Predictors and geographic analysis of road traffic accidents in Leon, Nicaragua

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Abstract

ABSTRACT: Objective: To identify environmental factors present in areas with high density of road traffic accidents (RTA) in Leon, Nicaragua. Methods: The analysis included all accidents recorded by the Police Department in León City, from January to June 2017. All crashes were georeferenced, and data were collected from the environment elements within a perimeter of 20 meters from the site in which accidents occurred with a pre-tested data collection instrument. We specified a Poisson regression model to estimate incidence rate ratios (IRR) and 95% confidence intervals (CI) to determine environmental factors associated with the event incidence. For the identification areas with high, medium, and low occurrences of crashes, kernel density around points in which RTA occurred were estimated. Results: Out of 667 recorded crashes, 90% involved men aged 15-40, and motorcycle accidents represented 60% of injuries or deaths. Environmental factors that were positively associated with RTA included good road conditions (adjusted IRR = 1.36, 95%CI 1.13 - 1.63) and the existence of bicycle lanes (adjusted IRR = 1.64, 95%CI 1.29 - 2.10). Environmental characteristics associated with higher speeds and heavier accidents can increase their incidence. Conclusion: We found that high-foot-traffic commercial or touristic centers are three areas with high density of crashes. Local authorities can use these findings to promote road safety measures in high-incidence areas in León City.

Translated abstract

RESUMO: Objetivo: Identificar os fatores ambientais presentes em áreas com alta densidade de acidentes de trânsito rodoviário (ATR) em León, Nicarágua. Métodos: Foram incluídos na análise todos os acidentes registrados pelo Departamento de Polícia da cidade de León de janeiro a junho de 2017. Georreferenciamos todos os acidentes e coletamos dados dos elementos ambientais em um perímetro de 20 metros do local até os acidentes ocorridos por meio de um instrumento de coleta de dados pré-testado. Foi especificado um modelo de regressão de Poisson para estimar as razões das taxas de incidência (TI) e intervalos de confiança de 95% (IC95%) para determinar os fatores ambientais associados à incidência do evento. Para identificar áreas com alta, média e baixa ocorrência de acidentes, estimamos a densidade do núcleo em torno dos pontos onde o ATR ocorreu. Resultados: Dos 667 acidentes registrados, 90% envolveram homens com idades entre 15 e 40 anos, e os acidentes de motocicleta representaram 60% dos ferimentos ou mortes. Os fatores ambientais que foram associados positivamente aos ATR incluíram boas condições da estrada (TI ajustada = 1,36; IC95% 1,13 - 1,63) e a existência de ciclovias (TI ajustada = 1,64; IC95% 1,29 - 2,10). Características ambientais associadas a velocidades mais altas e acidentes mais pesados podem aumentar a incidência deles. Conclusão: Constatamos que os centros comerciais ou turísticos com tráfego intenso são três áreas com alta densidade de acidentes. As autoridades locais podem usar essas descobertas para promover medidas de segurança no trânsito em áreas de alta incidência na cidade de León.

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Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Spencer L James, Degu Abate, Kalkidan Hassen Abate … (2020)

Summary Background The Global Burden of Diseases, Injuries, and Risk Factors Study 2017 (GBD 2017) includes a comprehensive assessment of incidence, prevalence, and years lived with disability (YLDs) for 354 causes in 195 countries and territories from 1990 to 2017. Previous GBD studies have shown how the decline of mortality rates from 1990 to 2016 has led to an increase in life expectancy, an ageing global population, and an expansion of the non-fatal burden of disease and injury. These studies have also shown how a substantial portion of the world's population experiences non-fatal health loss with considerable heterogeneity among different causes, locations, ages, and sexes. Ongoing objectives of the GBD study include increasing the level of estimation detail, improving analytical strategies, and increasing the amount of high-quality data. Methods We estimated incidence and prevalence for 354 diseases and injuries and 3484 sequelae. We used an updated and extensive body of literature studies, survey data, surveillance data, inpatient admission records, outpatient visit records, and health insurance claims, and additionally used results from cause of death models to inform estimates using a total of 68 781 data sources. Newly available clinical data from India, Iran, Japan, Jordan, Nepal, China, Brazil, Norway, and Italy were incorporated, as well as updated claims data from the USA and new claims data from Taiwan (province of China) and Singapore. We used DisMod-MR 2.1, a Bayesian meta-regression tool, as the main method of estimation, ensuring consistency between rates of incidence, prevalence, remission, and cause of death for each condition. YLDs were estimated as the product of a prevalence estimate and a disability weight for health states of each mutually exclusive sequela, adjusted for comorbidity. We updated the Socio-demographic Index (SDI), a summary development indicator of income per capita, years of schooling, and total fertility rate. Additionally, we calculated differences between male and female YLDs to identify divergent trends across sexes. GBD 2017 complies with the Guidelines for Accurate and Transparent Health Estimates Reporting. Findings Globally, for females, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and haemoglobinopathies and haemolytic anaemias in both 1990 and 2017. For males, the causes with the greatest age-standardised prevalence were oral disorders, headache disorders, and tuberculosis including latent tuberculosis infection in both 1990 and 2017. In terms of YLDs, low back pain, headache disorders, and dietary iron deficiency were the leading Level 3 causes of YLD counts in 1990, whereas low back pain, headache disorders, and depressive disorders were the leading causes in 2017 for both sexes combined. All-cause age-standardised YLD rates decreased by 3·9% (95% uncertainty interval [UI] 3·1–4·6) from 1990 to 2017; however, the all-age YLD rate increased by 7·2% (6·0–8·4) while the total sum of global YLDs increased from 562 million (421–723) to 853 million (642–1100). The increases for males and females were similar, with increases in all-age YLD rates of 7·9% (6·6–9·2) for males and 6·5% (5·4–7·7) for females. We found significant differences between males and females in terms of age-standardised prevalence estimates for multiple causes. The causes with the greatest relative differences between sexes in 2017 included substance use disorders (3018 cases [95% UI 2782–3252] per 100 000 in males vs s1400 [1279–1524] per 100 000 in females), transport injuries (3322 [3082–3583] vs 2336 [2154–2535]), and self-harm and interpersonal violence (3265 [2943–3630] vs 5643 [5057–6302]). Interpretation Global all-cause age-standardised YLD rates have improved only slightly over a period spanning nearly three decades. However, the magnitude of the non-fatal disease burden has expanded globally, with increasing numbers of people who have a wide spectrum of conditions. A subset of conditions has remained globally pervasive since 1990, whereas other conditions have displayed more dynamic trends, with different ages, sexes, and geographies across the globe experiencing varying burdens and trends of health loss. This study emphasises how global improvements in premature mortality for select conditions have led to older populations with complex and potentially expensive diseases, yet also highlights global achievements in certain domains of disease and injury. Funding Bill & Melinda Gates Foundation.

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Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories

Kyle J Foreman, Neal Marquez, Andrew J. Dolgert … (2018)

Summary Background Understanding potential trajectories in health and drivers of health is crucial to guiding long-term investments and policy implementation. Past work on forecasting has provided an incomplete landscape of future health scenarios, highlighting a need for a more robust modelling platform from which policy options and potential health trajectories can be assessed. This study provides a novel approach to modelling life expectancy, all-cause mortality and cause of death forecasts —and alternative future scenarios—for 250 causes of death from 2016 to 2040 in 195 countries and territories. Methods We modelled 250 causes and cause groups organised by the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) hierarchical cause structure, using GBD 2016 estimates from 1990–2016, to generate predictions for 2017–40. Our modelling framework used data from the GBD 2016 study to systematically account for the relationships between risk factors and health outcomes for 79 independent drivers of health. We developed a three-component model of cause-specific mortality: a component due to changes in risk factors and select interventions; the underlying mortality rate for each cause that is a function of income per capita, educational attainment, and total fertility rate under 25 years and time; and an autoregressive integrated moving average model for unexplained changes correlated with time. We assessed the performance by fitting models with data from 1990–2006 and using these to forecast for 2007–16. Our final model used for generating forecasts and alternative scenarios was fitted to data from 1990–2016. We used this model for 195 countries and territories to generate a reference scenario or forecast through 2040 for each measure by location. Additionally, we generated better health and worse health scenarios based on the 85th and 15th percentiles, respectively, of annualised rates of change across location-years for all the GBD risk factors, income per person, educational attainment, select intervention coverage, and total fertility rate under 25 years in the past. We used the model to generate all-cause age-sex specific mortality, life expectancy, and years of life lost (YLLs) for 250 causes. Scenarios for fertility were also generated and used in a cohort component model to generate population scenarios. For each reference forecast, better health, and worse health scenarios, we generated estimates of mortality and YLLs attributable to each risk factor in the future. Findings Globally, most independent drivers of health were forecast to improve by 2040, but 36 were forecast to worsen. As shown by the better health scenarios, greater progress might be possible, yet for some drivers such as high body-mass index (BMI), their toll will rise in the absence of intervention. We forecasted global life expectancy to increase by 4·4 years (95% UI 2·2 to 6·4) for men and 4·4 years (2·1 to 6·4) for women by 2040, but based on better and worse health scenarios, trajectories could range from a gain of 7·8 years (5·9 to 9·8) to a non-significant loss of 0·4 years (–2·8 to 2·2) for men, and an increase of 7·2 years (5·3 to 9·1) to essentially no change (0·1 years [–2·7 to 2·5]) for women. In 2040, Japan, Singapore, Spain, and Switzerland had a forecasted life expectancy exceeding 85 years for both sexes, and 59 countries including China were projected to surpass a life expectancy of 80 years by 2040. At the same time, Central African Republic, Lesotho, Somalia, and Zimbabwe had projected life expectancies below 65 years in 2040, indicating global disparities in survival are likely to persist if current trends hold. Forecasted YLLs showed a rising toll from several non-communicable diseases (NCDs), partly driven by population growth and ageing. Differences between the reference forecast and alternative scenarios were most striking for HIV/AIDS, for which a potential increase of 120·2% (95% UI 67·2–190·3) in YLLs (nearly 118 million) was projected globally from 2016–40 under the worse health scenario. Compared with 2016, NCDs were forecast to account for a greater proportion of YLLs in all GBD regions by 2040 (67·3% of YLLs [95% UI 61·9–72·3] globally); nonetheless, in many lower-income countries, communicable, maternal, neonatal, and nutritional (CMNN) diseases still accounted for a large share of YLLs in 2040 (eg, 53·5% of YLLs [95% UI 48·3–58·5] in Sub-Saharan Africa). There were large gaps for many health risks between the reference forecast and better health scenario for attributable YLLs. In most countries, metabolic risks amenable to health care (eg, high blood pressure and high plasma fasting glucose) and risks best targeted by population-level or intersectoral interventions (eg, tobacco, high BMI, and ambient particulate matter pollution) had some of the largest differences between reference and better health scenarios. The main exception was sub-Saharan Africa, where many risks associated with poverty and lower levels of development (eg, unsafe water and sanitation, household air pollution, and child malnutrition) were projected to still account for substantive disparities between reference and better health scenarios in 2040. Interpretation With the present study, we provide a robust, flexible forecasting platform from which reference forecasts and alternative health scenarios can be explored in relation to a wide range of independent drivers of health. Our reference forecast points to overall improvements through 2040 in most countries, yet the range found across better and worse health scenarios renders a precarious vision of the future—a world with accelerating progress from technical innovation but with the potential for worsening health outcomes in the absence of deliberate policy action. For some causes of YLLs, large differences between the reference forecast and alternative scenarios reflect the opportunity to accelerate gains if countries move their trajectories toward better health scenarios—or alarming challenges if countries fall behind their reference forecasts. Generally, decision makers should plan for the likely continued shift toward NCDs and target resources toward the modifiable risks that drive substantial premature mortality. If such modifiable risks are prioritised today, there is opportunity to reduce avoidable mortality in the future. However, CMNN causes and related risks will remain the predominant health priority among lower-income countries. Based on our 2040 worse health scenario, there is a real risk of HIV mortality rebounding if countries lose momentum against the HIV epidemic, jeopardising decades of progress against the disease. Continued technical innovation and increased health spending, including development assistance for health targeted to the world's poorest people, are likely to remain vital components to charting a future where all populations can live full, healthy lives. Funding Bill & Melinda Gates Foundation.

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Exploring spatial autocorrelation of traffic crashes based on severity

Ali Soltani, Sajad Askari (2017)

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Journal

Journal ID (publisher-id): rbepid

Title: Revista Brasileira de Epidemiologia

Abbreviated Title: Rev. bras. epidemiol.

Publisher: Associação Brasileira de Saúde Coletiva (Rio de Janeiro, RJ, Brazil )

ISSN (Print): 1415-790X

ISSN (Electronic): 1980-5497

Publication date (Print and electronic): 2021

Volume: 24

Electronic Location Identifier: e210003

Affiliations

[1] León orgnameUniversidad Nacional Autónoma de Nicaragua orgdiv1Facultad de Ciencias Médicas orgdiv2Centro de Investigación en Demografía y Salud Nicaragua

[2] Lima Lima orgnameUniversidad San Ignacio de Loyola orgdiv1Vicerrectorado de Investigación orgdiv2Centro de Excelencia en Investigaciones Económicas y Sociales en Salud Peru

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Publisher ID: S1415-790X2021000100403 Publisher ID: S1415-790X(21)02400000403

DOI: 10.1590/1980-549720210003

PubMed ID: 33331412

SO-VID: 439a2ed5-73ad-42cd-ba2a-5c915f0b8e17

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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Date accepted : 04 August 2020

Date received : 05 February 2020

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Figures: 0, Tables: 0, Equations: 0, References: 39, Pages: 0

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Keywords: Nicarágua,Epidemiology,Accidents, traffic,Sistemas de Informação Geográfica,Geographic Information Systems,Epidemiologia,Acidentes de trânsito,Nicaragua

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Keywords: Nicarágua, Epidemiology, Accidents, traffic, Sistemas de Informação Geográfica, Geographic Information Systems, Epidemiologia, Acidentes de trânsito, Nicaragua

Predictors and geographic analysis of road traffic accidents in Leon, Nicaragua Translated title: Preditores e análise geográfica de acidentes de trânsito em León, Nicarágua

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Most cited references 38

Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the Global Burden of Disease Study 2017

Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016–40 for 195 countries and territories

Exploring spatial autocorrelation of traffic crashes based on severity

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