Study On The Disease Burden Of Road Traffic Injury In Penglai City, Shandong, China

[Background]Because of high incidence and highly caused disability rate, injury is wasting vast health resources. It has brought the heavy burden to the country, society, family and individual. Among the causes of injuries, road traffic injury (RTI) is especailly serious. RTI is the eleventh leading death cause and ninth cause of disability adjusted life years (DALYs) loss. RTI is threating the human and society. The world health organization (WHO) report indicates that 20-50 million injuries or disabilities are caused and 518 billion dollars are lost by traffic accidents in one year around the world.Among the injuries in China, the burden of RTI is also the same serious as the world. The number of victims by RTI is largest all the world and is increasing by the speed of ten percent. The report of death registration in 2003 in Shandong province indicates that the mortality of injuries is 57.02/100000, and road traffic accident is the 2nd death cause among the injuries. The mortality is increasing. The rate was more 41.96% in 2001 than 1991. According to the result of sampling survey on injury in 2003 in Shandong, traffic accident is the 2nd injured cause and the economic loss is the first. By analyzing the data of emergency injury surveillance in 2005 in Penglai county, RTI is the major reason leading injured patients to visit the hospitals.Whereas RTI is more and more serious, each country is thinking much of preventing it, but finding the harm to health and social economy by RTI is the basis of health policy making. Thereby, this study is trying to find the epidemic status of RTI in Penglai county based on death registration, emergency injury surveillance and large-scale sampling survey. It's also to evaluate the health burden and economic burden caused by RTI, then to provide scientific evidence for health policy making.[Objectives]The major purpose of this study is to evaluating the burden of RTI from population health perspective and social economic perspective, consiquently providing scientific evidence for policy making and foundation for further study. The specific objectives of this study are as following:(1) To describe the epidemic status of RTI in Penglai county.(2) To calculate the disability weights of each type of injury caused of road traffic accident.(3) To measure the health burden of RTI with DALYs index that combine the fatal and non-fatal information of disease.(4) To evaluate the economic burden of RTI in Penglai county. [Methods]This study is a descriptive epidemic study. Firstly, the status of mortality and disability caused by traffic accident in Penglai county was estimated based on the data from death registration and sampling survey from 2006 to 2007. Secondly, together with the disability weights gained from global burden of diseases(GBD), the health burden (DALYs) were measured. Finally, the economic burden of RTI was evaluated.Using the mortality of death registration and the materials of disability from survey, combining the data of population, the total of death and the number of disability were valued. The direct costs were gotten from the survey. The Six-class Disability Standard was employed to classify the disability level of each injured case and for weight signing. The age-short/long-term-specific weights of each nature of injury were calculated according to GBD methods.The GBD formula was applied for DALYs calculating. YLLs were estimated by using the death data from the registration. YLDs were calculated by using the materials of the survey and the disability weights from GBD. The parameters for calculating DALYs were chosen in accordance with most burdens of diseases (BOD) studies, including standard life expectancy, 3% discounting rate and standard age weight (4%).In this study, the economic burden of RTI included direct and indirect economic burden. The latter was made up of costs caused by death and costs caused by disability. The direct burden was estimated using the average direct costs per year per case and the disability materials. The DALYs combined with human capital approach was employed to measure the indirect economic costs based on the GDP per capita of Penglai. The productivity weights were also used in the indirect costs calculating.[Results]1. It was estimated that RTI led 5325.82 persons to injure or die from 2006 to 2007 in Penglai county. The incidence rate is 0.60%. The rate of male is above the female and the rate of labor population aged 15～59 years. The mortality is 34.72/100000. The rate of male aged 15～29 years is nine times than the female. Along with the mortality is rising and the one of 30～44 years old is the highest. The number of the victims who used motorcycle is the most and the proportion among death is 55.01%, the mortality of pedestrians and bike users take second place. The incidence rate of non-fatal RTI is 0.56%, but the number is 16.24 times than the death. The non-fatal RTI frequently happened in the group aged 15～59 years, too. The trend of incidence rate is descending firstly, then going up, and descending at last. It's the lowest among the group aged 5～14 years old and the group aged 15～44 years old is the highest. As the same with death, the victims who used motorcycle is the most, and the major are the motorcycle drivers.2. From 2006 to 2007, the average loss of the health life years about RTI is 31373.04 in one year. 70.59 health life years were lost per 1000 persons. The loss of the male was higher than the female. The loss of DALYs of the age group 15～44 years is the first (39209.71 health life years) and accounts for 62.42% total DALYs. The group aged 45～59 years is the second(315531.2 health life years).79.45% of the total DALYs was caused by disability, and 24373.82 life years was lost by disability in one year. 20.55% of the total DALYs were attributed to premature death, and 3226.62 life years were lost in one year. 3. The total economic burden of RTI in 2006 and 2007 was as high as 2.19 billion RMB, which accounted for 4.89% of the total amount of GDP in Penglai. It equaled to 4911.61 RMB of cost per capita for the whole population and exceeded half of one person's income (9610 RMB). 1.54% of the total economic burden was direct costs (340 million RMB), and 16.87 million RMB was lost by direct burden every year. The cost of treating and medicine accounted for 61.27% of the total indirect costs. 460 million RMB was lost by death and 169 million RMB loss was due to disability. The direct economic costs (215 million RMB) accounted for 98.45% of the total burden, which equaled to the cost per people per year among the whole population (2417.89 RMB). The economic loss of the male was RMB 163 million, accounted for 75.78% of the total loss. 210 million RMB was lost by the group aged 15～59 years old, accounted for 97.65% of the total.[Conclusions]In the two years, 5325.52 persons were injured or died due to RTI in Penglai county. The mortality was higher than the report of death registration in 1997. The number of non-fatal persons is 16.24 times than the death. The injury incidence rate of the group aged 15～59 years was the highest and the males were more than the females. The happening rate of injury among the pedestrians and cyclists was higher than other type of users. Every year 31373.04 DALYs were lost due to RTI, and 70.59 health life years were lost per 1000 persons. The loss of health life years was high the total DALYs loss due to cancers in Shandong province. The major component of DALYs was YLDs by disability. The total economic burden of RTI in 2006 and 2007 was as high as 2.19 billion RMB, which accounted for 4.89% of the total amount of GDP in Penglai. It equaled to 4911.61 RMB of cost per capita for the whole population and exceeded half of one person's income (9610 RMB).[Recommendations]It is suggested that the local government should design RTI prevention and control strategies according to the findings in this study. Road safety should be further strengthened, especially expanding safe driving education and strictly executing the law aimed to motorcycle using. The measures should be taken to protect the easily-injured colony and advance the whole social consciousness on the road safety. Finally, it is to relieve the heavy burden of RTI on population health and social economy. Special institute on road safety should be set up, which should include different sections and different fields. The BOD study should further developed and well evaluated to road safety. The cost-benefit measures should be explored. The methodology for disability weights also need to be further carried out. In order to provide basic information for calculating the disability weights which accord with Chinese social and cultural condition, the cohort of injury should be established and national special scales table for quantifying the life due to injuries.