree A&E department. • Alder Hey A&E department. • Arrowe Park A&E department. • Royal Liverpool A&E department. • Southport and Ormskirk A&E department. • Whiston A&E department. A&E data covers the period from April 2004 to March 2005. 2.1.1 Demographics of RTA attendances at Accident and Emergency Across the six participating A&E departments there were 18,184 attendances classed as RTAs between April 2004 and March 2005 (Table 1). RTA attendances were slightly more likely to be male2 (55%) and aged between 15 to 59 years old (77%) (Figure 1). 2.1.2 Time and date of RTA attendances to Accident and Emergency Between April 2004 and March 2005, at all A&E departments combined, there was significant variation in the number of RTA attendances per month (p<0.05). January had the lowest number of RTA attendances with an average of 42 per day, whilst November had the highest number, with an average of 54 per day. Peak days for RTA attendance at the six A&E departments combined were Thursday and Monday, with both days accounting for 16% of RTA attendances. Saturday and Sunday had the least number of RTA attendances at A&E (13% each). Two thirds (67%) of all RTA attendances to the six A&E departments occurred between 10am and 7.59pm; peak hours were 4pm to 7.59pm, coinciding with the afternoon rush hour (people coming home from school and work) (Figure 2). 2.1.3 Alcohol – related RTA attendances Arrowe Park A&E department collects information on whether RTA attendances had been drinking prior to their accident. Analysis shows that between April 2004 to March 2005, 2% (N=88) of RTA attendances had been drinking prior to their accident. Just under two thirds (63%) of RTA attendances who had consumed alcohol were aged 15 to 29 years and almost eight in ten (78%) were male. Ambulance call outs Just under two-thirds (63%) of ambulance call outs for traffic accidents occurred between 10am and 7.59pm, with peak hours between 2pm and 7.59pm. Ambulance call outs for traffic accidents peaked on Saturdays (16%) and Thursdays (15%). On Thursdays, the peak times for ambulance call outs for a traffic accident were between 8am and 9.59am, 4pm and 5.59pm, and 8pm and 9.59pm. This was different to Saturdays, when peak hours were between 12pm and 5.59pm 3. Summary Road traffic accidents (RTA) are a major public health concern. During 2004 there were an average of 9 deaths per day in the UK due to a RTA (Department of Transport, 2005a), with many more people injured. RTAs affect injured persons, families, communities, and have implications for the workload of local health and police services. The government has set a number of targets to reduce RTAs by 2010. Injury prevention activity is required to continue and improve progress against these targets. This report provides an overview of the burden of RTAs across Cheshire and Merseyside. The information provided in this report can be used to target interventions aimed at reducing RTAs and meeting the national RTA targets. During 2004/2005 there were 18,184 RTA attendances to A&E departments across the Merseyside area. During the same period Merseyside Police recorded 4,980 RTAs where an injury was caused, causing injuries to 7,318 people. There is a large difference in the number of people injured in an RTA recorded by the police and the number of RTA A&E attendances across Merseyside. Although RTA attendances to A&E may include repeat attendances, this is unlikely to account for such a difference. What this highlights is the importance of using health data along with police data to gain a more accurate picture of the level of RTAs occurring across an area and the effectiveness of interventions. Nationally, RTA targets are based on STATS 19 returns (police data). Local health data show the same key groups as police data in which to target RTA prevention initiatives. A&E, ambulance and police databases illustrate that RTA victims across Cheshire and Merseyside are more likely to be male and aged 15 to 59 years. Area of residence of RTA attendances to A&E, location of ambulance call outs for traffic accidents and location of RTAs (where an injury was caused) recorded by the police can help identify target areas for prevention strategies. Combined analysis of RTA attendances to Aintree, Alder Hey, Arrowe Park, Southport and Ormskirk, and Whiston A&E departments found the wards of Tower Hill (Kirkby), Tranmere (Wirral), Whiston South (Whiston), Longview (Huyton), Birkenhead (Wirral), Claughton (Wirral), St Gabriels (Huyton), St Michaels (Huyton), Bidston (Wirral) and Knowsley Park (Knowsley) had the highest rates of RTA attendances to these five A&E departments. When looking at individual A&E departments, the wards of Tower Hill, Pirrie, Whitefield, Whiston South, St Gabriels, Tranmere, Birkenhead, Claughton, Norwood, Kew, Meols and the postcode area of L8 had the highest rates/number of residences attending their local A&E department as a result of a RTA. Using People and Places locality classifications (See appendix 1), areas classed as Qualified Metropolitans and New Starters had the highest rate of RTAs recorded by Merseyside Police where an injury was caused. People living in these areas are typically highly qualified professionals or students, living in small accommodation, with no car. One in fifty RTA attendances to one A&E department indicated that they had been drinking prior to their accident. Police data across Cheshire and Merseyside show that in 4% of RTAs where an injury was caused, the breath test proved positive, indicating that the driver was over the legal blood alcohol limit for driving. Over two thirds of RTA victims where alcohol was indicated either at A&E or via a breath test conducted by the police were male and over half were aged 15 to 29 years. When looking at the 15 to 29 year age group only, alcohol use increased in both the police dataset and A&E dataset. Interventions aimed at reducing drink driving were highlighted as important in reducing the number of RTAs in the Road Safety Bill published in 2005. Both enforcement and concentrated publicity have played a big part in reducing drink driving in the past by influencing public perception. However, drink driving is still particularly evident in younger age groups (Department for Transport, 2004), as such both enforcement and publicity campaigns need to be continued if drink-driving attitudes are to be changed in this age group. National data highlight children experienced higher rates of RTAs in 2004 (Department of Health, 2005a). Evidence also highlights that of the different types of road user, pedestrians are one of the groups that suffer the most severe injuries (Mayou and Bryant, 2002). Data presented here shows that between April 2004 and March 2005 across Merseyside there were 934 children aged 0 to 14 years injured in an RTA recorded by police, whilst 1,990 12 children attended a Merseyside A&E department as a result of a RTA. In particular, four in ten children injured in an RTA recorded by Merseyside police were pedestrians. Across Cheshire and Merseyside, Liverpool local authority area had the highest average rate of pedestrian accidents requiring hospital admission between April 1998 and March 2003. A number of characteristics have been identified as having an impact on reducing RTArelated injuries in children who are pedestrians. Included in these characteristics are: • Having speed reduction measures around schools and other areas with high child population densities, • Having play areas (e.g. parks) in residential areas, • Having publicity campaigns aimed at child pedestrian safety. (Christie et al, 2004). Other initiatives have also shown that practical roadside road safety training is an effective way to educate children in road safety, for example Kerbcraft (Department for Transport, 2002). ‘Walking Bus’ schemes provide an opportune environment where adults can educate children about road safety, as well as provide them with essential exercise, and an opportunity to socialise and reducing the number of cars on the road (Walking Bus, 2005).