Status of Road Safety and Injury Burden

THE INCIDENCE OF RTAS AND THE ASSOCIATED FATALITIES Within the past 3 decades, there have been 1 million Road Traffic Accidents (RTAs) mortalities in Brazil.1 Recent data indicate that 150,000 individuals die or sustain serious injuries because of these accidents annually.2 In Brazil, pedestrians, motorcyclists, and vehicle conductors are greatly overrepresented among accident victims. Most notably, the last decade witnessed a striking increase of motorcycle accidents, resulting in a 7-fold increase in mortality rates (0.09–0.76 per million individuals) when compared with a more stable trend in the vehicle (0.46–0.61 per million individuals) and a decrease in the pedestrian deaths (15.7–6.5 per million individuals).2 In fact, half of all the Road Traffic Accidents in Brazil are now attributed to motorcycles. The high number of Road Traffic Accidents in Brazil can be in part explained by the increased vehicle fleet, which rose between 1.3- and 1.6-fold over the last decade. Motorcycles comprise nearly 1/5 of the total vehicle fleet, which represented a 75% increase between 2001 and 2005.2 DISEASE BURDEN DUE TO RTAS: THE ORTHOPAEDIC TRAUMA PERSPECTIVE There is a paucity of reliable prospective data from orthopaedic trauma centers on Road Traffic Accidents in Brazil. As an example, Brazilian hospital records indicate that there are 120,000 admissions each year due to Road Traffic Accidents. Of these admissions, 1500 resulted in limb amputations and 500 involved severe spine injuries, both of which result in very poor long-term health and social outcomes for victims.1 Numerous studies suggest that motorcyclists are the most susceptible to significant trauma, including lower extremity fractures, which are open injuries 50% of the time. Furthermore, 12% of motorcyclists had consumed alcohol when the injury occurred.3,4 COSTS OF RTAS IN BRAZIL Within 2012, Road Traffic Accidents injuries directly cost the health care system approximately 110 million dollars.2 Although these costs are quite staggering, it is important to highlight the significant indirect costs, which actually comprise a greater proportion of the total economic burden of Road Traffic Accidents in Brazil.5,6 Notably, workforce loss comprises 42.8% of the economic burden of Road Traffic Accidents, whereas material (vehicle) losses are associated with 28.8%. Direct costs through health care expenditures represent 13.3% of the economic burden of Road Traffic Accidents in Brazil. However, these data are likely underestimates because minor injuries are excluded from this analysis and the investigators did not account for the private health system, which provides 20% of the health care for Brazilians.1 NATIONAL RESPONSE TO THE RTA BURDEN IN BRAZIL: DRINKING AND DRIVING Drinking and driving has been prohibited in Brazil since 2008. Subsequent to this, studies revealed an important decrease in injury patterns.6–8 Most recently, in January 2013, Brazil adopted a zero-tolerance “dry law” regarding the consumption of alcohol while driving and has set the maximum blood alcohol level at 0.2 g/L.7,8 The penalty for exceeding this limit is proportional to how far above the limit the driver is and can include suspension or prison. FUTURE OUTLOOK AND INITIATIVES Despite the success of these initiatives, RTAs remain a priority area for intervention within Brazil. Indeed, 2012 data demonstrate that given the increase in the number of drivers and vehicles on the roads in Brazil, the number of RTAs has not decreased as hoped; instead, it has remained constant.9,10 For the orthopaedic perspective, efforts to reduce RTAs should include public education, development of an efficient emergency care system, and strict transit policies. Road safety and infrastructure that support safer roads and the protection of pedestrians and cyclists are critical steps to improvement.11

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