The WHO has estimated that in the year 2000, 1.26 million persons died in traffic accidents around the world (2.2% of all deaths worldwide), making this the ninth most frequent cause of death. However, in persons aged 15 to 29 years, traffic accidents are the second most frequent cause of death after AIDS.1 Every day 3000 persons die on highways around the world, and 30 000 are seriously injured.2
In Spain, data provided by the National Institute of Statistics (Instituto Nacional de Estadística, www.ine.es) and the General Directorate of Traffic (Dirección General de Tráfico, www.dgt.es) speak for themselves. The overall mortality rate for Spain in 2002 was 131 per 100 000 inhabitants. Traffic accidents ranked fifth among the leading causes of death, behind cardiovascular disease, respiratory disease, digestive and metabolic diseases, and cancer. However, among 15-to-34-year-olds traffic accidents were the leading cause of death. During 2002, with 25 million registered vehicles on the road, there were 98 433 accidents with victims and 5347 deaths. Among those who died, 2286 were between 15 and 34 years of age.
One feature of mortality from traffic accidents is that it is needlessly premature and potentially avoidable, therefore all reasonable efforts should be brought to bear to bring this cause of mortality under control.
The epidemiological features of this scourge have been known in some detail for a number of years now. The distribution of accidents during the week displays a peak on weekends, and seasonal variations show highest accidents rates during vacation periods and bank holiday weekends. Mortality rates are 3-fold to 4-fold as high in men as in women, and victims occupy up to 10% of all hospital beds. In Europe and the U.S., most victims are drivers and passengers, whereas in developing countries most victims are pedestrians and cyclists.1
In economic terms, the overall cost of traffic accidents represents 1% to 3% of the gross national product.1
Studies aimed at offering recommendations for preventing injury due to traffic accidents identify different levels of evidence for the efficacy of specific measures in reducing risk, and different categories of effectiveness of specific recommendations (appropriate restraint and use of safety belts, not driving while under the influence of alcohol or drugs, air-bags, changes in pedestrians' behavior, advice to parents regarding appropriate seating for children, etc.).3
Risk estimates have been calculated for a number of driver-related factors connected with traffic accidents in Spain during the 1990s.4 Drowsiness was associated with excess risk, as determined by the odds ratio (OR) of 64.35; drinking was associated with an OR of 22.32; and inappropriate speed for weather conditions yielded and OR of 28.33. Years in possession of a driving license showed an interaction with age, such that in younger drivers age was a protective factor (OR, 0.95) whereas in drivers older than 65 years, the protective effect disappeared. Excess levels of risk were found for nonprofessional drivers, drivers with disabilities, persons with a history of administrative infractions, and persons who did not use safety belts. The age associated with the lowest risk was 25 to 49 years, and excess risk was found for younger drivers and those over 74 years of age. In recent years the spread of cell phones has become an additional element in the origin of many accidents.
Studies of mortality due to traffic accidents are not common in Spain. The article by Ruiz et al is of interest because it reports a 26-year follow-up of mortality rates associated with traffic accidents in the region of Andalusia, and has the added virtue of providing predictions for the year 2004.5 This type of study is useful in evaluating more accurately the effect of interventions by different administrations, and the impact of media campaigns. Thus, if the situation in Andalusia does not change, the current figures for mortality can be expected to follow the trend first recorded in 1995, with rates of around 20.2 men per 100 000 inhabitants, and 4.6 women per 100 000 inhabitants.
In light of the present situation, all parties involved should become aware of the gravity of the situation: what we face is not only a major health problem but also a problem with social, work-related, economic and safety-related repercussions. What is needed is effective cooperation between associations for victims of traffic accidents, foundations, the automobile industry, the Ministries of Public Works, the Interior, and Health, and different national, regional and local administrations.1 In Spain the program implemented in Alzira, based on intersectorial activities to prevent traffic accidents, is an example that is undoubtedly worth imitating.6
Key Points
* Traffic accidents are the leading cause of death in 15-to-34-year-olds.
* A feature of mortality from traffic accidents is that it is needlessly premature and potentially avoidable, therefore all reasonable efforts should be brought to bear to bring this cause of mortality under control.
* All parties involved should become aware of the seriousness of the situation, as the problems are not limited to issues of health.
