Timothy D. Baker

Distribution of road traffic deaths by road user group: a global comparison

Background: Road traffic deaths are a major global health and development problem. An understanding of the existing burden of road traffic deaths in the population is necessary for developing effective interventions. Objective: To outline systematically the global distribution of road traffic deaths by road user groups (pedestrians, bicyclists, motorcyclists, motorised four-wheeler occupants). Methods: Comprehensive searches of PubMed, Google, Google Scholar, TransportLink, grey literature and reference lists and communication with experts from international organisations and country-level institutions were conducted to identify eligible studies and data sources. All data sources that provided a breakdown of road traffic deaths by road user group at the national or sub-national level were eligible for inclusion. A breakdown of road traffic deaths by road user group was constructed for 14 epidemiologically defined World Health Organization (WHO) sub-regions in addition to World Bank income categories. In addition, the total number of road traffic fatalities by road user group in low-income, middle-income and high-income countries was estimated. Results: The breakdown of road traffic deaths by road user group varies dramatically across epidemiological WHO sub-regions. The magnitude of pedestrian fatalities ranges from more than half in African sub-region AfrE (55%) to 15% or less in AmrA or EurA. The distribution also varies across low-income, middle-income and high-income countries. 45% of road traffic fatalities in low-income countries are among pedestrians, whereas an estimated 29% in middle-income and 18% in high-income countries are among pedestrians. The burden of road traffic injuries on vulnerable road users differs substantially across income levels. An estimated total of 227 835 pedestrians die in low-income countries, as opposed to 161 501 in middle-income countries and 22 500 in high-income countries each year. Conclusions: Ameliorating road safety requires the implementation of context-specific solutions. This review of the road traffic injury literature provides strong evidence that the distribution of road traffic fatalities varies dramatically across different parts of the world. Therefore, context-appropriate and effective prevention strategies that protect the particular at-risk road user groups should be carefully investigated.

THE EPIDEMIOLOGY OF PROSTATE CANCER IN JAMAICA

PURPOSE Before this study, the highest reported incidence of prostate cancer in the world was thought to be among United States black men. The age adjusted rates in 1992 for United States black and white men were 249 and 182/100,000 respectively. The epidemiology of prostate cancer in Jamaica, a country of 2.5 million people of primarily African descent, was studied and compared with that of white and black Americans. MATERIALS AND METHODS The study included 1,121 cases of prostate cancer diagnosed from 1989 to 1994. Sources of information included the Jamaican Cancer Registry, government pathology laboratory, hospital and clinic records, and physician office records. Incidence rates were computed using data from the 1991 Jamaican census. Age adjustments were made using the 1970 United States standard population. RESULTS The average age adjusted incidence of prostate cancer in Kingston, Jamaica was 304/100,000 men. Median patient age at diagnosis was 72 years. More than 80% of the cases were pathologically confirmed. Of the patients 30% presented with acute urinary retention, 16% presented with bone metastases, 15% had gross hematuria at the time of diagnosis and an abnormal rectal examination suspicious for cancer was noted in 42%. Prostate specific antigen was measured in only 7% of cases in 1989 but in 48% of cases by 1994. CONCLUSIONS These data demonstrate that Jamaican men in Kingston have a high incidence of prostate cancer, much higher than even black Americans during a similar period. Furthermore, the cancers are more significant clinically with greater morbidity in Jamaica than in the United States.

Overseas fatalities of United States citizen travelers: An analysis of deaths related to international travel

STUDY OBJECTIVE Studies of travel-related mortality and morbidity have been limited to nonfatal events. Causes of travel-related mortality may differ significantly from morbidity and thus have different prevention strategies. DESIGN We examined the overseas fatalities of US citizen travelers for the years 1975 and 1984. The death certificates were abstracted; all deaths under age 60 and a 20% sample of deaths 60 and older were examined. SETTING AND TYPE OF PARTICIPANTS All overseas travel fatalities of US citizens were examined excluding those occurring in Canada. INTERVENTIONS None. RESULTS Cardiovascular events (including myocardial infarctions and cerebrovascular accidents) and injuries accounted for 49% and 25% of the overseas deaths of US citizen travelers, respectively. Infectious diseases other than pneumonia accounted for only 1% of the deaths. Eighty percent of injury deaths occurred outside of hospitals. Injury death rates for male travelers were greater than US age-specific death rates. CONCLUSIONS Greater emphasis on the prevention of fatal events, especially those resulting from injury, must be given by physicians and other individuals and organizations who advise travelers. Further studies are needed to explore the issues of preventable injury deaths, emergency medical services, and overseas travel.

The impact of the national polio immunization campaign on levels and equity in immunization coverage: evidence from rural North India

Few studies have investigated the impact of immunization campaigns conducted under the global polio eradication program on sustainability of polio vaccination coverage, on coverage of non-polio vaccines (administered under Expanded Program on Immunization (EPI)), and on changes in social inequities in immunization coverage. This study proposes to fill the gaps in the evidence by investigating the impact of a polio immunization campaign launched in India in 1995. The study uses a before-and-after study design using representative samples from rural areas of four North Indian states. The National Family Health Survey I (NFHS I) and NFHS II, conducted in 1992-93 and 1998-99 respectively, were used as pre- and post-intervention data. Using pooled data from both the surveys, multivariate logistic regression models with interaction terms were used to investigate the changes in social inequities. During the study period, a greater increase was observed in the coverage of first dose of polio compared to three doses of polio. Moderate improvements in at least one dose of non-polio EPI vaccinations, and no improvements in complete immunization against non-polio EPI diseases were observed. The polio campaign was successful, to some extent, in reducing gender-, caste- and wealth-based inequities, but had no impact on religion- or residence-based inequities. Social inequities in non-polio EPI vaccinations did not reduce during the study period. Significant dropouts between first and third dose of polio raise concerns of sustainability of immunization coverage under a campaign approach. Similarly, little evidence to support synergy between polio campaign and non-polio EPI vaccinations raises questions about the effects of polio campaign on routine health systems functions. However, moderate success of the polio campaign in reducing social inequities in polio coverage may offer valuable insights into the routine health systems for addressing persistent social inequities in access to health care.

Productivity losses from injury in China.

Objective: To examine the productivity losses and costs of injury and disease in China using an improved approach. Methods: Potentially productive years of life lost (PPYLL) were calculated for injury and four major disease groups (respiratory, cardiovascular, infectious, neoplastic). Data sources: The mortality data are from the 1999 National Health Statistics Report and the morbidity data from the 1998 Second National Health Service Survey Report. Results: Injuries caused an annual PPYLL of 12.6 million years, more than for any disease group. The estimated annual economic cost of injury is equivalent to US

Comparing road traffic mortality rates from police-reported data and death registration data in China

12.5 billion, almost four times the total public health services budget of China. Motor vehicle fatalities accounted for 25% of the total PPYLL from all injury deaths. Conclusion: Injury control and prevention programs merit priority to reflect the social and economic burden of injury in China.

Increase in suicide by hanging/suffocation in the U.S., 2000-2010.

OBJECTIVE To compare death rates from road traffic injuries in China in 2002-2007 when derived from police-reported data versus death registration data. METHODS In China, police-recorded data are obtained from police records by means of a standardized, closed-ended data collection form; these data are published in the China statistical yearbook of communication and transportation. Official death registration data, on the other hand, are obtained from death certificates completed by physicians and are published in the China health statistics yearbook. We searched both sources for data on road traffic deaths in 2002-2007, used the χ(2) test to compare the mortality rates obtained, and performed linear regression to look for statistically significant trends in road traffic mortality over the period. FINDINGS For 2002-2007, the rate of death from road traffic injuries based on death registration data was about twice as high as the rate reported by the police. Linear regression showed a significant decrease of 27% (95% confidence interval, CI: 35-19) in the death rate over the period according to police sources but no significant change according to death registration data. CONCLUSION The widely-cited recent drop in road traffic mortality in China, based on police-reported data, may not reflect a genuine decrease. The quality of the data obtained from police reports, which drives decision-making by the Government of China and international organizations, needs to be investigated, monitored and improved.

Familial study of prostate cancer in Jamaica

BACKGROUND Recently, suicide exceeded motor vehicle crashes as the leading cause of injury death in the U.S. However, details of this change in suicide methods and the relationship to individual demographics, such as age and societal influences, have not been reported. PURPOSE To determine the characteristics of the changes in suicide rates between 2000 and 2010. METHODS Data came from CDCs Web-Based Injury Statistics Query and Reporting System (WISQARS™). Line charts were plotted to reveal changes in suicide rates by firearm, poisoning, and hanging/suffocation (ICD-10 codes: X72-X74, X60-X69, and X70). The measure of change used is the percentage change in suicide rate between 2000 and 2010. RESULTS The overall suicide rate increased from 10.4 to 12.1 per 100,000 population between 2000 and 2010, a 16% increase. The majority of the increase was attributable to suicide by hanging/suffocation (52%) and by poisoning (19%). Subgroup analysis showed: (1) suicide by hanging/suffocation increased by 104% among those aged 45-59 years and rose steadily in all age groups except those aged ≥70 years; (2) the largest increase in suicide by poisoning (85%) occurred among those aged 60-69 years; and (3) suicide by firearm decreased by 24% among those aged 15-24 years but increased by 22% among those aged 45-59 years. The case fatality rates for suicide by hanging/suffocation during 2000-2010 ranged from 69% to 84%, close to those for suicide by firearm. Analyses were conducted in 2012. CONCLUSIONS Substantial increases in suicide by hanging/suffocation and poisoning merit attention from policymakers and call for innovations and changes in suicide prevention approaches.

Road-traffic deaths in China, 1985–2005: threat and opportunity

OBJECTIVES Rates of prostate cancer in Kingston, Jamaica are extremely high (occurring in more than 300 men out of 100,000 in 1989 to 1993). This article addresses the familial aggregation of prostate cancer in Jamaica. Early evidence for familial prostate cancer was found in the Utah Mormon population. Increased risk of prostate cancer in men with a family history of prostate cancer has been consistently observed in subsequent studies. There have been few studies, however, involving black men, who are known to have an overall higher risk of developing prostate cancer. METHODS Two hundred sixty-three patients with prostate cancer documented by histology were studied. Two hundred sixty-three age-matched control patients were used for comparison. Extensive pedigrees were obtained for both patients with cancer and controls. Data on other malignancies including lung, breast, colon, stomach, and uterine were also collected. RESULTS The patients with cancer and the controls were comparable with respect to age and family size. Thirty patients with cancer had a first degree relative (ie, brother, father, or son) with prostate cancer compared to 15 controls. The odds ratio is 2.1 (95% confidence interval 1.1 to 4.4). Nine patients with cancer had a second degree relative (ie, grandfather, grandson, or uncle) affected compared to 3 controls. The odds ratio is 3.1 (95% confidence interval 0.8 to 17.8). There was no statistically significant difference in the rates of any of the other cancers studied. CONCLUSIONS Familial aggregation of prostate cancer is clearly evident in black Jamaican men. A man with one first degree relative with prostate cancer is twice as likely as the general population to develop prostate cancer. In addition, there may be a statistical difference in the risk of developing prostate cancer if an individual has one second degree relative affected.

Urban-Rural Disparities in Injury Mortality in China, 2006.

Objective: To examine recent trends and geographic variations in road-traffic deaths in China. Design: A longitudinal descriptive analysis of national and provincial data on road-traffic deaths, examining recent trends and geographic variations. Setting: China, 1985–2005. Data sources: The Transportation and communications yearbook of China (1986–2006) and the National statistics yearbook of China (1996–2006). Main outcome measures: The percentage change in death rates per 100 000 population was used to examine the trend. Epi Info was used to map the geographic distribution of road-traffic death rates and the increases in rates. Correlation coefficients were calculated between per capita gross regional product, road quality, and the number of motor vehicles in the 31 provinces, to help understand the geographic variations in road-traffic mortality at the provincial level in China. Results: The road-traffic death rate increased by 95%, from 3.9/100 000 persons in 1985 to 7.6/100 000 persons in 2005. High death rates and the greatest increases in death rates occurred in both developed provinces in the southeast and underdeveloped northern and western provinces. Xizang/Tibet, Qinghai, and Xinjiang, with the lowest population density, had the highest death rates per 100 vehicles. Conclusions: China’s government should introduce and support measures to prevent road-traffic injuries. Developed and underdeveloped provinces in China should both be considered when road-traffic policy and interventions are developed.