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The epidemiology of road traffic injuries in the Republic of Lithuania, 1998–2007

Raimundas Lunevicius, Hadley K. Herbert, Adnan A. Hyder
DOI: http://dx.doi.org/10.1093/eurpub/ckq007 702-706 First published online: 8 February 2010

Abstract

Background: This article highlights the epidemiology of road traffic injury (RTI) in Lithuania between 1998 and 2007. The purpose of this study is to explore the incidence of RTI, age-standardized mortality rates (ASMR), gender-specific rates and the RTI profile of different user groups. In doing so, this analysis attempts to emphasize the need for RTI prevention policies and programmes. Methods: Six databases were analysed using ICD-10 codes V01–V99, pertaining to the causes of road traffic crashes. Data between 1998 and 2007 were obtained from these databases to identify and calculate RTI incidence and mortality rates. This was then analysed with regard to ASMR, gender, user groups and the use of alcohol. Results: In 2007, RTI incidence in Lithuania was reported as 270/100 000 people, 10.7% higher than in 1998. ASMR declined from 28 deaths per 100 000 in 1998 to 25 deaths per 100 000 in 2007. Between 1998 and 2007, the male ASMR declined from 46 to 40 deaths per 100 000 and the female ASMR decreased from 13 to 11 deaths per 100 000. Car occupant and pedestrian fatalities comprised 87% of all RTI deaths. Thirty-four percent of those injured and 21% of the dead were under influence of alcohol. Conclusions: From 1998 to 2007, the incidence of RTI has worsened and mortality rates remain high in Lithuania. Alcohol remains a prominent risk factor of traffic injury and death. The need to develop effective prevention programmes to address traffic injury is essential.

  • Eastern Europe
  • Lithuania
  • road accidents
  • road traffic injuries
  • trauma

Introduction

Road traffic injury (RTI) is a leading cause of death in the world and Europe.1–3 In the European region, ∼2.4-million people are injured and 127 000 are killed annually from RTI, with RTI-related costs exceeding 2% of the European Gross Domestic Product.4 In 2002, RTI accounted for 16% of all deaths in Europe, making it the leading cause of death for individuals aged 5- to 29-years old.4 Lithuania has the highest traffic-related mortality rate in Europe.5 While the World Health Organisation reported in May 2009 that 73% of Lithuanian’s RTI prevention programmes have implemented interventions, the incidence and mortality rates of RTI have failed to significantly decrease, making this a major public health concern.6

A 2003 national longitudinal study revealed an increasing trend in the prevalence of RTI in Lithuania between 1990 and 1997.7 This study showed that despite a decline in other age groups, males aged 20–24 years and females aged 10–14 and 20–29 years had an increase in RTI incidence. Studies on mortality among children and adolescents show that RTI-related deaths among adolescents have increased in Lithuania since 1971.7–13 In particular, one retrospective study found the RTI mortality rate for Lithuanian adolescents aged 15- to 19-years-old increased by 34.5% between 1971 and 2005.9 Despite this trend, no study has examined RTI incidence among all age groups in Lithuania since 1997.7 Moreover, while ICD-10 codes have been available since 1998, Lithuanian studies have not used these codes to categorize national RTI incidence and mortality rates.3,14

The primary objective of this study is to explore the epidemiology of RTI in Lithuania between 1998 and 2007. Specifically, this article will examine trends related to the overall RTI incidence and mortality, gender- and age-related mortality and the influence of alcohol as a risk factor. We hope such analyses will encourage a dialogue in Lithuania to address traffic injury and implement effective injury prevention policies and initiatives.

Methods

This study analysed information from six Lithuanian databases. As outlined in table 1, these databases were used to identify and calculate the characteristics of RTI, including incidence and mortality rates. The International Statistical Classification of Diseases and Related Health Problems (ICD-10) codes V01–V99 were used to search for mortality data within the European Detailed Mortality Database.14,15 Codes pertaining to pedestrian injury (V01–V09), pedal-cyclist injury (V10–V19), motorcyclist injury (V20–V21) and car occupant injury (V30–V99) were included.

View this table:
Table 1

Databases used to identify and calculate RTI-related indicators

DatabaseIndicators
Department of Statistics for the Government of the Republic of Lithuania16Lithuanian population size
Lithuanian Police Traffic Supervision Service Database17Total number of motor vehicles in the country
Incidence of road traffic crashes
Incidence of RTI, 1998–2007
RTI survival rates
Number of deaths and ASMR from RTI, 2007
Alcohol-related RTI, 1999–2007
Lithuanian State Enterprise ‘Regitra’18Total number of motor vehicles in the country
Lithuanian Road Administration19Lithuania’s total road length
The European Detailed Mortality Database15Incidence of RTI, 1998–2007
Mortality rates, 1998–2007
Number of deaths and ASMR from RTI, 1998–2007
Lithuanian Health Information Centre20Incidence of RTI, 1998–2007
Mortality rates, 2007
Number of deaths and ASMR from RTI, 2007
  • ASMR per 100 000 population per year.

Data from Lithuania between 1998 and 2007 were entered, calculated and analysed in Microsoft Office Excel 2003. RTI incidence was calculated from data pertaining to the number of injured, defined as cases per 100 000 population per year. Age-standardized mortality rates (ASMR) based on the European population standard,15 gender-specific rates and the distribution of different user groups among the injured and dead were estimated from these databases. Ratios of RTI injury per crash, deaths per crash and deaths per injury were also calculated. The role of alcohol in crashes and deaths was examined using the Lithuanian Police Traffic Database. Data, however, from the Police Traffic Database were not available for 1998. Thus, in evaluating alcohol as a risk factor, data from 1999 to 2007 were used.

Results

Time trends of RTI incidence, ASMR and traffic crash rates between 1998 and 2007 are shown in figure 1. While there appears to be an increase in the occurrence of crashes, mortality rates remain unchanged. In 1998, there were 3.5-million inhabitants in Lithuania and 8669 reported RTIs; while Lithuania’s population declined to 3.3-million in 2007, the number of RTIs increased to 9111. Thus the overall RTI incidence was 10.7% higher in 2007 (270/100 000) compared to 1998 (244/100 000). While the RTI-related ASMR decreased from 28 to 25 deaths per 100 000 population per year between 1998 and 2007, the road traffic crash rate was 7.7% higher in 2007 when compared with 1998. During this time period, the number of vehicles per 1000 people increased from 308 in 1998 to 585 in 2007, but Lithuania’s total road length remained unchanged, consisting of 80 000 km.

Figure 1

Time trends of road traffic crashes, overall traffic injury incidence, and mortality between 1998 and 2007, Lithuania (Source: Lithuanian Police Traffic Supervision Service database,17 the European Detailed Mortality Database20 and Lithuanian Health Information Centre20)

The ASMR among males decreased between 1998 and 2007, from 46 to 40 deaths per 100 000. When grouped according to age, males between the ages 20 and 24 years in 1998 had an ASMR of 81 deaths per 100 000. This rate declined to 59/100 000 by 2000, but remained consistently high in the following 7 years. In 2007, at 61/100 000, males aged 20–24 years had one of the highest mortality rates in any age group. Between 1998 and 2007, the ASMR among females decreased from 13 to 11 deaths per 100 000, respectively. The male to female mortality ratio was three to four times higher between 1998 and 2007.

Figure 2 shows the RTI-related ASMR averaged from 1998 to 2007. Both males and females demonstrate an overall increase in ASMR after 15 years of age. The mortality rates are similar for both genders <15 years of age: in children aged 10–14 years, the mortality rates for males and females are 7 and 5 per 100 000, respectively. The RTI mortality rate peaks among males aged 20–24 years (64 deaths per 100 000) and remains elevated in older age groups. Among female children and adolescents, mortality rates peak earlier at 15–19 years of age (14 deaths per 100 000). Additionally, the female elderly aged 75–79 years experience a high ASMR of 23 deaths per 100 000.

Figure 2

ASMR per 100 000 males, 100 000 females and 100 000 entire population (averaged for 1998–2007), Lithuania (Source: The European Detailed Mortality Database15)

Figure 3 highlights the distribution of RTI-related deaths as a percentage of all deaths in defined age groups averaged from 1998 to 2007. RTI is a leading cause of death for both males and females aged 1–34 years. This rate is highest among males between the ages 1 and 29 years, where RTI-related deaths account for >20% of all deaths.

Figure 3

Distribution of traffic-related deaths as a percentage of all deaths in defined age groups (averaged for 1998–2007), Lithuania (Source: the European Detailed Mortality Database15)

Between 1998 and 2007, there were 8751 road traffic fatalities in Lithuania, with an average of 875 deaths per year. Of these deaths, 50% (N = 4327) were car occupants, 37% (N = 3234) were pedestrians, 10% (N = 908) were cyclists and 3% (N = 282) were motorcyclists. When categorized according to ICD-10 codes, the ICD-10 V03 code, ‘pedestrian from collision with car, pick-up truck or van’ accounts for 30% (N = 2209) of traffic injury deaths between 1998 and 2007. Codes V47, ‘car occupant injured in collision with fixed or stationary object’, and V48, ‘car occupant injured in non-collision transport accident’ each account for 13% of deaths; code V43, ‘car occupant injured in collision with car, pick-up truck or van,’ accounts for 12%; and code V13 ‘pedal-cyclists injured in collision with car, pick-up truck or van’ accounts for 8% of RTI deaths. These five mechanisms comprise 77% of all traffic fatalities between 1998 and 2007 in Lithuania.

While car occupant and pedestrian cause-specific ASMR were similar in 1998 (13 and 12 deaths per 100 000, respectively), only pedestrian ASMR decreased to 8 deaths per 100 000 (N = 299) in 2007. Conversely, car occupant mortality rates increased to peak at 14 deaths per 100 000 (N = 480) in 2006. Between 1998 and 2007, cause-specific ASMRs among pedal cyclists and motorcyclists were unchanged at 2–3 and 1 death per 100 000, respectively.

The ratios of rates of injury per crash, death per crash and death per injury remained unchanged between 1998 and 2007. The ratio of injury per crash was 1.35 in 1998, when compared with 1.38 in 2007; the ratio of deaths per crash was 0.16 in 1998, compared with 0.13 in 2007; and the ratio of death per injury was 0.12 in 1998, compared with 0.10 in 2007. This indicates that for every two motor vehicle-related crashes, three people were injured and every seven crashes resulted in one death. Overall, every 10 RTIs resulted in one fatality in Lithuania.

Data from the Lithuanian Police Traffic Database were used to examine the prevalence of alcohol in road crashes between 1999 and 2007. On average 34% (N = 2898/year) of injured individuals and 21% (N = 184/year) of deaths were associated with a positive alcohol level at the time of the crash. The percentage of injuries and deaths related to alcohol has not significantly decreased between 1999 and 2007. In 1999, 35% of RTIs were related to alcohol. Eight years later, this decreased only from 1% to 34% in 2007. Similarly, alcohol-related deaths accounted for 21% of all traffic deaths in 1999, and decreased only to 19% in 2007.

Discussion

By exploring the epidemiology of RTIs in Lithuania, this study demonstrates that RTI remains a serious public health concern in Lithuania. While other developed countries have experienced a significant decline in traffic injury mortality rates since the 1960s, Lithuania’s RTI mortality rates have failed to decrease and are among the highest in the European Region.2,5,21 While Lithuania’s RTI-related ASMR decreased from 28 to 25 deaths per 100 000 population per year from 1998 to 2007, it remains much higher than the European Region’s 2007 ASMR of 13.4/100 000.22 Lithuania’s road network is considered one of the most dangerous in Europe, together with Bulgaria, Spain, Romania and Hungary.23 These findings support similar conclusions presented in analyses such as the Lithuanian National Health Board Annual Report, 2007 and the World Health Organization’s 2009 Global Status Report on Road Safety.24,25 This questions the effectiveness of existing national policies and interventions that address this burden within Lithuania’s health and transport sectors.

Results from this study show that males, youth, pedestrians and the elderly suffer a significant burden of RTI. Since mortality rates are three to four times higher in males than females, this may reflect a higher exposure to RTI risk factors among males. In general, every third death in those aged 20–24 years is a result of RTI. Approximately one-third of fatal RTIs are pedestrians involved in motor vehicle crashes, which according to ICD-10 codes, is the most common mechanism of RTI mortality in Lithuania. This study also shows that mortality rates are high in the elderly, aged ≥65 years. This is likely due to the fewer number of elderly within the population, their greater vulnerability to injury and reduced capacity for clinical recovery compared to younger individuals.26

This study shows one in every five RTI deaths is related to alcohol consumption. While the Law on Alcohol Control of the Republic of Lithuania was recently amended in 2008 to include detailed provisions regarding the restriction of both the sale and advertisement of alcohol, alcohol use remains a serious risk factor associated with RTI. Alcohol-related injuries and deaths have not decreased significantly from 1999 to 2007. A greater emphasis on effective policies is needed to implement drunken driving laws and address the dangers of driving while under the influence of alcohol.27–29

To date, the Lithuanian Ministry of Health has taken steps to address road safety through the establishment of the National Injury Prevention Program in 2000. This programme addresses legislation, road use and vehicle safety, while implementing education activities and traffic safety initiatives.9 Such legislation includes nationally set speed limits and laws regarding drunk driving, motorcycle helmets, seat belts and child restraints. According to the World Health Organization’s 2009 Global Status Report on Road Safety, these programmes received a score 6 out of 10 in terms of enforcement, with the exception of child restraint laws, which scores only 5 out of 10. This score represents a consensus of professional opinions, where a score of 10 is considered highly effective.25 While initiatives such as the National Injury Prevention Program suggest that policy makers are aware of the challenges regarding road safety, findings from this study support WHO’s consensus that current policies and programmes in Lithuania are only marginally effective. Hence, policies should be reviewed and evaluated carefully to address the effectiveness of seat belt safety laws, enforcement of speed limits, selected traffic-calming designs to control speed, drunk driving laws, graduated driving licenses for youth and safer road infrastructure.30

Data from this retrospective data analysis of six different national sources have been combined. The validity of each source was not assessed independently but all of these data banks are used for national consumption. In some instances, such as determining the prevalence of alcohol in traffic crashes, data was not available for specific years. These datasets capture only alcohol as a risk factor for RTI; data for other risk factors, such as the use of seat belts, crash helmets, cell phones and illicit drugs was not available. There is also a lack of detailed data regarding specific risks to different age groups, particularly the youth and elderly, across various traffic settings.

Data regarding age-specific patterns and injury-related risk factors are needed to further inform effective prevention strategies in Lithuania. Further prospective studies are also necessary to evaluate the extent to which these risk factors affect injury incidence. Finally, no information on the design and efficacy of trauma care in Lithuania and its influence on RTI outcomes are available. As a result, this study serves as a call to action to explore the predictors, risk factors and cost of care of RTIs in Lithuania. The results from this study and future studies will hopefully provide an empirical basis to aid in the development of Lithuania’s injury prevention strategy and implement specific interventions.4,31,32 By developing effective primary and secondary injury prevention programmes to address pre- and post-crash phases, Lithuania has the potential to lower its high rates of injury incidence and mortality in the next decade. The Global Ministerial Summit on Road Safety held in November 2010 in Russia offers a perfect opportunity for Lithuania to make such a commitment and monitor its progress to safer roads in the country.

Conflicts of interest: None declared.

Key points

  • From 1998 to 2007, the incidence of traffic injury has increased in Lithuania.

  • Road traffic fatalities remain high in Lithuania. Of these fatalities, 50% are car occupants and 37% are pedestrians.

  • One in every 10 road traffic injury results in a fatality. One in every seven road traffic crash results in a fatality.

  • One in every three persons is injured in a traffic crash and one in every five deaths is under the influence of alcohol.

References

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