|Year : 2022 | Volume
| Issue : 2 | Page : 52-56
Road traffic accident fatalities and its association with key sociodemographic determinants in Nashik, Maharashtra: A recurring challenge
Tej Bahadur Chhetri1, Syed Meraj Ahmed2
1 Department of Forensic Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra, India
2 Department of Community Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik, Maharashtra, India
|Date of Submission||30-Nov-2021|
|Date of Decision||16-Feb-2022|
|Date of Acceptance||18-Apr-2022|
|Date of Web Publication||28-Jun-2022|
Syed Meraj Ahmed
Department of Community Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik - 422 003, Maharashtra
Source of Support: None, Conflict of Interest: None
Background: Road traffic accidents are not a new phenomenon, rather it's a disturbing occurrence which shows no sign of abating very soon. Rather, it remains one of those public health issues which even the most educated and civilized populations tend to ignore, primarily for the thrill of it. This study aims to identify the outcome associated with vehicular accidents and its association with socio-demographic factors. Method: This is a retrospective, record-based study of victims of road traffic accidents admitted in a tertiary care hospital in Nashik, Maharashtra. The data would include records from the 2018 to 2019. The variables will include the socio-demographic factors, site of injuries and its severity. A descriptive analysis would be done by SPSS software to find out the prevalence of vehicular accidents, association of site of injury with age and severity of the trauma. Ethical approval would be taken before the initiation of the study. Result: A total of 486 victims of RTAs were included from the medical records of the casualty of a tertiary care hospital, out of which 330 were from the year 2018 and 156 from 2019. A look at the sociodemographic profiles of the RTA victims showed that females comprised only 19.3% (2018) and 18.6% (2019) of the total victims in road traffic accidents, while majority, 80.6% (2018) and 81.4% (2019) were males during the same period. Overall, we can also observe that both in 2018 (38.5%) and 2019 (50.6%) most of the road traffic accidents among the victims were of moderate grade. Conclusion: The need of the hour is to bring about a change from within through self-reflection of lawmakers, strict implementation of traffic rules and guidelines with hefty fines, lockup, and criminal punishment to habitual wrongdoers.
Keywords: Age, facial trauma, gender, head trauma, multiple injuries, road traffic accident
|How to cite this article:|
Chhetri TB, Ahmed SM. Road traffic accident fatalities and its association with key sociodemographic determinants in Nashik, Maharashtra: A recurring challenge. J Forensic Sci Med 2022;8:52-6
|How to cite this URL:|
Chhetri TB, Ahmed SM. Road traffic accident fatalities and its association with key sociodemographic determinants in Nashik, Maharashtra: A recurring challenge. J Forensic Sci Med [serial online] 2022 [cited 2022 Aug 12];8:52-6. Available from: https://www.jfsmonline.com/text.asp?2022/8/2/52/348660
| Introduction|| |
In a country like India, where the frequency of traffic accidents is one of the highest in the world, large variations in mortality across different regions will be minimal considering the average population density. Sociodemographic factors are the benchmark for identifying the key risk areas that contribute to a high incidence of accidents and fatalities. A study in South India found that male-to-female ratio was 6:1, and the age group of 21–50 years constituted 83% of all road traffic accidents (RTAs). Furthermore, one study found that male aggression was the major contributing factor in a higher incidence of accidents as compared to females. Zhang et al. mention in their study that the absence of streetlights contributes to fatigue-related severe crashes and a high fatality. A study in Brazil (2016) elaborated on the higher vulnerability of motorcycle riders to RTAs compared to those in other types of vehicles.
Sociodemographic determinants form an integral part of our search for a measurable comparison with an increasing RTA-related casualty admission. For this reason, factors such as young age group, breaking traffic rules, health disorders, mental state of mind, use of protective gear, error in judgment, and social and family problems, including momentary distractions (mobile use while driving), were taken into consideration. The specific factors associated with the vehicle such as overspeeding, changing lanes, overcrowding, and heavy traffic were also included to emphasize the environmental conditions. One study found that socioeconomic factors did not make any difference in the distribution of RTAs. While another study in Georgia found that age, employment, and wealth status appeared to be strong independent predictors of RTA mortality among females. Predictably, studies in India and neighboring countries have shown that high frequency of accidents and mortality was associated with a younger age victims as compared to elder drivers.,,
This leads to an important and arguably the most agreed issue of the impact that RTAs cause to individuals, families, and communities. A study on the financial impact of RTA points out that there is an immense loss to all persons involved both in short-and long-term analysis. Another study in Spain pointed out that governments and policy-makers need to strengthen road accident preventive measures to reduce the high socioeconomic costs.
A recent search on the web for any RTAs associated with sociodemographic variability in Nashik did not bring any results. It was felt that due to an evolving population and the rapid pace of technology that brings speed and thrill in vehicular experience, an exploratory study is required on RTAs. Our research question explores the sociodemographic variables where the accidents occur the most and those who are primarily vulnerable to it.
- To study the association of RTAs with sociodemographic factors among the participants
- To identify the risk factors associated with increasing severity of RTA among the participants
- To give recommendations on the probable approach that could optimally minimize the occurrence of RTAs among the vulnerable population.
| Methodology|| |
This study was a retrospective, cross-sectional, and observational study.
Patients admitted to the trauma ward of the casualty of a tertiary care center in Nashik due to RTAs in the past 1 year.
All the patients in the records with chief complaints of RTAs and admitted through the casualty.
The study duration was 6 months from the date of approval from the Ethics Committee.
All the patients in the medical records with complaints of RTAs during the study period were included in the study.
A total enumeration of all the patients' records admitted with complaints of RTAs in the casualty in a tertiary care hospital, Nashik, from 2018 to 2019.
Data were collected from the medical records of the patients admitted with complaints of RTAs within 2018–2019.
All the relevant data would be entered in the statistical software IBM Corp. Released 2017. IBM SPSS Statistics for Windows, Version 25.0. Armonk, NY: IBM Corp. and analyzed. All the quantitative data were statistically analyzed, and descriptive analysis of the results was displayed.
This study has obtained prior approval from the Institutional Ethics Committee on 14/05/2020 with approval no. Dr. VPMCH and RC/IEC/04/2019–20.
| Results|| |
A total of 486 victims of RTAs were included from the medical records of the casualty of a tertiary care hospital, out of which 330 were from 2018 and 156 from 2019. A look at the sociodemographic profiles of the RTA victims showed that females comprised only 19.3% (2018) and 18.6% (2019) of the total victims in RTAs, whereas majority, 80.6% (2018) and 81.4% (2019), were males during the same period.
[Figure 1] shows the distribution of the age group among male and female victims during the study period, and it shows a wide variation in the range in certain age groups. Among the female gender, there is a moderate decline among RTA victims (21–40 years) from 10.0% in 2018 to7.1% in 2019. Whereas, apart from a negligible increase of female victims among the age group of <20 years, there is a significant increase from 3.9% to 7.1% in the 41–60 years and a drop of 2.4%–1.9% in the >60 years age group. Comparatively, among male victims of RTAs, it was seen that there was a minimal downward shift in the numbers of victims from 44.8% in 2018 to 43.6% in 2019.
|Figure 1: Distribution of the sample population as per age and gender. RTA: Road traffic accidents|
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[Table 1] shows the distribution of accident severity among different age group victims. It is seen that most of the accidents have occurred in the 21–40 years' age group and having larger distribution in the severe grade (21.8% in 2018 and 10.3% in 2019) in both the years. Overall, we can also observe that both in 2018 (38.5%) and 2019 (50.6%), most of the RTAs among victims were of moderate grade. Very fewer victims (8.2% in 2018 and 5.8% in 2019) were in the elderly age group (>60 years old). It is seen that among the age group of 41–60 years RTA victims, more numbers were involved in 2018 (20.6%) as compared to 2019 (24.4%)
[Table 2] shows the distribution of anatomical site of injury to the severity scale as per the Abbreviated Injury Scale (AIS). Overall, in 2018, the severity of injury was higher (level 3%–37.3%) as compared to 2019 (level 2%–39.7%). The level of severity among head trauma victims was higher in all categories as compared to injury to other anatomical parts of the body. Comparatively, Grade 3 severity among head trauma victims was higher (24.5%) in 2018, whereas it was Grade 2 (30.1%) in 2019. Furthermore, the critical level of severity (Grade 5) was higher in 2018 (6.4%) as compared to 2019 (3.8%). On comparison of facial trauma victims, it is seen that a greater number of patients suffered in all levels of severity in 2019 than in 2018. Even among victims of multiple injuries, Grade 2 category was higher (3.8%) in 2019 as compared to 2018 (2.7%). Abdominal trauma patients had the least severity on an average in all categories in both the years (2018 and 2019)
|Table 2: Distribution of injuries according to the Abbreviated Injury Scale|
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[Table 3] shows the distribution of area of injury on the human body with the severity after the RTAs among victims. In 2018, most of the RTA injuries were associated with trauma to the head (73.3%), followed by multiple injuries (13.3%), chest trauma (7.58%), facial trauma (5.15%), and a miniscule percentage had abdominal trauma (0.61%). In 2019, majority of the victims had sustained head trauma (65.4%), followed by facial trauma (17.9%), multiple injuries (11.5%), chest trauma (3.8%), and abdominal trauma (1.3%). It is observed that in 2018, majority of the victims had severe head trauma (29.7%) closely followed by victims with moderately severe trauma to the head (27.58%). Comparatively, in 2019, we see that most of the victims had moderate trauma (34.6%) and fewer had severe trauma (12.2%) to the head, which shows a distinct decrease. Again, severe multiple injuries were higher in 2018 (6.67%) as compared to 2019 (3.2%). Overall, the severe multiple injuries due to RTAs in 2018 (42.12%) were much higher than in 2019 (23.7%).
|Table 3: Distribution of injuries severity and category among the participants|
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| Discussion|| |
The purpose of this study has been to enhance the quality of information related to injuries due to RTAs and its demographic distribution. Even with better roads, infrastructure, and health information for drivers, there is also a need to monitor the prevalence of RTAs to develop better plans of safety on the road. Our study shows that 21–40 years age group is the most vulnerable with the highest percentage of accidents (2018‒54.8% and 2019‒50.6%) as compared to other age groups. Next is the 41–60 years age group (2018–20.6% and 2019–24.4%) which is having a high percentage of RTAs. Furthermore, as seen in [Figure 1], males were more likely to be involved in accidents than females. A study in India (2017) similarly published that 30–59 years age group is the most vulnerable, and males are more likely to be involved in RTAs. Another study from Bangladesh reported that 15–44 years age group are the most vulnerable, and males accounted for 73% of the mortality in RTAs. A study in Delhi analyzed 3 years of data to conclude that among others, gender, vehicle speed, and traffic volume were significantly associated with the risk of RTAs.
AIS is an internationally recognized scoring system for a variety of traumatic injuries since its beginnings as a marker used for tracking injuries in automotive and aircraft mishaps. In our study, we see that head injury victims have a higher severity score in all grades than injuries to other parts of the body. A study on severity risks of specific injuries due to RTA found that head injuries were associated with a score of AIS 2+. Our study showed that compared to the injury to other anatomical parts of the body, head injury carried a higher AIS grade even till level 5 (2018–6.4% and 2019–3.8%). A similar study on motor vehicular accidents involving drivers found that head injury victims scored 3+ in the AIS grading. In our study, victims of abdominal trauma were very few, but among those who received the injury the AIS score was 3+ in both 2018 and 2019. Similarly, a study involving abdominopelvic injuries due to RTAs showed that injury score was in the range of four and five.
In this study, it is seen that head injury constitutes most RTAs both in 2018 (73.3%) and 2019 (65.4%). A similar study reported that nonhelmet-wearing riders have a four times higher risk of head injuries in a vehicular accident. Our study showed that there was a steep increase in facial injuries from 2018 (5.2%) to 2019 (17.9%). A 12-year retrospective study in Gujarat found that maxillofacial injuries are the most common in RTAs in developing countries. Other studies have also pointed out that riders without helmets and those with helmets who sustained visor damage were most likely to suffer from trauma to the face during a vehicular accident., In this study, we also found that multiple injuries due to RTA were 13.3% (2018) and 11.5% (2019), respectively, in which most of the fatalities were in the 21–40 years age group in both 2018 (7.9%) and 2019 (5.1%). A descriptive study in China (2017) stated that multiple injuries constituted 40.6% of the total injuries recorded which was way higher than our findings. A study in the Netherlands found a high incidence of multiple traumas, cerebral hemorrhage, and fractures among bicycle victims of RTA. A worldwide collaborative review article has grim predictions for India which has already overtaken China as the RTAs capital of the world, saying that it would most likely cross the mark of 250,000 within the next 4 years. A similar exploratory study in Bihar concluded that the occurrence of accident is independent of age and sex distribution, but the severity of injuries are seen more in the third and fourth decades of life.
| Conclusion|| |
This study questions the reasons or lack thereof as far as increasing RTAs are concerned in the present India. The burgeoning middle-class population and the availability of vehicles in all forms and sizes exponentially increase the probability of accidents on the road. Combine this with a lack of education, awareness, belligerence, substance of influence, lawlessness, and exposure to a gargantuan social media with its thrills and chills, we are looking at a chasm of impossibilities. The need of the hour is to bring about a change from within through self-reflection of lawmakers, strict implementation of traffic rules and guidelines with hefty fines, lockup, and criminal punishment to habitual wrongdoers. More than that, a vigorous campaign through social media, banners, advertisements, school health programs, village skit plays, movies, dramas, Panchayat meetings, etc., to bring about a broad awareness about safety against RTAs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
World Health Organization. Global Status Report on Road Safety 2015. WHO Bulletin: World Health Organization; 2015.
Shetty B, Kanchan T, Menezes RG, Bakkannavar SM, Nayak VC, Yoganarasimha K. Victim profile and pattern of thoraco-abdominal injuries sustained in fatal road traffic accidents. J Indian Acad Forensic Med 2012;34:16-9.
Lyu N, Cao Y, Wu C, Xu J, Xie L. The effect of gender, occupation and experience on behavior while driving on a freeway deceleration lane based on field operational test data. Accid Anal Prev 2018;121:82-93.
Zhang G, Yau KK, Zhang X, Li Y. Traffic accidents involving fatigue driving and their extent of casualties. Accid Anal Prev 2016;87:34-42.
Souto CC, Reis FK, Bertolini RP, Lins RS, Souza SL. Profile of work-related road traffic accident victims recorded by sentinel health units in Pernambuco, Brazil, 2012-2014. Epidemiol Serv Saude 2016;25:351-61.
Hong V, Iwamoto SK, Goto R, Young S, Chomduangthip S, Weeranakin N, et al.
Socio-demographic determinants of motorcycle speeding in Maha Sarakham, Thailand. PLoS One 2020;15:e0243930.
Lomia N, Berdzuli N, Sharashidze N, Sturua L, Pestvenidze E, Kereselidze M, et al.
Socio-demographic determinants of road traffic fatalities in women of reproductive age in the republic of Georgia: Evidence from the national reproductive age mortality study (2014). Int J Womens Health 2020;12:527-37.
Kumar PS, Srinivasan K. To study the socio demographic profile of road traffic accident victims in district hospital, Karimnagar. Int J Res Dev Health 2013;1:136-40.
Kahn PS, Hussain RA. An epidemiological study of road traffic accident cases attending a tertiary care hospital, Tirupati. IOSR Journal of Dental and Medical Sciences, Volume 14, Issue 9 Ver. III (Sep. 2015), pp 38-43.
Gudadinni MR, Nuchhi UC, Angadi MM. A study of road traffic accident cases admitted in BLDEU'S Shri BM Patil Medical College Hospital and Research Centre, Bijapur. Indian J Forensic Med Toxicol 2013;7:48.
Gorea R. Financial impact of road traffic accidents on the society. IJETV 2016;2:6.
Alemany R, Ayuso M, Guillén M. Impact of road traffic injuries on disability rates and long-term care costs in Spain. Accid Anal Prev 2013;60:95-102.
Gennarelli TA, Wodzin E. Abbreviated injury scale 2005: update 2008. Russ Reeder. 2008. Association for the Advancement of Automotive Medicine, Barrington, IL • USA;200.
Singh SK. Road traffic accidents in India: Issues and challenges. Transp Res Procedia 2017;25:4708-19.
Anjuman T, Hasanat-E-Rabbi S, Siddiqui CK, Hoque MM. Road traffic accident: A leading cause of the global burden of public health injuries and fatalities. InInProc. Int. Conf. Mech. Eng. Dhaka Bangladesh 2020 Dec (pp. 29-31).
Rankavat S, Tiwari G. Pedestrians risk perception of traffic crash and built environment features – Delhi, India. Saf Sci 2016;87:1-7.
Loftis KL, Price J, Gillich PJ. Evolution of the abbreviated injury scale: 1990-2015. Traffic Inj Prev 2018;19:S109-13.
Weaver AA, Talton JW, Barnard RT, Schoell SL, Swett KR, Stitzel JD. Estimated injury risk for specific injuries and body regions in frontal motor vehicle crashes. Traffic Inj Prev 2015;16 Suppl 1:S108-16.
Conroy C, Tominaga GT, Erwin S, Pacyna S, Velky T, Kennedy F, et al.
The influence of vehicle damage on injury severity of drivers in head-on motor vehicle crashes. Accid Anal Prev 2008;40:1589-94.
Subedi N, Yadav B, Jha S. Application of abbreviated injury scale and injury severity score in fatal cases with abdominopelvic injuries. Am J Forensic Med Pathol 2014;35:275-7.
Yu WY, Chen CY, Chiu WT, Lin MR. Effectiveness of different types of motorcycle helmets and effects of their improper use on head injuries. Int J Epidemiol 2011;40:794-803.
Weihsin H, Thadani S, Agrawal M, Tailor S, Sood R, Langalia A, et al
. Causes and incidence of maxillofacial injuries in India: 12-year retrospective study of 4437 patients in a tertiary hospital in Gujarat. Br J Oral Maxillofac Surg 2014;52:693-6.
Abhinav RP, Selvarasu K, Maheswari GU, Taltia AA. The patterns and etiology of maxillofacial trauma in South India. Ann Maxillofac Surg 2019;9:114-7.
] [Full text]
Kumar R, Sarkar B, Kumar A, Azam Q. Socio-demographic analysis of injury pattern among road traffic accident victims admitted in a tertiary care hospital. Int J Orthop 2021;7:39-42.
Yu W, Chen H, Lv Y, Deng Q, Kang P, Zhang L. Comparison of influencing factors on outcomes of single and multiple road traffic injuries: A regional study in Shanghai, China (2011-2014). PLoS One 2017;12:e0176907.
de Guerre LE, Sadiqi S, Leenen LP, Oner CF, van Gaalen SM. Injuries related to bicycle accidents: An epidemiological study in The Netherlands. Eur J Trauma Emerg Surg 2020;46:413-8.
Mohammed AA, Ambak K, Mosa AM, Syamsunur D. A review of traffic accidents and related practices worldwide. The Open Transportation Journal. 2019 Jun 30;13(1).
Sinha AP. Study of orthopedic injuries pattern by road traffic accident victims. Int J Life Sci Sci Res 2017;3:961-3.
[Table 1], [Table 2], [Table 3]