A study of pedestrian-vehicle accidents in Iran in 2013

 

Afshari M, MSc1*, Khazaei S, MSc2, 3, Mohammadian M, MSc4, Mohammadian Hafshejani A, MSc5

 

1-  MSc, PhD Student in Health Education and Health promotion, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran. 2- MSc, PhD Candidate in Epidemiology, Dept. of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran. 3- MSc, PhD Candidate in Epidemiology, Deputy of Health, Hamadan University of Medical Sciences, Hamadan, Iran. 4- MSC in Epidemiology, Social Development and Health Promotion Research Center, Gonabad University of Medical Sciences, Gonabad, Iran. 5- MSc, PhD Candidate in Epidemiology, Social Determinants in Health Promotion Research Center, Hormozgan University of Medical Sciences, Bandar Abbas, Iran.

 

Abstract                                                                                       Received: July 2016, Accepted: October 2016

Background: In recent decades, ýdue to the increase in users of roads and inadequate attention to the creation and development of appropriate passageways for traffic, there has been a growing trend in traffic accidents and casualties caused by them. The traffic accidents among pedestrians to take necessary measures in a timely fashion should be well studied. This study was conducted with the goal of survey traffic accidents among pedestrians in 2014.

Materials and Methods: This cross-sectional study was conducted using data from the National Accidents Record Program ýregarding 2013. In this study, all traffic accidents in which the injured person was referred to a public or private ýhospital in the country to receive health services or was transferred to the hospital by EMS 115 and ýreceived remedial measures on an outpatient or inpatient basis in all provinces were consideredý. The incidence of pedestrian-vehicle accidentsý was calculated per ten thousand. Map GIS software package was used for the mapping of occurrence of events and Microsoft EXCEL and Stata software were used for data analysis.

Results: In this study, the 82066 pedestrians who were injured in road accidents consisted of a total of 53240 men and 28826 women. The rate of traffic accidents was higher in men than in women (64.87% and 35.13%, respectively) and the majority of individuals affected were in the age group of 20 to 24 years. Most pedestrian-vehicle ýaccidents had occurred on the street (89.8%).

Conclusion: Pedestrians are at risk of the irreversible outcomes of traffic accidents; therefore, effective and regular training on the prevention of injury and secure environment is essential to reduce injuries.

Keywords: Accidents, Traffic, Injury, Pedestrians

 

Introduction

In recent decades, with the increase in users of roads and inadequate attention to the creation and development of appropriate passageways for traffic, there has been a growing trend in traffic accidents and casualties caused by them (1). Injuries caused by car accidents are one of the major problems in the world that threaten the human health (2). Nearly 2.1 million individuals lose their lives due to traffic accidents each year, and more than 50 million individuals suffer some degrees of damages (3). It has been estimated that this amount increased to 65% in the whole world and nearly 80% in developing countries from 2000 to 2020 (4). Many of those who are at risk of damages caused by traffic accidents are pedestrians and do not have vehicles (5). In developed countries, 30 to 40 killed or injured per hundred thousand pedestrians are due to car accidents each year, and this problem is increasing rapidly in* developing countries (6).

Almost a third of vehicles ply on different routes on a daily basis in developing countries, but the majority of traffic accidents involve pedestrian in these countries (7). The most important factors that increase injuries caused by traffic accidents particularly among pedestrians in Iran include an increase in the number of vehicles, inadequate and insufficient infrastructures of roads and health sector, unfavorable status of traffic control, use of non-standard vehicles, poor safety on roads and streets, and lack of traffic culture for pedestrians (7, 8).

Today, with the increase in the production and development of vehicles on the one hand and urbanization population growth on the other hand, attention to issues of pedestrians particularly in terms of security is necessary (9). Pedestrian injuries cause many issues in the society such as social problems and economic costs, and intensify the existing problems within the society (10). It is clear that continuation of the current growth in injuries caused by accidents among pedestrians and failure to adopt desirable and appropriate predictive and preventative methods can be a potential threat to the population of the country and waste many material and immaterial resources (11).

Given that our country is also among developing countries and the number of vehicles is rapidly increasing in this country, traffic problems especially for pedestrians will be the most important issues that threaten public health and increase unnecessary costs within the society, particularly for pedestrians (12). In a study which was conducted on secure traffic behaviors among students by Ramezankhani et al. in 2013 based on the Theory of Planned Behavior, the results showed that training can affect the secure behaviors of students in crossing the street (10). Similarly, in another study which was conducted on pedestrians in Tehran (Iran) by Holakouee and Moradi in 2007, the results showed that the performance of pedestrians regarding traffic regulations is poor in Tehran (11). Maki and Kajzer reviewed pedestrian accident cases in Japan from 1995 to 1998 (13). They found that 22% of serious injuries and 64% of fatal injuries were head injuries. This finding indicated that the odds to be fatally injured were 6.3 times as high when sustaining a head injury relative to when sustaining other injuries (13). Moreover, the results of a study by Yao et al. showed that a sizeable proportion of adult pedestrians involved in vehicle-versus-pedestrian accidents suffer head injuries, some of which can lead to lifelong disability or even death (14).

Therefore, controlling and moderating these issues as well as promoting desirable methods and appropriate culture-making including the culture of not responding to the cell phone while driving, not eating or drinking while driving, driving with reliable speed, attention to pedestrian crossings and crosswalks, attention to traffic lights, and other necessary precautions are related to the epidemiological characteristics of accidents (15). Thus, the best and most economical way of reducing and controlling the occurrence of injuries caused by traffic accidents, particularly in pedestrians, can be adopted. Therefore, this study was conducted with the goal of survey traffic accidents among pedestrians in 2014.

 

Material and Methods

This cross-sectional, descriptive, and analytical study was conducted using data of the National Accidents Record Program related to 2013 in Iran. In this study, all traffic accidents in which the injured person was referred to a public or private hospital in the country to receive health services or was transferred to the hospital by EMS 115 and received remedial measures on an outpatient or inpatient basis in all provinces were considered. Other accidents that resulted in deaths at the scene of the crash or individuals who did not have to go to the hospital due to mild injuries were not considered in the study because no information was available on them. In this study, the required information were extract from patients' emergency care report forms and  medical history information that were obtained by nurses and physicians using the National Accidents Record Program. This information is usually extracted from patient records by a medical records expert and is entered into the National Accidents Record Program software. This information is completed by hospitals and is transferred to provincial health centers periodically and information related to all of the cities of a province is collected for each year (16). In this study, hospital incidence rate of pedestrian-vehicle accidents is calculated and presented on the basis of per ten thousand people. To calculate the incidence rate in each province, the population of that province in 2013 was considered. Mapping the occurrence of accidents was conducted using ArcGIS software (version 10, Esri, Redlands, CA, USA) and a map of low and high risk areas of the country was presented.

In addition, the risk ratio of occurrence of traffic accidents on the basis of sex (male to female) was calculated and presented with 95% confidence intervals. Microsoft EXCEL software (2010, Microsoft Corp., Redmond, WA, USA) and Stata software (version 11, StataCorp LP, TX, USA) were used to analyze the data. In this study, the significance level was considered as less than 0.05.


 

Table 1: The incidence rate and sex ratio of pedestrian-vehicle ýaccidents in each province in 2013 (82066 individuals)

P

 

Lower bound

Upper bound

Risk ratio (M/W)

Women

Men

Incidence rate per 10000

Province

0.001

1.64

1.77

1.7

1268

2152

9.21

Azarbaijan Sharghi

0.001

2.14

2.27

2.2

1317

2844

13.80

Azarbaijan Gharbi

0.001

2.04

2.17

2.1

141

312

3.50

Ardabil

0.001

1.44

1.57

1.5

2325

3377

12.02

Isfahan

0.001

1.74

1.87

1.8

1192

2149

14.52

Alborz

0.001

1.54

1.67

1.6

176

287

8.33

Ilam

0.001

1.54

1.67

1.6

145

229

3.76

Bosheher

0.001

1.94

2.07

2

4985

9954

11.23

Tehran

0.001

1.94

2.07

2

50

102

1.61

Chaharmahal and Bakhtiari

0.001

1.14

1.27

1.2

224

227

6.62

Khorasan Jonobi

0.001

1.54

1.67

1.6

632

1041

19.30

Khorasan Shomali

0.001

1.54

1.97

1.9

3603

6865

16.92

Khorasan Razavi

0.001

2.14

2.27

2.2

1745

3863

11.45

Khozestan

0.001

1.54

1.97

1.9

116

226

3.28

 Zanjan

0.001

1.24

1.37

1.3

411

521

14.88

Semnan

0.001

2.94

3.07

3

250

761

3.94

Sistan and Balochestan

0.001

1.54

1.67

1.6

1094

1805

6.18

Fars

0.001

1.74

1.87

1.8

365

665

8.49

Ghazvin

0.001

1.44

1.57

1.5

927

1433

19.45

Ghom

0.001

1.64

1.77

1.7

276

473

4.73

Kordestan

0.001

1.84

1.97

1.9

1097

2059

12.84

Kerman

0.001

2.14

2.27

2.2

1943

4225

31.37

Kermanshah

0.001

1.34

1.47

1.4

158

217

5.34

Kohgiluyeh and Boyer-Ahmad

0.001

1.64

1.77

1.7

857

1437

13.06

Golestan

0.001

2.34

2.47

2.4

674

1647

10.20

Gilan

0.001

1.84

1.97

1.9

412

788

6.52

Lorestan

0.254

0.94

1.07

1

1473

2084

11.57

Mazandaran

0.001

1.74

1.87

1.8

160

325

3.34

Markazi

0.001

1.94

2.07

2

160

325

3.23

Hormozgan

0.001

1.14

1.27

1.2

208

254

2.56

Hamadan

0.001

1.24

1.37

1.3

442

593

10.22

Yazd

 

Results

In this study, the 82066 pedestrians who suffered from a traffic accident and its consequent injuries during 2013 included 53240 (64.87%) men and 28826 (35.13%) women.

The study results regarding pedestrian-vehicle ýaccidents presented in table 1 show that the highest frequency of injured individuals was related to men (64.87%). The sex ratio of injured pedestrians among men was higher than women in all provinces of Iran except Mazandaran (Iran) in which the sex ratio was equal between injured men and women. The incidence rate of pedestrian-vehicle ýaccidents per 10000 was highest in the province of Kermanshah (31.37%) and lowest in the provinces of Chaharmahal and Bakhtiari (1.61%), and Hamedan (Iran) (2.56%), respectively.

The results of table 2 show that the highest frequency of the location of pedestrian-vehicle accidents occurrence was related to the alleys and streets (89.8%). Furthermore, according to sex, the majority of accidents had occurred in men (88.6%) and women (91.5%) in the alleys and streets, respectively, and the least accidents had occurred in the school in both sexes (0.1%).

 

 

Table 2: Frequency of the location of pedestrian-vehicle accidents occurrence (82066 individuals)

Total

Women

Men

Location of traffic accidents

Number (%)

Number (%)

Number (%)

273 (0.3)

113 (0.2)

160 (0.2)

House yard and surroundings

36 (0.1)

8 (0.1)

28 (0.1)

School and education facilities

477 (0.6)

173 (0.5)

304 (0.6)

Public areas

175 (0.2)

63 (0.2)

112 (0.2)

Sport and recreation areas

73757 (89.8)

26364 (91.5)

47393 (88.6)

Alleys and streets

6423 (7.8)

1812 (6.0)

4611 (9.0)

Highways and roads

136 (0.1)

14 (0.4)

122 (0.2)

Around the workplace*

73 (0.1)

25 (0.1)

48 (0.1)

Other areas**

817 (1.0)

284 (1.0)

533 (1.0)

Unknown***

* Occupational accidents in the workplace in collisions with cars

** Locations other than the locations listed above

*** Location of the accident of pedestrians who were not identified

 

 

Moreover, the frequency of pedestrian-vehicle ýaccidents in terms of age group in the country in 2013 is illustrated in figure 1. The majority of pedestrian-vehicle ýaccidents in both sexes had occurred in the age group of 20 to 24 years, and the least number of pedestrian-vehicle ýaccidents in both sexes had occurred in the age group of 85 years.

Figure 2 shows the incidence rate of
pedestrian-vehicle ýaccidents in the country. In the provinces that are specified with the color white, the incidence rate of pedestrian-vehicle ýaccidents ranged between 1.61 and 4.73 per 10000 people. They have a better situation than the provinces that are specified with yellow and red colors (incidence rate of pedestrian-vehicle accidents: 13.81 to 31.37 per 10000 people).

 

Figure 1: The frequency of pedestrian-vehicle ýaccidents in terms of age group in the country in 2013 (82066 individuals)

 

Figure 2: Incidence rate of pedestrian-vehicle accidents in the country (82066 individuals)

 

Discussion

This study was conducted with the goal of determining the rate of pedestrian-vehicle ýaccidents in 2013. As mentioned, in this study, the frequency of injuries in men was higher than women. In addition, the sex ratio was greater than 1 in all provinces apart from Mazandaran, which indicates a higher proportion of men in these accidents. The average amount of fatal lesions in men is 24% more than women according to statistics from the World Health Organization (WHO) (17). Moreover, the results of the study by Nazari et al. on the mortality rate and severity of injuries caused by traffic accidents in patients admitted to hospital in Amol (Iran) in 2011 showed that men were injured more than women (18). Investigation of injured people in terms of sex distribution in other studies, including the studies by Menon et al. and Dandona et al., show that the majority of injured people were men (19, 20). Furthermore, Maki and Kajzer reviewed pedestrian accident cases in Japan from 1995 to 1998 and found that men were injured more than women (13).

This can be due to working conditions, high working hours outside the home, and more physical activity among men. The majority of injured people in the study were of the age group of 20 to 24 years. In addition, several conducted studies have confirmed that traffic accidents occur in young age groups (19, 21, 22). This study showed that most injured people are those who are at working ages. The high rate of accidents in this age group is probably due to Iran's young population as well as the educational, occupational, and physical conditions of this age group who spend more time outdoors. The highest frequency of the location of pedestrian-vehicle ýaccidents occurrence was related to the alleys and streets. This result was almost consistent with that of the study conducted by Mobaleghi et al. on mortality caused by traffic accidents at the hospital in Sanandaj (Iran) in 2002 (12). In their study, almost 2.33% of those who had been referred to the hospital were pedestrians (12). The results of other studies, including the study by Peden et al. on traffic accidents according to the WHO in 2004 as well as the study by Karbakhsh et al. in 2004, showed that suburban accidents have particular importance (7, 22). However, in other areas of the world, urban accidents had greater importance according to the WHO (23). The results of the study of WHO in 2001 showed that 55-77% of accidents had occurred in urban areas (23). The inconsistency between the results of this study and other studies (7, 22) is probably due to an increase in cars in the city, lack of suitability of the existing roads, and the poor safety culture.  

Incidence rate of pedestrian-vehicle ýaccidents in the country shows that the provinces specified with red and yellow colors in figure 2 had the most pedestrian-vehicle ýaccidents. This can be because most cities which have higher incidence rate are religious cities with higher commuting rates, and are significant in terms of structural, economic, and political situations, and the higher commuting rate leads to problems such as pedestrian accidents. Furthermore, accident analysis revealed that the windshield and its surrounding frames were the main sources of head injury for adult pedestrians (14). The use of information from patients’ medical records was the limitation of this study, and 100% use of all available evidence for pedestrian-vehicle ýaccidents was the advantage of this study. 

 

Conclusion

Given that the injuries had occurred in young age groups, being at risk of injuries caused by traffic accidents as well as higher consequent mortality and disability rates in this age group. Therefore, young people and authorities should be aware of the possible consequences resulting from injuries caused by traffic accidents and take measures to avoid and prevent these accidents. According to the abovementioned issues, the prediction and prevention of injuries is very essential. It seems that in prophylactic and intervention programs, causal factors of pedestrian-vehicle ýaccidents and the ways to prevent them should be fully distinguished. Ultimately, the results obtained can provide planners and health authorities with appropriate strategies in the studied field in order to design effective programs.

 

Acknowledgement

We would like to thank all those who participated in this project and helped us in performing this project.

 

Conflict of interests: None declared

 

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Available from:

http://www.who.int/iris/handle/10665/66160


* Corresponding author: Maryam Afshari, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.

Email: afshari_m20@yahoo.com