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Istituto Superiore di Sanità
EpiCentro - L'epidemiologia per la sanità pubblica
Istituto Superiore di Sanità - EpiCentro


Traffic fatalities in Italy, 1969-1998

Marco Giustini Laboratory of Epidemiology and Biostatistics Istituto Superiore di Sanità, Rome

 

The social and health consequences of traffic accidents represent one of the major public health problems of Italy. Over the past 30 years, more than 300,000 traffic-related fatalities have occurred, including 7732 in 1998, the most recent year for which data are available. Half of these deaths occurred among persons under the age of 40 years, and traffic-related fatalities represent the main cause of death in the 15-44 year age group.

 

Many of these deaths could have been prevented through a series of interventions of various types, including those designed to avoid the occurrence of accidents (e.g., driver education), those which reduce the possibility of injury at the time of an accident (e.g., use of seat belts), those which reduce the risk of death after the accident (e.g., emergency services and rehabilitative care).

 

To analyse trends in mortality and to identify the groups most at risk for traffic accident deaths, mortality data from the Italian Statistics Institute (ISTAT) for 1969 to 1998 were examined. The analysis was performed using the AMIS module of an analytic program for accidental and violent deaths developed as part of the DATIS project, a collaboration between the ISS and the Inspectorate General for Traffic and Road Safety.

 

Deaths from traffic accidents are identifiable through the use of International Classification of Disease, 9th revision (ICD-9) codes. In addition to the actual cause of death (N cause), a second code is also assigned when a traumatic event is involved that identifies the type of event that caused the injury (E cause), e.g., traffic accident, fall, drowning, etc.  By cross-referencing these codes, it is possible to reconstruct, given the limitations of the coding system, the cause and consequences of an accidental event. In this study, traffic-related fatalities were identified as those with E codes between 8100 and 8299, while for the cause of death, three categories were considered:  head trauma (cause N 8000-8049 if cranial fracture occurred and 8500-8549 for intracranial trauma without skull fracture); trauma to the thorax, abdomen, and pelvis (TAP), identified through a large number of codes, but primarily those between 8050 and 8099 and 8600 and 8699, and other (all remaining N causes of death).

 

During the last 30 years, the death rate from traffic accidents has fallen by 48% overall, from 24.5 to 12.6 deaths /100,000 residents/year. This decline, however, has not been uniform across age groups. Indeed the trend in mortality rates for those ages 15-29 years has not changed substantially over time. If current trends continue, the mortality rate in this age group will soon exceed that of all other groups (Figure).

The relative stability in rates in those 15-29 years suggests that the many interventions directed toward this group are ineffective and that risk factors associated with accidents in this age group may actually be increasing.  Indeed, many of the interventions that have occurred in the past 30 years to lower the overall mortality (improvements in medical diagnosis and care, the introduction of seat belts, and targeted driver education programs) are potentially most effective in younger persons. The lack of decline instead suggests that either the risk or exposure of young persons has changed, perhaps because of more aggressive or careless driving or because of greater use of cars, motorcycles and motor scooters than in the past.

 

The main characteristics of those who died as a result of traffic-related injuries in 1970, 1980, 1990, and 1998 are shown in the Table. The analysis shows  that, in addition to the differing trends by age already illustrated, that:

- Males are four times more likely to die of traffic-related injuries than are females

- Rates are highest in the north and lowest in the south, although the differences are diminishing over time

- Head trauma deaths have decreased by more than half, while TAP mortality has increased as both a percentage of total deaths and absolute rates compared with 1970 (although recently it too has decreased).

 

With respect to the type of injury, the reduction in death resulting from head trauma is most likely the result of a variety of complex factors including those designed to reduce the risk of traffic accidents (education, information, and seat belt use) but perhaps more to medical advances, especially the introduction of CAT scans for diagnosis that have permitted prompt intervention in these situations. By contrast, the increase in TAP injuries may be related to increased speeds at which accidents currently tend to occur.

 

Despite the consistent declines in mortality from traffic accidents, there is nonetheless further room for improvement, especially in the younger age groups. The relative increase in deaths in the younger population requires the development of interventions require a multidisciplinary approach involving the health sector, those involved in the road infrastructure, and the educational sector. In addition to general measures, the single most effective and least costly method that would likely result in decreased mortality would be to increase the use of seat belts. Current use is estimated at only 30% as measured by the national surveillance system on seat belt use (ULISSE).

Given that 60-65% of all traffic-related deaths involve cars, mathematic models demonstrate that increasing the use of seatbelts to 75% could reduce the number of annual deaths in Italy by 1352 , the number of permanently disabled by 2704, and the number of hospitalisations by 27,040.

 

References

Taggi F. Mobilità e sicurezza.  Insieme verso il 2000.  Aspetti sanitari della sicurezza stradale- schede riassuntive. Ministero delle Infrastrutture e dei Trasporti.  Ispettorato generale per la circolazione e la sicurezza stradale.  2001.