Cape Saint Claire, MD, United States
Cape Saint Claire, MD, United States

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Esser M.B.,Johns Hopkins International Injury Research Unit | Bao J.,Johns Hopkins International Injury Research Unit | Hyder A.A.,Johns Hopkins International Injury Research Unit
American Journal of Public Health | Year: 2016

Objectives.To evaluate the evidence base for the content of initiatives that the alcohol industry implemented to reduce drink driving from 1982 to May 2015. Methods. We systematically analyzed the content of 266 global initiatives that the alcohol industry has categorized as actions to reduce drink driving. Results. Social aspects public relations organizations (i.e., organizations funded by the alcohol industry to handle issues that may be damaging to the business) sponsored the greatest proportion of the actions. Only 0.8% (n = 2) of the sampled industry actions were consistent with public health evidence of effectiveness for reducing drink driving. Conclusions. The vast majority of the alcohol industry's actions to reduce drink driving does not reflect public health evidenced-based recommendations, even though effective drink-driving countermeasures exist, such as a maximum blood alcohol concentration limit of 0.05 grams per deciliter for drivers and widespread use of sobriety checkpoints.


Hyder A.A.,Johns Hopkins International Injury Research Unit
Journal of Public Health (United Kingdom) | Year: 2013

BackgroundBurns are a significant cause of mortality and morbidity in developing countries. We examined the epidemiology of unintentional burns in South Asia to identify trends and gaps in information.MethodsA MEDLINE/PUBMED search (1970-2011) was undertaken on empirical studies that focused on burns in India, Pakistan, Bangladesh and Sri Lanka. Data analyzed included demographics, injury details and risk factors.ResultsTwenty-seven studies were identified, mostly from India. Burns were more common among males at younger ages (0-12 years) and among females from adolescence onward (>14 years). Flame-related burns and scalds accounted for over 80% of burns in most cases, and were the most common types of injuries observed among children and women with most burns occurring in the home. Electrical burns occurred mostly among men. Important risk factors for burns included low socioeconomic status, being younger, wearing loose, flammable clothing and the use of kerosene. Data on care-seeking and treatment were limited.ConclusionsPreventing burns in the household in South Asia, particularly around kitchen activities, is essential. Children in South Asia are susceptible to burns and are an important target population. Future research should focus on filling the gaps in burn epidemiology found in this review. © The Author 2013, Published by Oxford University Press on behalf of Faculty of Public Health.


Esperato A.,Johns Hopkins International Injury Research Unit | Bishai D.,Johns Hopkins International Injury Research Unit | Hyder A.A.,Johns Hopkins International Injury Research Unit
Traffic Injury Prevention | Year: 2012

Objective: The Road Safety in 10 Countries (RS-10) project will implement 12 different road safety interventions at specific sites within 10 low- and middle-income countries (LMICs). This evaluation reports the number of lives that RS-10 is projected to save in those locations, the economic value of the risk reduction, and the maximum level of investment that a public health intervention of this magnitude would be able to incur before its costs outweigh its health benefits. Methods: We assumed a 5-year time implementation horizon corresponding to the duration of RS-10. Based on a preliminary literature review, we estimated the effectiveness for each of the RS-10 interventions. Applying these effectiveness estimates to the size of the population at risk at RS-10 sites, we calculated the number of lives and life years saved (LYS) by RS-10. We projected the value of a statistical life (VSL) in each RS-10 country based on gross national income (GNI) and estimated the value of the lives saved using each country's VSL. Sensitivity analysis addressed robustness to assumptions about elasticity, discount rates, and intervention effectiveness. Results: From the evidence base reviewed, only 13 studies met our selection criteria. Such a limited base presents uncertainties about the potential impact of the modeled interventions. We tried to account for these uncertainties by allowing effectiveness to vary ±20 percent for each intervention. Despite this variability, RS-10 remains likely to be worth the investment. RS-10 is expected to save 10,310 lives over 5 years (discounted at 3%). VSL and $/LYS methods provide concordant results. Based on our estimates of each country's VSL, the respective countries would be willing to pay $2.45 billion to lower these fatality risks (varying intervention effectiveness by ±20 percent, the corresponding range is $2.0-$2.9 billion). Analysis based on $/LYS shows that the RS-10 project will be cost-effective as long as its costs do not exceed $5.14 billion (under ±20% intervention effectiveness, the range = $4.1-$6.2 billion). Even at low efficacy, these estimates are still several orders of magnitude above the $125 million projected investment. Conclusion: RS-10 is likely to yield high returns for invested resources. The study's chief limitation was the reliance on the world's limited evidence base on how effective the road safety interventions will be. Planned evaluation of RS-10 will enhance planners' ability to conduct economic assessments of road safety in developing countries. © 2012 Copyright Taylor and Francis Group, LLC.


Chandran A.,Johns Hopkins International Injury Research Unit | Sousa T.R.V.,Federal University of Rio Grande do Sul | Guo Y.,Johns Hopkins International Injury Research Unit | Bishai D.,Johns Hopkins International Injury Research Unit | Pechansky F.,Federal University of Rio Grande do Sul
Traffic Injury Prevention | Year: 2012

Objective: According to the World Health Organization, the global burden of road traffic mortality exceeds 1.27 million people annually; over 90 percent occur in low- and middle-income countries. Brazil's road traffic mortality rate of ~20 per 100,000 is significantly higher than nearby Chile or Argentina. To date, there has been very little information published on road traffic fatalities among vulnerable road users (VRUs) in Brazil. Methods: Road traffic fatality data from 2000 to 2008 were extracted from Brazil's Mortality Information System (SIM). Road traffic deaths were extracted using the International Classification of Diseases (ICD-10) V-codes (V01-V89) and then subcategorized by VRU categories. Information was then disaggregated by gender, age, and region. Results: In 2008, 39,211 deaths due to road traffic injuries were recorded in Brazil, resulting in a crude mortality rate of 20.7 per 100,000 inhabitants. Pedestrian mortality averaged 5.46 deaths per 100,000 between 2000 and 2008. The mortality rate for elderly pedestrians (80+ years) is 20.1 per 100,000, over 10 times that of 0- to 9-year-olds. In the past decade, motorcycle occupant mortality has dramatically increased by over 300 percent from 1.5 per 100,000 in 2000 to 4.7 per 100,000 in 2008. The 20- to 29-year age group remains most affected by motorcycle deaths, with a peak fatality rate of 10.76 per 100,000 in 2008. The north and northeast regions, with the lower per capita gross domestic product (GDP), have higher proportions of VRU deaths compared with other regions. Conclusions: Vulnerable road users are contributing an increasing proportion of the road traffic fatalities in Brazil. Nationally, elderly pedestrians are at particularly high risk and motorcycle fatalities are increasing at a rapid rate. Less prosperous regions have higher proportions of VRU deaths. Understanding the epidemiology of road traffic mortality in vulnerable road user categories will better allow for targeted interventions to reduce these preventable deaths. © 2012 Copyright Taylor and Francis Group, LLC.


Puvanachandra P.,Johns Hopkins International Injury Research Unit | Hoe C.,Johns Hopkins International Injury Research Unit | Ozkan T.,Ankara University | Lajunen T.,Ankara University
Traffic Injury Prevention | Year: 2012

Objective: Road traffic injuries (RTIs) are one of the leading causes of global deaths, contributing to 1.3 million lives lost each year. Although all regions are affected, low- and middle-income countries share a disproportionate burden. The significance of this public health threat is growing in Turkey, where current estimates show that 2.0 percent of all deaths in the country are due to RTIs. Despite the significance of this growing epidemic, data pertaining to RTIs in Turkey are limited. In order to address the gap in knowledge, this article presents an overview of the epidemiology of RTIs in Turkey through an analysis of available secondary data sets and a comprehensive review of scientifically published studies. Methods: A literature review was performed during December 2010 using PubMed, Embase, and ISIS Web of Knowledge databases and Google search engines. Peer-reviewed literature pertaining to Turkey and RTIs were selected for screening. Secondary data were also procured with assistance from Turkish colleagues through an exploration of data sources pertaining to RTIs in Turkey. Results: The literature review yielded a total of 70 studies with publication years ranging from 1988 to 2010. Secondary data sources were procured from the ministries of Health and Interior as well as the Turkish Statistical Institute. These data sources focus primarily on crashes, injuries, and fatalities (crash rate of 1328.5 per 100,000 population; injury rate of 257.9 per 100,000 population; fatality rate of 5.9 per 100,000). Risk factor data surrounding road safety are limited. Conclusion: The findings reveal the significant burden that RTIs pose on the health of the Turkish population. The introduction of new technologies such as the novel digital recording systems in place to record pre-hospital services and Global Positioning System (GPS) tracking of road traffic crashes by the police have allowed for a more accurate picture of the burden of RTIs in Turkey. There are, however, some considerable gaps and limitations within the data systems. Incorporation of standardized definitions, regular data audits, and timely review of collated data will improve the utility of RTI data and allow it to be used for policy influence. © 2012 Copyright Taylor and Francis Group, LLC.


Ma S.,Johns Hopkins International Injury Research Unit | Li Q.,Johns Hopkins International Injury Research Unit | Zhou M.,U.S. Center for Disease Control and Prevention | Duan L.,U.S. Center for Disease Control and Prevention | Bishai D.,Johns Hopkins International Injury Research Unit
Traffic Injury Prevention | Year: 2012

Objective: Road traffic injury (RTI) has become one of the leading causes of deaths in China, yet numbers on road traffic deaths are often inconsistent. This study sought to systematically review 4 national-level data sources that can be used to estimate burdens of RTI, including mortality, injury, and crashes in China. Methods: We conducted structured literature reviews in PubMed, using combined key words of injury or fatality or injury surveillance and traffic and China in order to identify relevant studies (in both English and Chinese) and data sources. We also conducted interviews and hosted seminars with key researchers from the Chinese Center for Disease Control and Prevention (Chinese CDC) to identify potential useful data sources for injury surveillance. We then extracted key information from publicly available reports of each data source. Results: Four national-level data sources were reviewed and compared: Ministry of Health-Vital Registration (MOH-VR) System, Chinese CDC-Disease Surveillance Points (DSP), Chinese CDC-National Injury Surveillance System (NISS), and police reports. Together they provide a complementary yet somewhat contradictory epidemiological profile of RTIs in China. Estimates on road traffic fatalities obtained from MOH-VR and police reports are often used by researchers and policymakers, whereas DSP and NISS, both with great merits, have virtually not been used for RTI research. Despite the well-documented problems of underreported deaths with both MOH-VR and DSP, estimated road traffic deaths from both systems were 3 times those reported by the police. Conclusions: As the foundation of injury prevention, national-level data sources and surveillance systems were reviewed in the study. Existing data infrastructures present the Chinese government a great opportunity to strengthen and integrate existing surveillance systems to better track road traffic injury and fatality and identify the population at risk. © 2012 Copyright Taylor and Francis Group, LLC.


Barffour M.,Johns Hopkins International Injury Research Unit | Gupta S.,Johns Hopkins International Injury Research Unit | Gururaj G.,National Institute of Mental Health and Neuro Sciences | Hyder A.A.,Johns Hopkins International Injury Research Unit
Traffic Injury Prevention | Year: 2012

Objective: To assess the availability and coverage of publicly available road safety data at the national and state levels in India. Methods: We reviewed the 2 publicly accessible data sources in India for the availability of data related to traffic injuries and deaths: (1) the National Crime Records Bureau (NCRB) and (2) the Ministry of Road Transport and Highways (MORTH). Using the World Health Organization (WHO) manual for the comprehensive assessment of road safety data, we developed a checklist of indicators required for comprehensive road safety assessment. These indicators were then used to assess the availability of road safety data in India using the NCRB and MORTH data. We assessed the availability of data on outcomes and exposures indicators (i.e., number of crashes, injuries, deaths, timing of deaths, gender and age distribution of injuries and deaths), safety performance indicators (i.e., with reference to select risk factors of speeding, alcohol, and helmet use), and cost indicators (i.e., medical costs, material costs, intervention costs, productivity costs, time costs, and losses to quality of life). Results: Information on outcome indicators was the most comprehensive in terms of availability. Both NCRB and MORTH databases had data for most of the need areas specified by the WHO under outcomes and exposure indicators. Regarding outcome and exposure indicators, data were available for 81 and 91 percent of specified need areas at the national level from NCRB and MORTH databases, respectively. At the state level, data on outcome and exposure indicators were available for only 54 percent of need areas from either of the 2 sources. There were no data on safety performance indicators in the NCRB database. From the MORTH database, data availability on safety performance indicators was 60 percent at both national and state levels. Data availability on costs and process indicators was found to be below 20 percent at the national and state levels. Conclusion: Overall, there is an urgent need to improve the publicly available road safety data in India. This will enhance monitoring of the burden of traffic injuries and deaths, enable sound interpretation of national road safety data, and allow the formulation effective road safety policies. © 2012 Copyright Taylor and Francis Group, LLC.


Vecino-Ortiz A.I.,Johns Hopkins International Injury Research Unit | Hyder A.A.,Johns Hopkins International Injury Research Unit
Journal of Urban Health | Year: 2015

Road injuries are an important cause of global mortality especially in low- and middle-income countries. While these countries undergo major urban transformations, an integral part of their development has often been the implementation of mass transportation systems, including Bus Rapid Transit (BRT) systems. However, the net effect of BRT systems on road safety is still unclear, and while there is reason to believe that BRT systems improve safety, very few available empirical studies have tested this hypothesis using observational data. Furthermore, the existing evidence is mixed and sparse. This paper reviews the available literature on the links of BRT systems and road safety and calls for more research to strengthen the body of evidence on the effect of BRT systems on road safety  in the future. © 2015, The New York Academy of Medicine.


Bhalla K.,Johns Hopkins International Injury Research Unit | Mohan D.,Indian Institute of Technology Delhi
IATSS Research | Year: 2015

The safety of children younger than 10. years on motorized two-wheeled vehicles (MTWs) in low- and middle-income countries receives substantial attention from global road safety advocates. However, there is little empirical evidence available to describe the magnitude of the problem. Therefore, we constructed a population-level database of road traffic injury statistics disaggregated by age (<. 5, 5-9, 10. + years) and mode of transport. Our database included mortality data from 44 countries and 5 Indian cities, and hospital admissions from 17 countries. The MTW fleet in these settings ranged from 2% to 70% of all registered vehicles. We find that children under 5. years averaged 0.05% (SD 0.13%) of all road traffic deaths, and 5-9. year olds averaged 0.11% (SD 0.25%). Even in regions with high prevalence of MTWs, young children comprised at most 1.5% of all road traffic deaths and 5.8% of all MTW deaths. Young children were a slightly larger proportion of all road traffic deaths in countries where MTWs were more common. However, after adjusting for population age structure, this effect was no longer evident. The percentage of child road traffic injuries that are due to MTWs increased with increasing MTW use, but at a much lower rate. Our findings suggest that children may be at lower risk from MTW crashes than previously assumed, and certainly at a lower risk than as pedestrians. Further studies are needed to explain the underlying mechanisms that regulate risk of road users. © 2014.


Bhalla K.,Johns Hopkins International Injury Research Unit | Harrison J.E.,Flinders University
International Journal of Epidemiology | Year: 2015

Background: We assessed the quality of Global Burden of Disease-2010 (GBD-2010) estimates of road injury deaths by comparing with government statistics for Organisation for Economic Co-operation and Development (OECD) countries that report to the International Road Traffic Accident Database (IRTAD).Methods: We obtained tabulated data for 25 OECD countries that report to IRTAD and also report vital registration (VR) data to WHO. We collated VR deaths corresponding to the GBD-2010 road injury definition and estimated 'traffic', 'non-traffic' and 'unspecified whether traffic or non-traffic' components. We estimated national road injury deaths by redistributing partially specified causes of death, as was done by GBD until this was replaced by more complex methods in GBD-2010.Results: GBD-2010 estimates of road injury deaths exceeded IRTAD by 45% overall. IRTAD values fell below the GBD-2010 95% uncertainty interval in all but three countries. Mismatch of conceptual scope accounted for about 8% of this discrepancy, 5% was because GBD-2010 included cases other than road traffic and 3% because GBD-2010 (unlike IRTAD) includes deaths >30 days after injury. Pro rata distribution of partially specified causes in VR data gave estimates that were 18% higher than IRTAD but closer than GBD-2010 estimates for all but two countries. Cases in VR data specified as road injury gave estimates closer to IRTAD. Conclusions: GBD-2010 road injury mortality estimates are substantially higher than the road death toll in OECD countries. The discrepancy is not explained by wider scope of the GBD road injury construct nor by undercounting by IRTAD. GBD-2010 likely attributed substantially more deaths with partially specified causes to road injuries than is appropriate. © The Author 2015; all rights reserved. Published by Oxford University Press on behalf of the International Epidemiological Association.

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