Burden of road traffic injuries related to delays in implementing safety belt laws in low- and lower middle-income countries

Objective: Delayed implementation of effective road safety policies must be considered when quantifying the avoidable part of the fatal and non-fatal injuries burden. We sought to assess the avoidable part of Disability-Adjusted Life Years (DALYs) lost due to road-traffic injuries related to delays in implementing road safety laws in low- and lower middle-income countries. Methods: We chose one country for each of the regions of the World Health Organization (WHO) and World Bank (WB) country income levels. We used freely available data sets (WHO, International Traffic Safety Data and Analysis Group, the WB). Delays in implementation were calculated until 2013, from the year mandatory use of safety belts by motor vehicle front seat occupants had been first introduced worldwide. We used life expectancy tables and age groups as social values in the DALY calculation model. From the estimated total burden, avoidable DALYs were calculated using estimates of the effectiveness of seatbelt laws on fatal and non-fatal injuries combined, as extracted from published international reviews of evidence. Results: From the reference year 1972, implementation delays varied from 27 years (Uzbekistan) to 41 years in Bolivia (no seat belt law as of 2013). During delays, total absolute numbers of DALYs lost due to road-traffic injuries reached 8 462 099 in Nigeria, 7 203 570 in Morocco, 4 695 500 in Uzbekistan, 3 866 391 in Cambodia, 3 253 359 in Bolivia and 3 128 721 in Sri Lanka. Using effectiveness estimates ranging from 3 to 20% reduction, the avoidable burden of road-traffic injuries for car occupants were the highest in Uzbekistan (avoidable part from 1.2% to 10.4%) and in Morocco (avoidable part from 1.5% to 12.3%). In countries where users of public transport and pedestrians were the most affected by the burden, the avoidable parts ranged from 0.5% to 4.4% (Nigeria) and from 0.5% to 3.4% (Bolivia). Burden of road-traffic injuries mostly affected motorcyclists in Sri Lanka and Cambodia where the avoidable parts were less than 2% in both countries. In all selected countries, burden of traffic injuries mostly affected men (about 80%) as well as young people (15–34 years). Conclusions: Despite limited data availability in low- and middle-income countries, the avoidable part of the burden related to delayed intervention is measurable. These results can be used to convince countries to avoid delaying the provision of better protection to road users.

Objective: 在量化道路交通伤害所致致命与非致命伤害负担的可避免部分时，必须考虑有效道路安全政策的延迟实施问题。本研究旨在评估低收入及中低收入国家中，因道路交通安全法规实施延迟导致的道路交通伤害所致伤残调整生命年（Disability-Adjusted Life Years, DALYs）损失的可避免部分。
Methods: 本研究针对世界卫生组织（World Health Organization, WHO）及世界银行（World Bank, WB）的国家收入分级区域各选取一个国家。研究使用了公开可获取的数据集（来自WHO、国际道路交通安全数据与分析组及世界银行）。以全球首次实施机动车前排乘员强制使用安全带法规的年份为起点，计算至2013年的法规实施延迟时长。在伤残调整生命年计算模型中，本研究采用预期寿命表及年龄分组作为社会价值参数。基于已发表的国际循证综述提取的安全带法规对致命与非致命伤害的综合有效性评估数据，从估算的总伤害负担中计算可避免的伤残调整生命年损失。
Results: 以1972年为基准年，各国的法规实施延迟时长从乌兹别克斯坦的27年到玻利维亚的41年不等（玻利维亚截至2013年仍未出台安全带法规）。在延迟实施期间，各国因道路交通伤害所致的伤残调整生命年总损失绝对数分别为：尼日利亚8462099人年、摩洛哥7203570人年、乌兹别克斯坦4695500人年、柬埔寨3866391人年、玻利维亚3253359人年以及斯里兰卡3128721人年。基于3%至20%的伤害减少有效性评估范围，轿车乘员道路交通伤害的可避免负担以乌兹别克斯坦（可避免比例为1.2%至10.4%）及摩洛哥（可避免比例为1.5%至12.3%）为最高。在公共交通使用者与行人受伤害负担影响最严重的国家，可避免负担比例范围为尼日利亚的0.5%至4.4%，以及玻利维亚的0.5%至3.4%。斯里兰卡与柬埔寨的道路交通伤害负担主要影响摩托车骑手，两国的可避免负担比例均低于2%。在所有入选国家中，道路交通伤害负担主要影响男性（约占80%）及15至34岁的年轻群体。
Conclusions: 尽管中低收入国家可获取的数据有限，但与干预延迟相关的伤害负担可避免部分仍可被量化。本研究结果可用于敦促各国避免延迟为道路使用者提供更完善的安全保护措施。