Shahrzad Bazargan-Hejazi
1*, Alireza Ahmadi
2, Anaheed Shirazi
3, Elaheh Ainy
4, Shirin Djalalinia
5, Seyed-Mohammad Fereshtehnejad
6, Nader Jahanmehr
7, Aliashgher Kiadaliri
8, Maziar Moradi-Lakeh
9, Mahboubeh Parsaeian
10, Farshid Pourmalek
11, Kazem Rahimi
12, Sadaf G.Sepanlou
13, Arash Tehrani
14, Reza Malekzadeh
15*, Mohsen Naghavi
161 Professor, College of Medicine, Department of Psychiatry, Charles R. Drew University of Medicine and Science, and David Geffen School of Medicine, University of California at Los Angeles (UCLA), USA
2 Department of Anesthesiology, Critical & Pain Management, Kermanshah University of Medical Sciences (KUMS), Kermanshah, Iran
3 Charles R. Drew University of Medicine and Science, College of Medicine, Los Angeles, California, USA
4 Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
5 Deputy of Research and Technology, Ministry of Health and Medical Education and NCDRC EMRI, Tehran University of Medical Science, Tehran, Iran
6 Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institute, Stockholm, Sweden
7 Safety Promotion and Injury Prevention Research Center, School of Public Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
8 Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Sweden
9 Associate Professor in Community Medicine, Department of Community Medicine, School of Medicine, Iran University of Medical Sciences and Health Services, Tehran, Iran
10 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
11 School of Population and Public Health, University of British Colombia, Vancouver, BC, Canada
12 Associate Professor of Cardiovascular Medicine, University of Oxford, Deputy Director, The George Institute for Global Health, Director, Deep Medicine program, Oxford Martin School, University of Oxford, Honorary Consultant Cardiologist, Oxford University Hospitals NHS Foundation Trust
13 Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
14 Deputy of Research of Preventive Medicine and Public Health Research Center, Assistant professor of Community Medicine Department, Iran University of Medical Sciences, Tehran, Iran
15 Professor of Medicine, Digestive Disease Research Institute, Tehran University of Medical Sciences, Shariati Hospital, Tehran, Iran
16 Professor of Global Health, Institute for Health Metrics and Evaluation (IHME), University of Washington, Seattle, USA
Abstract
Background: The Global Burden of Disease (GBD) Study provides estimates of deaths, years of life lost (YLL), years of life lived with
disability (YLD), and disability-adjusted life years (DALYs) due to 249 causes of death, 315 diseases and injuries, and 79 behavioral,
environmental, occupational, and metabolic risk factors in 195 countries, territories, and regions by sex and 20 age categories in 195
countries and regions since 1990. In this study, we aimed to present the burden of road traffic injuries (RTIs) in Iran and 15 surrounding
countries in 1990–2016.
Methods: The standard Cause of Death Ensemble modeling (CODEm) is used to estimate deaths due to all causes of injury by age, sex,
country and year. A range of 27 causes is used for estimating non-fatal health outcomes based on inpatient and outpatient datasets
using DisMod-MR 2.0. Disability-adjusted life years (DALYs) estimate quantify the total burden of years lost due to premature death or
disability and was computed by summing the fatal burden and non-fatal burden associated with a cause (i.e., YLL+YLD).
Results: In 2016, age-standardized transport injuries in Iran accounted for 35.6 (UI: 29.64–43.44) deaths per 100000 compared to 60.8
(UI: 51.04–72.49) in 1990. Transport injury became the fourth leading cause of death in Iran in 2016, up from the 5th leading cause
of death in 1990. The burden of RTIs was mainly caused by motor vehicles and motorcycles and mostly affected the economically
productive age groups (15–49), males and children, especially those at school age. Afghanistan with 59.14 deaths (52.09–66.8) and
UAE with 53.71 deaths (36.59–72.77) had the largest transport injury death rates per 100000. From 1990 to 2016, Iran had -2.06
annual percent change in transport death rates. The lowest annual percent change is reported for Turkmenistan at -3.43. While Pakistan,
UAE and Qatar had the highest annual percent change in transport injury. Across all countries, the observed-to-expected ratios for
transport injury death rates varied considerably in 2016.The UAE had the largest age-standardized ratios of observed-to-expected rate
(2.93), followed by Oman (2.39), Saudi Arabia (2.23), Afghanistan (2.04) and Iran (1.95).
Conclusions: RTIs continue to be a public health burden in Iran and its neighboring countries, even though, there is evidence for decline
in RTIs across all countries except Pakistan. The most frequent sub-causes of death and injury are the motor vehicle, motorcycle, and
pedestrian injuries. The most vulnerable road users are children and young adults.