|Year : 2019 | Volume
| Issue : 3 | Page : 79-85
Epidemiological determinants of road traffic accidents in a largely rural hilly population
Bhanu Awasthi1, Sunil Kumar Raina2, Lucky Verma1
1 Department of Orthopaedics, Dr. RP Government Medical College, Kangra, Himachal Pradesh, India
2 Department of Community Medicine, Dr. RP Government Medical College, Kangra, Himachal Pradesh, India
|Date of Web Publication||28-Jan-2020|
Dr. Sunil Kumar Raina
Department of Community Medicine, Dr. RP Government Medical College, Tanda, Kangra, Himachal Pradesh
Source of Support: None, Conflict of Interest: None
Background: Although Himachal Pradesh contributes less in terms of total number of road traffic accidents (RTAs), the RTA is of huge concern in terms of accident rate per thousand vehicles registered in this Hill state. In terms of death due to RTA/100,000 population Himachal Pradesh ranks in top ten states while in terms of number of persons killed/10,000 vehicle Himachal Pradesh ranks fourth. In view of these facts, it was planned to identify the epidemiological determinants (in terms of person, place, and time) of RTA in a largely rural and hilly population. Material and Methods: The study was conducted among patients of RTAs of all age groups, presenting to a tertiary care center in a rural area of Himachal Pradesh between 2014 and 2015. The epidemiological determinants were identified after collecting information on a structured per forma specially designed for the purpose. Results: A total of 313 patients of RTA were included in the study. The epidemiological determinants were classified as person, place, and time profiles. Under each profile-specific determinants were analyzed. Age, sex, occupation, day, and time of the accident were identified as important determinants. Conclusion: Despite contributing less to the total RTA burden across India, Himachal Pradesh is fast emerging as a state with far reaching consequences of increase in vehicular traffic.
Keywords: Determinants, epidemiological, hilly, road traffic accidents, rural
|How to cite this article:|
Awasthi B, Raina SK, Verma L. Epidemiological determinants of road traffic accidents in a largely rural hilly population. J Sci Soc 2019;46:79-85
| Introduction|| |
According to the World Health Organization, the number of deaths due to road traffic accidents (RTAs) is expected to rise to 2.34 million in 2020 from 0.99 million in 1990. Its global report on road safety highlighted that more peoples die in RTAs in India than elsewhere in the world, including China. In India, nearly 80,000 people get killed and 340,000 are injured every year in about 300,000 accidents on the road network of 2,200,000 km. There is an accident every minute and death every 8 min.,
The total number of registered motor vehicles in India increased from 0.3 million on March 31, 1951, to 159.5 million on March 2012. With the increase in the motor vehicles, there has been rapid increase in the RTAs.
Although Himachal Pradesh contribute less in term of total number of RTAs, the RTA are of huge concern in terms of accident rate per thousand vehicles registered and also in terms of severity of the accident. Transport research wing, ministry of road transport and highways, government of India reveals that the incidence of RTA in Himachal Pradesh is 45/100,000 population which far less in comparison to Goa which account for about 313 accidents/100,000 population. The number of accidents per 10,000 vehicle registered is 50 in comparison to Sikkim where maximum number of accidents per 10,000 vehicle registered are 105.
In terms of death due to RTA/100,000 population Himachal Pradesh ranked in top ten states while in terms of number of person killed/10,000 vehicle Himachal Pradesh ranked fourth only after Sikkim, Bihar, and West Bengal.
RTAs hit the peoples in economical productive age group and hence results in economic loss to the nations. Various studies have been conducted to find out the epidemiological profile of the road traffic accidental injuries. However, the focus of most of these is on urban population. Himachal Pradesh is a largely rural state (90% of its population lives in rural areas) with a predominantly hilly terrain therefore highlighting the importance of identifying the epidemiological determinants of RTA in this setting.
| Materials and Methods|| |
The study was conducted among patients of RTAs of all age groups, presenting to a tertiary care center in a rural area of Himachal Pradesh between 2014 and 2015. For the purpose of the study, a RTA was defined as accident, which took place on the road between two or more objects, one of which must be any kind of a moving vehicle.
Any injury on the road without involvement of a vehicle (e.g., a person slipping and falling on the road and sustaining injury) or injury involving a stationary vehicle (e.g., persons getting injured while washing or loading a vehicle) or deaths due to RTA were excluded from the study. The victims of the accidents were interviewed to obtain the information about the circumstances leading to accident.
The patient enrolled in the study and his attendants were adequately informed of the aims, methods, the anticipated benefits and potential risks of the study, and the discomfort it may entail them and the remedies thereof. Written informed consent was obtained from all the patients and attendants included in the study. In case of minors, consent was taken from the parents/local guardians.
Standard questionnaires were completed as per data collection form which included personal and family profile (age, sex, economic status, occupation, per capita income, type of family, number of family member, and address of patient) and the information regarding the time profile of the accident (day and time of accident) and place profile (rural and urban).
History regarding the mode of trauma was taken from the patient and his attendants. Thorough primary and secondary survey was done in each patient. After clinical examination, the relevant radiological assessment was done in order make the diagnosis and accordingly the patient was managed with conservative/operative intervention after relevant blood investigation. All the information collected was entered in the per forma made for data collection.
Data collected was entered into MS Excel 2007. The statistical analysis was done using SPSS (Statistical Package for Social Sciences) version 17.0 (IBM corporation Armonk, New York, US) statistical analysis software. The results were expressed as percentages. The statistical significance was assessed using Chi-square test and the P < 0.05 was taken as statistically significant.
| Results|| |
A total of 313 patients of RTA were included in the study. The results were analyzed as person profile, time profile, and place profile as components of epidemiological determinants of RTA. [Table 1] provides details on the person profile of RTA. RTA was found to be common in the age group ranging from 16 to 30 years (n = 135/313; 43.13%).
In majority of the young participants (16–30 years), two-wheeler (n = 82/135, 60.74%) was the most common vehicle involved; however, in the age group (31–45 years), the light motor vehicle was predominantly involved (n = 40/87, 45.97%) in RTA. The association with vehicles in different age groups was found to be significant statistically (P < 0.05). RTAs were common in male participants (n = 258/313; 82.42%) as compared to female participants (n = 55/313; 17.57%). Herein, two-wheeler was the most common vehicle involved in RTA in male participants (n = 137/258, 52.10%) whereas light motor vehicle was the most commonly involved vehicle (n = 32/55, 58.18%) in RTAs in female participants. The association of vehicle with sex was found to be statistically significant (P < 0.05). Participants belonging to above poverty line (APL) families (n = 232/313; 74.12%) were more commonly involved in RTAs in comparison with participants belonging to below poverty line (BPL) families (n = 75/313; 23.96%). The association of vehicular involvement in different economy status group was found not significant statistically (P > 0.05). Majority of the participants involved in the RTAs were students (n = 86/313; 27.47%) followed by government employees (n = 70/313; 22.36%). Further, it is observed that among student participants, two-wheelers were the most commonly vehicle involved (n = 59/86; 68.60%). The light motor vehicle was the most commonly involved vehicle government employee group (n = 29/70; 41.42%). The association of vehicle involvement in different occupation group was found significant statistically (P < 0.05). Most of the patients (n = 103/313; 32.90%) with RTA were educated up to graduation level, followed by people who were educated up to 12th standard (n = 89/313; 28.43%). In general, the two wheelers were the cause of RTA in all education groups, except in postgraduate group in which the light motor vehicle (n = 8/12, 66.66%) was commonly involved in RTA. The association of the different vehicle involvement in different education groups was found not significant statistically (P > 0.05). Most of the cases of RTA belonged to the family which had per capita income <4000 (n = 152/313; 48.56%). Only few participants (n = 54/313; 17.25%) belonged to family which had per capita income >8000. Two wheelers were most commonly involved vehicle in all per capita income groups. The association of different vehicular involvement in different precapita income group was found not significant statistically (P > 0.05). Participants who were living in a nuclear family were more frequently involved in RTA (n = 210, 67.09%). Two-wheeler was the commonly involved vehicle involved in people living in nuclear family (n = 113/210, 53.80%) while light motor vehicle was the most commonly involved in people living in joint families (n = 46/100, 46%). However, the association of the different vehicle involvement in different family groups was found not significant statistically (P > 0.05).
[Table 2] and [Table 3] provide details on the time profile of epidemiological determinants. The proportion of the two-wheeler involvement in RTA was higher on Tuesday (n = 22/36, 61.11%), Wednesday (n = 28/48, 58.33), and Sunday (n = 31/53, 58.49%). The light motor vehicle was involved in majority of RTA on Thursday (n = 23/44, 52.27%); however, the proportion of vehicular involvement on different days was found nonsignificant statistically (P > 0.05) [Table 2]. That most of the RTA occurred between 6:00 p.m. and 11:59 p.m. (n = 136, 43.45%). Large number of RTA had also occurred from 6:00 am to 12:00 noon (n = 90, 28.75%) [Table 2]. The proportion of the two-wheeler involvement is more during morning hours between 6:00 a.m. and 11:59 a.m. (n = 51/90, 56.66%) whereas the proportion of light vehicle in more during the night hours between 12:00 a.m. and 5:59 a.m. (n = 17/24, 70.83%). The majority of RTAs were reported from October to March (n = 188/313, 60.63%). Only few cases were reported in the months of rainy season (i.e., July and August) (n = 26/313, 8.31%) [Table 3].
[Table 4] provides details on the place profile of RTA. The table shows that the peoples belonging to rural area were more frequently involved in RTAs (n = 296, 94.56%) and two-wheeler was the vehicle involved in most of the cases (n = 148/296, 50%). The association of the vehicle involvement in different area population was found statistically not significant (P > 0.05). The table also shows that pedestrian (n = 132, 42.17%) and motorcyclist (n = 124, 39.61%) were the most common road users involved in the RTA. Public transport buses account for the least (n = 26/313, 8.30%) number of accidents. The pedestrian was injured by two wheelers and light motor vehicle in equal frequency (n = 60/132, 45.45%), whereas two wheeler was the most common cause of RTA in motorcyclist (n = 90/124, 72.58%).
| Discussion|| |
In the present study, people in the younger age group (16–31 years) were involved more (n = 135/313, 43.13%) frequently in RTAs followed by the people in the age group of 31–45 years (n = 87/313, 27.79%). Peoples <16 years (n = 24, 7.66%) and older than 60 years (n = 20/313, 6.38%) were least involved in the RTAs.
In a study conducted by Srinivasa Kumar and Srinivasan  from September 2011 to August 2012, they found 21–30 years of age group to be involved in RTAs in 52.5% cases, followed by the age group of 31–40 years in 26.2% cases.
Similar results have been found by Ganveer et al. in their cross-sectional study in central India, where the highest number of accidents were observed in the age group of 18–37 years. Others studies also reported a higher incidence of RTA in similar age groups. This differential involvement of the RTA may be attributed to the fact that the peoples in this age group are more actively involved in the outdoor activities and hence are more exposed to the motor vehicular traffic. This may also be attributed to the fact that peoples in the younger age group also have risk-taking behavior.
In the present study, it is found that RTAs were common in male participants (n = 258/313; 82.42%) as compared to female participants (n = 55/313; 17.57%). M:F ratio is found to be 4.7:1. In a study  conducted by Ganveer and Tiwari in 2005, they found male to be involved in RTA 6 times more commonly than females. A study conducted in a hilly area also found male to female ratio 5.3:1. Similar results have also been found in other studies too.,, The review article on RTAs in India brought out that a majority of the victims are young adults, with male-to-female ratio of 4:1–5:1. The male:female ratio observed in our study closely matches that of India.
The predominance of the males in RTAs may be attributed to the fact that they are more involved in the outdoor activities whereas females are more confined to the household activities, hence males are exposed more to the vehicular traffic accidents.
The present study demonstrates that the participants belonging to APL families (n = 232/313; 74.12%) were more commonly involved in RTAs in comparison with participants belonging to BPL families (n = 75/313; 23.96%). A study  conducted on sociodemographic determinants of musculoskeletal injuries in Himachal Pradesh also reported the people belonging to the APL families, to be injured more as compared with participants belonging to BPL families. This has been attributed to the low poverty rate of Himachal Pradesh as compared with that of the national poverty rate.
Most of the patients of RTAs were with per capita income <4000 (n = 152/313; 48.56%). Only few participants (n = 54/313; 17.25%) were with income >8000. Hence, the present study shows that the peoples belonging to low-to-middle socioeconomic status are more commonly involved in RTAs. A study conducted in Nepal also showed that the peoples of low-to-middle socioeconomic status get more involved in RTA. Similar observations were also made in other studies also.,,,,
This may be due to the fact that most of the peoples in the state belong to low-to-middle socioeconomic status. Moreover, the possibility of peoples with higher socioeconomic status being treated at private hospital cannot be denied.
Our study demonstrates that most of the patients (n = 103/313; 32.90%) were educated up to graduation level, followed by peoples who were educated up to 12th standard (n = 89/313; 28.43%). Similar results were observed in a study conducted by Srinivasa Kumar and Srinivasan, where, most of the victims were also educated to graduate level (n = 144/366, 39.3%) followed by peoples who were educated up to higher secondary level (n = 114/366, 31.1%). Mishra et al. in his study reported RTAs in school educated peoples in 49.16% cases whereas peoples educated up to graduation were involved in 39.15% cases. These observations are in contrast to a study which reported people who were educated up to 10th grade to be involved in that RTAs in 30.69% (62/206) of cases followed by peoples who were illiterate in 20.79% (42/2016) of cases. Similar observations were also reported by other authors also.,
In our study, the involvement of the peoples in higher education group may be due to the higher literacy rate of our state in comparison to the other state.
In our study, the majority of the participants involved in the RTAs were students (n = 86/313; 27.47%) followed by government employees (n = 70/313; 22.36%). There are few number of laborers (n = 32/313, 10.22%) involved in RTAs in our study. In a study reported the laborer (n = 104/206, 50.38%) to be involved n RTAs more commonly followed by students (n = 40/206, 19.41%). In a study conducted in Shimla in 2005, it is found that employees were involved in 34.7% of cases followed by students in 18.5% of cases. In another study, business group had a higher incidence, followed by service group and the labor group. Our observations are different from other studies where laborers were found to be commonly involved in RTAs.,,
In our study, majority of the participants were students, this may be due to the fact that students are mostly exposed to the RTAs while going to the school and colleges. Moreover, they use two-wheelers as the mode of transport, which is commonly involved in RTAs.
It is observed in the present study that participants who were living in nuclear families were more involved in RTA more frequently (n = 210, 67.09%) as compared to participants living in a joint family (n = 100, 31.94%).
Observations in our study are different from a study conducted in Nepal in which it is found that peoples living in joint families (n = 247/360, 68.61%) are commonly involved in RTAs.
This difference observed in our study could probably only be explained due to the fact that the social structure of the society is being changing from joint family to nuclear family.
It is seen in our study that most of the peoples (n = 296/313; 94.56%) suffered from RTA belonged to rural area. Similar results have been found in other studies also., This may be due to the fact that the study has been conducted in a predominantly rural population.
In our study, most of the RTA occurred between 6:00 pm and 11:59 pm (n = 136, 43.45%). Large number of RTA had also occurred from 6:00 am to 12:00 pm (n = 90, 28.75%). Our results probably stem from the fact that these are the time periods when there is high human and traffic congestion on roads.
Our results are similar to the study in Nepal  where majority of accidents reported to occur at 3:00 p.m.–7:00 p.m. followed by 7:00 a.m.–11 a.m. Results similar to our study were obtained in a study  conducted by Kaul A et al. Malhotra et al. in his study, reported that accidents mostly occurred during the day time in Nagpur and Delhi, respectively.
In a study conducted by the Bayan et al., they found that RTA use to occur more on weekends and holidays. The least number of accident occurred on midweek as per this study on Wednesday. In our study, there is slight increase in RTAs on Sunday, but the distribution of RTA on days seems to be evenly distributed.
In our study, majority of RTAs reported from October to March (n = 188/313, 60.63%). Only few cases reported in the months of rainy season (i.e., July and August) (n = 26/313, 8.31%).
It was observed in a prospective study on RTAs  that majority [48.5%] RTA occurred during rainy season and least number of accidents (18.0%) in the summer season. In another study  by Biswas et al., he reported majority of RTA to take place during summer.
Our study results are different from these studies as most of the accidents occurred during the month of winters. This may be because of the reason that winters season forms the predominant season. Most of the accidents observed in the study involved two wheelers and this may be the other reason as peoples do not prefer to go by two wheelers in rainy season.
In our study, the pedestrian (n = 132, 42.17%) and motorcyclist (n = 124, 39.61%) were most common road users involved in the RTA. Public transport buses and other heavy motor vehicles, they account for the least (n = 26/313, 8.30%) number of accidents. Our study results were similar to other studies ,,,, where pedestrian were reported to be injures in majority of RTA cases.
A study on epidemiological profile of RTA in Nepal  reported occupants to be involved in majority of RTA cases. Our study results are also different from study conducted in Shimla  where occupants of light motor vehicle were found to be the victim of RTA in majority of cases followed by pedestrian.
This difference may be due to the fact that most of the population catered by the institution belongs to low-to-middle income families. Most of the people use two wheelers or prefer to travel by transport buses.
| Conclusion|| |
Despite contributing less to the total RTA burden across India, Himachal Pradesh is fast emerging as a state with far reaching consequences of increase in vehicular traffic.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4]