Abstract
AIM:
To determine the characteristics of the Socio-medical profile of road traffic accidents in Kosovo, between 2010 and 2015 year.
STUDY DESIGN:
Retrospective study.
METHODS:
A descriptive method based on the database of road traffic accidents from the National Police of Kosovo.
RESULTS:
In Kosovo for the period 2010-2015, on average, the yearly number of road traffic accidents is 18437 with mortality rate 7.4 per 100000 and lethality of 1.5%. The highest number of fatal cases are drivers and above 19 years old with more than 80%. Among injured significantly highest percentage is among passengers for all years and above 19 years old. Road traffic accident with a vehicle occurs most frequently, with approximately over 70%, mostly on dry road 72.9% and clear weather 71.1%. The driver is the contributing factors of road traffic accidents on average 99.3% whereas climatic conditions only 0.5%, with over 50% of crashes occurring in urban road 56.2%, mostly during Monday 16.0% and in the afternoon rush hours between 14.00-18.00 with 31.0%.
CONCLUSIONS:
There is a slight decrease in the mortality rate of 0.1‰ and lethality rate of 0.1% each year, whereas there is an increase of 21.5‰ for traumatism rate for each year.
Keywords: Road traffic accidents, Public health problem, traffic injuries, traffic mortality, Kosovo
Introduction
Road traffic accidents are the major public health problem, in both developed and developing countries. Based on WHO report, the overall global road traffic fatality rate is 17.4 per 100000. Low-income countries have the highest annual road traffic fatality rates, 24.1 per 100000, middle-income countries 18.4 while the rate in high-income countries is lowest, at 9.2 per 100000 [1]. Traffic mortality, traumatism, absenteeism, and disabilities have an impact not only each victim but also on their families and wider society at the national level of pandemic proportions with medical, psychological, economic and quality of life consequences. According to WHO report road traffic injuries are the eighth leading cause of death globally, and the leading cause of death for young people aged 15–29 years. Globally, more than a million people die annually. Approximately, 90% of the world’s fatalities on the roads occur in low and middle-income countries [1]. The rapid increase in road traffic crashes in low and middle-income countries has driven an overall global increase in deaths and injuries due to the rapid rate of motorization and lack of prioritization for several years of safety strategies, disordered urbanization which causes financial costs up to 3–5 % of their gross national product whereas consequences of these road traffic accidents cost up billions of dollars due to the cost of treatment, rehabilitation lost productivity and incident investigation [1].
The annual cost of road traffic accident in Australia, in 2003, was about 2.3% of the Gross Domestic Product (GDP) [2]. For the same year, in Barcelona total costs of road traffic accidents were 367 million euro with (89.8%) direct costs equalled euro 329 million, including property damage costs, insurance administration costs, and hospital costs [3]. In Iran, traffic accident costs were US$2.2 million in 2007 [4] while in Kuwait cost per traffic fatality is more than the US $500,000 [5].
In Kosovo, a country in transition with the improper and non-strict implementation of road security measures, inappropriate land use planning, an increase of the number of cars and particularly imported old cars from the second-hand European Union market increases the risk for traffic insecurity together with lack of proper road infrastructure and urban spatial planning, characteristic for developing countries.
Public health importance of road traffic accidents stands because they are largely preventable with traffic security cost-beneficial and cost-effective measures. Consequences are not only health related but also economic and social too.
This study aims to determine socio-medical characteristics of road traffic accidents in Kosovo, between 2010 and 2015 by exploring trend in road traffic accidents, fatal and non-fatal accidents, type, contributing factors, the site, superficial road conditions, time, day of the week and climatic condition of occurrence.
Methods
For this study, a retrospective study of road traffic accidents in the period from January 2010 to December 2015 was conducted. As descriptive study based on a database of road traffic accidents of Kosovo National Police and demographic data (2010 -2015) from Statistical Agency of Kosovo, therefore we did not need any ethical approval since data are anonymous, presented by gender and age group.
The information provided by the National Police of Kosovo included the 2010-2015 databases, in Excel format. This information allowed the analysis of the following variables: number of accidents, type, contributing factors, the day of the week, time of occurrence, climatic conditions, and road users involved by age, the place, superficial road conditions, distributions of the accidents. A limitation of the database is the lack of disaggregated age data. From the database, incidence, mortality and lethality indicators are calculated. The incidence was determined by the number of new cases of road traffic accidents deaths and injuries that occurred during 2010-2015. Mortality was calculated by dividing the number of deaths among the total susceptible population, according to the Kosovo Statistical Agency per 100.000 inhabitants whereas lethality by dividing the number of deaths on the number of injured persons by road traffic accidents per 100. The statistical analysis reported frequencies, percentages, trends and chi-square statistical significance test. For the study purpose statistical program Excel, 2016 was used.
Results
According to the Statistics of the National Police of Kosovo, for the period 2010-2015, there have been 110622 road traffic accidents at the national level. Regarding mortality, between the years 2010-2015, road traffic accidents have caused 826 deaths nationwide. The year 2010 had the highest number of deaths in the country 175. For the period 2010-2015, 54809 injured people are recorded, with an average yearly number of road traffic accidents 18437, annually average of dead persons 138, injured 9135 and average mortality of 7.4 per 100.000, average traffic traumatism 497.6 per 100.000 and average lethality of 1.5%.
The basic index shows an increase of road traffic accidents for period 2010-2013 and in 2014 show decrease of 9.6%, for 2015 decrease of 1.7%. Verig index show similarly increases for the same period 2010-2013, and for 2014 there is a decrease of 18.6% and 8.7% for 2015. According to trend analysis, there is a slight decrease of the mortality rate of 0.1 ‰ and lethality rate of 0.1% each year whereas there is an increase of 21.5‰ for traumatism rate for each year (Table 1).
Table 1.
Traffic accidents and related health indicators, Kosovo 2010-2015
Table 2, shows trend and statistical significance for the period 2010-2015. For death cases, the trend is decreasing on average for nine new cases each year and for injuries increase of 575.2 new cases, and for victims in general also, increase for 566 each year. For years there is statistical significance for p<0.00 for death cases with the highest number recorded on 2010 and for injuries highest number for 2015. We can notice that while the number of accidents is falling, the number of fatal cases is decreasing and the number of victims and injuries increasing (Table 2).
Table 2.
Victims of traffic accidents, Kosovo 2010-2015
Regarding age group, highest percentage is among victims with above 19 years with more than 80% during period 2010-2015 and least percentage among adolescents 13-18 years old but there is no statistical significance (Table 3).
Table 3.
Dead and injured according to their involvement in traffic accidents and age-group, Kosovo 2010-2015
Among injured according to their involvement in traffic, highest percentage is among passengers for all years and the smallest percentage is among pedestrians, the statistically significant difference (p=0.0001). Age group, similarly above 19 years old are mostly injured for entire period with a statistically significant difference (p = 0.000) (Table 3).
Road traffic accidents are caused by three main factors, human, motor vehicles, and environmental conditions. In Kosovo for the period 2010-2015, an accident with a vehicle is most frequent, with approximately over 70% during the entire period, followed by vehicle to vehicle with average 8%. Regarding contributing factors, the driver is responsible for an average of 99.3% for entire period 2010-2015 whereas climatic conditions only 0.5% and technical vehicle condition 0.1%. Among superficial road conditions in road traffic accidents, dry road recorded mostly with average 72.9% for the entire period, followed by wet road with 14.2%, snow 3.3% and icy road only 1.2%. As far the climatic conditions, most accidents happened in clear weather with 71.1%, cloudy 8.5%, fog 1.0% with snow 4.3%. Most crashes occur in the afternoon rush hours between 14.00-18.00 with 31.0%, followed by 10.00-14.00 with 27.9% and followed by 18.00-22:00 with 18.9%. Over 50% of crashes occurred in the urban road with an average of 56.2% followed by national road with 24.3% and rural road with 9.5%. Most of these crashes take place during Monday with an average of 16.0%, followed with 15.0% for Tuesday, Wednesday, Friday and at least on Sundays with 10.8%. There is no statistically significant difference between years and all above-analyzed modalities (Table 4).
Table 4.
Traffic accidents characteristics, Kosovo 2010-2015
According to Health For All database, for SEE-countries for 2011, and Kosovo Police data for Kosovo, Kosovo has the highest number of road traffic accidents with injuries, 478.3 per 100 000 (Fig. 1).
Figure 1.
Road traffic accidents with injury per 100 000, SEE countries, 2011
Discussion
Road traffic accidents are among main epidemiologic problems and public health issues in developed and in developing countries. Road traffic accidents as a global challenge are on the global agenda through Sustainable Development Goals SDG 3 and 11 which aim to half the number of global deaths and injuries from road traffic accidents by 2020 and provide access to safe, affordable, accessible and sustainable transport systems and improving road safety by 2030.
Public health importance of road traffic accidents besides that are largely preventable, are also health consequences as death, disability, quality of life, economic burden with direct and indirect losses for the victims and their families.
It is estimated that every day in the world 3287 people dies in-car accidents [6]. According to the World Health Organization’s Report-2015 on the situation of road safety, the traffic accident mortality rate in Italy is 6.1 per 100,000, Austria 5.4, France 5.1 less than Kosovo mortality rate 6.4 per 100,000 inhabitants, which is the smaller rate in comparison with Hungary and Serbia with 7.7 and Bulgaria 8.3 per 100 000 inhabitants. The highest mortality rate in the region is recorded in Bosnia and Hercegovina with 17.7 and Albania with 15.1 per 100,000 inhabitants. In Iran, road traffic accidents are the reason for 25% of unnatural deaths [4]. In Rumania injuries caused by road traffic accidents represent an important morbidity and mortality risk factor. The incidence of road traffic injuries was 30.61 for 100,000 inhabitants, whereas the mortality rate 10.28 deaths for 100,000 inhabitants [7].
In Kosovo for the period 2010-2015, on average yearly number of road traffic accidents is 18437, dead persons 138, injured 9135, mortality rate 7.4 per 100000 and lethality of 1.5%. In our study the most frequent age of fatal cases and victims in general in traffic crashes was over 19 years old that is in line with many other studies like one in Brazil [8], similarly mostly affected in road traffic accidents in Africa are young and especially young men. People in the 20-54 age group accounted for 71.8% of all those fatal cases annually [9]. The young population between ages of 20 and 34 is the age group mostly affected, and since is economically active, consequences overcome a person with wider implication on economic losses of their families also [10].
Highest fatal cases according to their involvement in traffic, is among drivers. Regarding contributing factors, the driver is responsible on average of 99.3% for entire period 2010-2015 whereas climatic conditions only 0.5% and technical vehicle condition 0.1%. Similar results were found in different studies, in the United Arab Emirates, driving behaviour are more prevailing contributing factors, and vehicle safety is least [11]. In South Africa, most of the casualties of road traffic accidents were drivers (46%) [10]. In Taiwan, human factor respectively psychosocial influences are responsible up 3 to 4% of accidents [12]. In Lasi driver’s error was identified as the main contributing factor in about two-thirds of all road traffic accidents [7].
In a report from Africa, more passengers were killed than any other road user in the years 2010-2012, accounting for 43.8% of all fatalities in 2010, 51.1% in 2011 and 43% in 2012 and the least affected road users are drivers, at 26.4%, 25.7% and 28.5% of all fatalities in 2010, 2011 and 2012 with the most prevalent death risk factors disregarding traffic rules (45%) and driver rushing (31%) [13]. While in Africa passengers are the most affected road users in crashes, in Kosovo mostly fatal cases are among drivers. In Peru, the majority of the fatalities were pedestrians (61%) [14], and in Basel similarly, for injuries, the majority of the fatalities (84.8%) occurred among pedestrians [15].
In Kosovo for the period 2010-2015, an accident with a vehicle is most frequent with about over 70% during the entire period, followed by vehicle to vehicle with average 8%. Similarly, in a study conducted in Iran, most collisions were vehicle-vehicle crashes 52.3% [16]. While in Kosovo over 50% of crashes occurred in the urban road, in Iran most fatal injuries (61.4%) occurred on outer-city roads and only 27.4% occurred on inner-city roads [16]. In Kosovo majority of accidents happen on Fridays and Saturdays similarly with other studies [9, 10, 14, 18, 19), while Sunday is the day with the lowest accident rate, similar with Peru [14].
In Kosovo most crashes occur in the afternoon rushing hours between 14.00-18.00hrs with 31.0%, similarly, with other studies, road traffic accidents occur mainly between two in the afternoon and eight at night [9, 10, 14], followed by 10.00-14.00 hrs with 27.9%. In Saudi Arabia, the most frequent time was during the rush period of noon to 3 pm [17], while in other studies during early evening hours [18, 19].
Among superficial road conditions in road traffic accidents, the dry road was recorded mostly with average 72.9%, mostly in clear weather with 71.1% similar to another study [17].
A large number of vehicles contribute to air pollution which has an impact on increasing burden of chronic respiratory diseases as asthma and emphysema. Policy interventions in many countries as in the example in Rumania have reduced road traffic crashes, in a short period [7]. Safety belts are shown to be helpful as road safety measures, since 1976 after enforcement of the law on safety belts, 31% less injured persons, four times fewer head injuries, three times less minor injuries and five times less severe injuries were found [15]. In Verona after low enforcement on the seat belt, a significant reduction of injured/accidents ratio was recorded 29%, head trauma for 50.3% [20]. In line with Decade of Action for Road Safety (2011–2020) aiming to stabilise and reducing the increasing trend of road traffic fatalities and saving an estimated 5 million lives over the period, in Kosovo several interventions were taken to maintain citizens’ life and wellbeing. Road safety is associated with legal, institutional, technical and financial support with enforcement of new traffic Law no. 05 / L-088, with new rules for all participants in traffic to increase safety in road traffic, traffic flow and environmental protection [21].
For the period 2010-2015, there is a slight decrease in the mortality rate of 0.1‰ and lethality rate of 0.1% each year whereas there is an increase of 21.5‰ for traumatism rate for each year. A Higher number of fatal cases are drivers and above 19 years with more than 80%. Among injured significantly highest percentage is among passengers for all years and above 19 years old. Traffic accident with a vehicle is mostly too happened with approximately over 70%, mostly on dry road 72.9% and clear weather 71.1%. The driver is contributing factors of road traffic accidents on average 99.3% whereas climatic conditions only 0.5%, with over 50% of crashes occurred in urban road 56.2% mostly during Monday 16.00% and in the afternoon rushing hours between 14.00-18.00hrs with 31.0%. A joint effort from health, education and police sectors should compile a public health strategy and action plan to increase awareness and traffic culture focused on human risk factors.
In conclusion, there is a slight decrease in the mortality rate of 0.1‰ and lethality rate of 0.1% each year, whereas there is an increase of 21.5‰ for traumatism rate for each year. Limitation of the study was disaggregated data on excel database which was a barrier for depth calculation and analyse.
Acknowledgment
To the Statistics Department of the National Police of Kosovo for access to the information they collect.
Footnotes
Funding: This research did not receive any financial support.
Competing Interests: The authors have declared that no competing interests exist.
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