Road traffic injuries in China: Time trends, risk factors and economic development

More than 90% of the world's deaths from injuries occur in low and middle income countries. Road traffic crashes cause an enormous loss of life, disability and economic loss all over the world (1). China is undergoing great economic development, and is experiencing rapidly increasing motorization, road traffic volume and road traffic crashes, injuries and deaths.;The dissertation, using nine years of data from the China Statistical Yearbook (1998-2006) and four years of more detailed data from the Yunnan Transportation Management Bureau (2002-2005), describes the scale and characteristics of road traffic injuries; the associated risk factors, and the relation to economic development.;The dissertation reviewed all available English and Chinese research papers and studies on road traffic injury in China during 1985 and 2006. A descriptive study showed trends in road traffic injury throughout China from 1998 to 2006 and explored the road traffic distribution and change over 27 provinces and 4 municipal cities. Time variation and province variation were examined using longitudinal data analysis tools. An examination of the association between GDP per capita and road traffic deaths and injuries was conducted. With more detailed data, the Yunnan study explored the epidemiological characteristics and risk factors associated with road traffic injuries to supplement the findings using overall China data.;The results show that as motorization increased, China faced higher road traffic crash rates, fatality rates and injury rates per population. All provinces were affected by the increased road traffic injuries, but provinces with lower GDP per capita bore a higher relative increase in burden. Very high fatality rates per 100 000 population during 1998 to 2006 in China were found in both developed regions and undeveloped regions. The correlation of fatality rate per 100 000 population with GDP per capita was non-linear. When GDP per capita is under 9 000 Yuan a year, there was an increasing trend for fatality rate per 100 000 population, but with higher income there was a somewhat decreasing trend.;The fatality rate/100 000 population was much lower with the data from the Chinese government (8.5/100 000) than that from WHO (19.0/100 000). Some of the discrepancies may be accounted for by differences in the criteria of inclusion and definition of a road traffic fatality. But the main differences seem due to different data sources with that from WHO based on selected surveillance sites while that from the China government based exclusively on police reports.;This investigation provides new evidence for time trends and epidemic features of road traffic injuries in China and Yunnan Province. This study recommends improving injury surveillance systems and building reliable data sources, linking police data with other sources of data, detailed studies of the causes of crashes (e.g., case control studies) and of intervention studies examining all three levels of factors in accord with Haddon's matrix.