• Users Online: 555
  • Print this page
  • Email this page


 
 
Table of Contents
REVIEW ARTICLE AND META-ANALYSIS
Year : 2023  |  Volume : 12  |  Issue : 1  |  Page : 1-16

The frequency of road traffic injuries and deaths in Eastern Mediterranean Region: A systematic review and meta-analysis


1 Noncommunicable Diseases Research Center, Bam University of Medical Sciences, Bam, Iran
2 Department of Medical Informatics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Center for Healthcare Data Modeling, Departments of Biostatistics and Epidemiology, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
4 Department of Medical Informatics; Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

Date of Submission03-Dec-2022
Date of Decision11-Feb-2023
Date of Acceptance12-Feb-2023
Date of Web Publication30-Apr-2023

Correspondence Address:
Seyyed-Mohammad Tabatabaei
Clinical Research Development Unit, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad
Iran
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/atr.atr_76_22

Rights and Permissions
  Abstract 


Background and Objectives: Deaths and injuries due to road traffic accidents are important public health problems in the world and the Eastern Mediterranean Region (EMR). The current study aimed to review published articles and registry-based reports on the burden of road traffic injuries and deaths in the EMR for all road users. Methods: PubMed, Scopus, Web of Science, and Index Medicos for Eastern Mediterranean Region databases were searched to identify all related articles published until January 9, 2023. The search strategy included a thorough search of the keywords as follows: (burden OR disability-adjusted life years OR DALY OR incidence OR prevalence OR morbidity OR mortality OR death) AND (road traffic accident OR road traffic injury OR road traffic crash) AND (EMRO OR “Eastern Mediterranean Region” OR name of countries in EMRO). The population-based or registry-based data, and hospital-based data with underlying causes of death (codes V01–V99) were included. The death of other transportation, literature reviews, viewpoints, and commentaries was excluded. The quality of papers was assessed using the STROBE checklist. Available data for all road users based on their type were extracted and analyzed. Finally, a random-effects meta-analysis was performed, and pooled rates of road traffic injuries and deaths were estimated. Moreover, meta-regression was performed to identify the potential sources of heterogeneity. Results: The review of 69 studies showed that the pooled rate was 173.9/100,000 population (95% confidence interval [CI]: 165.1–182.9). The pooled fatal and crash injury rates were 31.4 deaths (95% CI: 30.3–32.7) and 218.6 injuries (95% CI: 212.5–224.6) per 100,000 population. The highest road traffic crash rates belonged to motorized four-wheeler users at 73.8/100,000 population (95% CI: 70.7–77.0), followed by motorized two–three wheelers/cyclists at 30.2/100,000 population (95% CI: 4.1–64.5). Conclusions: The burden of road traffic injury and death was high in EMR. Therefore, the modification of the traffic crash data logging system and active monitoring of the consequences of traffic crashes in this region are required.

Keywords: Burden, Eastern Mediterranean region, road traffic injuries and deaths


How to cite this article:
Abedi-Gheshlaghi L, Rasoulian-Kasrineh M, Taheri-Soodejani M, Mandegari Z, Tabatabaei SM. The frequency of road traffic injuries and deaths in Eastern Mediterranean Region: A systematic review and meta-analysis. Arch Trauma Res 2023;12:1-16

How to cite this URL:
Abedi-Gheshlaghi L, Rasoulian-Kasrineh M, Taheri-Soodejani M, Mandegari Z, Tabatabaei SM. The frequency of road traffic injuries and deaths in Eastern Mediterranean Region: A systematic review and meta-analysis. Arch Trauma Res [serial online] 2023 [cited 2024 Mar 19];12:1-16. Available from: https://www.archtrauma.com/text.asp?2023/12/1/1/375451




  Introduction Top


Road traffic deaths and injuries are major public health problems in the world. According to the statistics, more than 1.35 million individuals die due to road traffic incidents annually, and a number of 20–50 million individuals have been injured.[1] The World Health Organization (WHO) reported that road traffic crashes were among the few nonbiological causes in the list of the top-ten causes of human deaths in 2016.[2] Currently, such crashes are the most important causes of death among children and young individuals aged 5–29 years. In addition, more than 50% of road traffic deaths occur more frequently in pedestrians, cyclists, and motorcyclists.[1]

According to the WHO, in 2018, more than 90% of road traffic crashes occurred in low-and middle-income countries, of which only 59% of the total number of vehicles in these countries were registered. Therefore, the burden of road traffic deaths was considerable in low- and middle-income countries.[1],[3] In 2016, in the Eastern Mediterranean Region (EMR), the rate of road traffic deaths was 18/100,000 population, which was almost higher than in 2013 (17.9/100,000 population).[1] The increase in road traffic injuries and deaths is, to some extent, related to the economic development of countries, which has increased the number of vehicles on the roads without improving the road infrastructure itself.[3],[4]

A study showed that road traffic crashes in the EMR were underreported. Moreover, information about factors affecting the occurrence of traffic crashes was underreported in many countries due to the lack of supportive structures of multi-sectoral cooperation.[5] Thus, underreporting and unavailability of road traffic databases were two major barriers to health-based planning in prehospital and emergency care contexts as well as other governmental agencies. To improve the underreporting gap in road traffic injuries and deaths, this study aimed to review the published articles and registry-based reports on the burden of road traffic injuries and deaths in the EMR attributed to all road users (i.e. pedestrians, motorized four-wheelers motorized two-three wheelers and cyclists).


  Methods Top


Literature search

Electronic databases, including PubMed, Scopus, Web of Science, and Index Medicos for the Eastern Mediterranean Region, were searched to emerge articles published until January 9, 2023. The search strategy comprised of the MeSH terms as follows: (burden OR disability-adjusted life years OR DALY OR incidence OR prevalence OR morbidity OR mortality OR death) AND (road traffic accident OR road traffic injury OR road traffic crash) AND (EMRO OR “Eastern Mediterranean Region” OR name of countries in EMRO). Conference abstracts were searched in Scopus. All searches were performed by two independent reviewers.

Study selection

Papers possessing the following criteria were included in the present study: (a) Clearly referred to road traffic injuries or deaths, b) Included population-based or registry-based data, and c) Included hospital-based data with underlying causes of death which were coded in the International Classification of Disease and Related Health Problems, 10th revision (ICD-10), with codes V01–V99.

Papers were excluded if they: (a) Referred to death through other means of transportation, including water, air, and any other unspecified transportation means, (b) Were literature reviews, viewpoints, and commentaries, and (c) Were not clearly defined and consistently applied a case definition of a road traffic injury or fatality. No language restriction was applied.

In this study, an injury referred to nonfatal cases from a road traffic accident. Death was defined as a result of a road traffic accident in which one or more affected individuals died immediately or within 30 days after the accident. For nonfatal injuries, the case severity ranged from minor injuries with short-term disabilities to severe injuries with lifelong disabilities.

Titles and abstracts of the retrieved articles were independently evaluated by two reviewers. Abstracts that failed to provide adequate information regarding the eligibility criteria were further evaluated through a full-text search. The extracted articles were hand-checked for potentially referred eligible articles that had not been retrieved through electronic search. Reviewers independently evaluated full-text articles and determined study eligibility. Disagreements were addressed by consensus and a third reviewer's opinions in case of unresolved disagreements.

Data extraction

Two reviewers independently conducted the data extraction, and any disagreements were resolved by a third reviewer's opinions. Key data were extracted using a predefined checklist, including the data of the first author, publication year, study period, country (study setting), study design, study type (registry-based or population-based), source of data, type of data (death or injury), age range, sex, the common cause of death or injury, type of road user, and mechanism of injury [Table 1].
Table 1: Characteristics of the studies on burden of road traffic injuries and deaths in Eastern Mediterranean Region

Click here to view


Quality assessment

The texts of the papers were evaluated according to the STROBE checklist.[74] The items of the STROBE checklist were ranked zero (poor), one (medium), or two (good). The poor-quality papers included papers with a total score of 30 or lower. The medium-quality group consisted of papers with a score between 31 and 35. The good-quality group included the papers with a score of 36 or higher. The study design, completeness, appropriateness of statistical and analytical methods, and state of limitations were explicitly checked for each study. Moreover, the quality of the reported sample size or study population was assessed to provide a representative estimate.

Data analysis

All extracted data on road traffic accidents, including injuries and deaths, were converted to rates per 100,000 population. Studies were subdivided into population- and registry-based studies and analyzed separately for all road users and by road user category. The heterogeneity among rate estimates was checked by I2 index as the proportion of total variance due to between-study variance. Moreover, the Q-test for heterogeneity where in a P < 0.1 was became taken into consideration as statistically significant. The eager test was used to assess the publication bias. Since there was heterogeneity among studies, a random effects (DerSimonian and Laird) meta-analysis was conducted on an extracted road traffic accident, injury, and death rates using Metan command by Stata version 13.1 (StataCorp. LP, College Station, the United States of America). A forest plot was used to display the results of each study along with the pooled estimates and their 95% confidence intervals.

After observing substantial heterogeneity across the studies, meta-regression was run to identify the potential sources of heterogeneity, and the variables of publication year, sample size, study type (population- and registry-based), and type of road user were included independently in the model. Subgroup analysis was performed according to the type of road user.


  Results Top


About 2783 articles were retrieved by database searching. After reviewing articles, 69 articles were investigated for qualitative evaluation and meta-analysis using inclusion criteria [Figure 1]. Some extracted features are presented in [Table 1].
Figure 1: Flow diagram of the search strategy for meta-analysis on the burden of road traffic injuries and deaths in Eastern Mediterranean Region

Click here to view


The results of the quality assessment revealed that 15 (22%) studies were of good quality, 44 (63.7%) were of medium quality, and 10 (14.3%) were of poor quality.

According to the eager test, there was no evidence of publication bias for injury rates (β =0.17, 95% CI:-1.3–1.7, P = 0.41) and death rates (β =0.74, 95% CI:-0.24–1.7, P = 0.13).

Of all 69 articles, 67 articles were from Iran and two articles were from Pakistan and Qatar. More than two-thirds of studies (58 articles) have been conducted since 2010 and their time duration varied from 1 to 12 years.

Overall, a number of 63 cross-sectional, three case-control, and three prospective cohort studies were included in the present study. The study type was population-based in three articles and registry-based in the rest. The most common data sources in the reviewed articles were hospital and emergency sources (29 articles), police sources (18 articles), and forensic data sources (25 articles). In the reviewed studies, lower and upper extremities injuries (7 articles, 14.9%), and head-and-face injuries (4 articles, 8.5%) have been reported as the most common types of road traffic injuries [Figure 2] and [Figure 3].
Figure 2: The most common reported causes of road traffic deaths in the Eastern Mediterranean Region in the articles published during 2004–2023

Click here to view
Figure 3: The most common reported site of road traffic injuries in the Eastern Mediterranean Region in articles published during 2004–2023

Click here to view


The vehicles in the reviewed studies included four-wheeled vehicles (14 articles), motorcycles and bicycles (6 articles), pedestrians (5 articles), and a combination of all (50 articles). The mechanism of occurring road traffic crashes was reported in 16 articles. In these articles, vehicle collision (11 articles), motorcycle collision with vehicle (7 articles), vehicle collision with pedestrian (3 articles), vehicle collision with fixed objects (3 articles), and overturning (7 articles) were reported as the most common types of crash mechanisms [Table 1].

Reported rates

According to the registry-based studies, the highest and lowest reported road traffic injury rates were 1810.1 and 0.21/100,000 population in 2016 and 2017, respectively.[7],[8] The lowest road traffic death rate reported in 2019 was 0.06/100,000 population,[15] and the highest rate was 251.9/100,000 population in 2013.[54] The estimated pooled rates for the Eastern Mediterranean region are presented in [Table 2]. For all crashes, the pooled rate was 173.9/100,000 population.[7],[17] The pooled road traffic death and injury rates were estimated as 31.4 deaths and 218.6 injuries/100,000 population, respectively. The pooled rates showed that the highest road traffic death and injury rates belonged to four-wheeled vehicles. Among two–three-wheeled vehicles and cyclists, the pooled road traffic injury and death rates were 30.2, 39.8, and 3.4/100,000 population, respectively. The pooled road traffic injury and death rates among pedestrians were 24.4, 46.4 and 3.9/100,000 population, respectively [Table 2]. From 2004 to 2023, road traffic death rates decreased from 33.5 to 24.1/100,000 population [Figure 4]. In contrast, injury rates decreased from 225.2 to 88.9/100,000 population since 2004-2015, but this rate increased to 128.6/100,000 population since 2016-2023 [Figure 5].
Table 2: Pooled total road traffic injury and death estimates by road user type, Eastern Mediterranean Region, 2004-2023

Click here to view
Figure 4: Forest plot of random-effects meta-analysis of the death rate of road traffic crashes in Eastern Mediterranean Region between 2004 and 2023

Click here to view
Figure 5: Forest plot of random-effects meta-analysis of the injury rate of road traffic crashes in Eastern Mediterranean Region between 2004 and 2023

Click here to view


Meta-regression analysis showed a significant association between the sample size of studies and the injury rate (β = −5.59, P = .03). However, there was no significant association between injury rate and the publication year (β = −7.8, P = 0.47), type of road user (β = −65.9, P = 0.18), and study type (β =155.1, P = 0.31). Moreover, there was no significant association between death rate and the publication year (β = −1.1, P = 0.44, type of road user (β = −11.9, P = 0.06), and sample size (β =0.34, P = 0.24).


  Discussion Top


According to the results of this study, the rate of total crashes was 173.9/100,000 people in the EMR during 2004–2023. Moreover, the rate of road traffic death and injury was 31.4 and 218.6/100,000 people, respectively. Based on a recent study, about 9.7% of road traffic deaths in the world occur in the EMR, while this region comprises only 7.4% of the total world population.[3],[11] In 2016, a report by the WHO showed that the road traffic death in a region was 18/100,000 individuals,[1] which is different from the results of this study, but it is a significant amount that needs more attention of officials and policy makers. According to a report from the WHO in 2018, road traffic crashes have caused major concern for all countries in the EMR regardless of their income level, so it has the third-highest number of road traffic deaths after Africa and Southeast Asia.[76]

The report on road traffic deaths and injuries between 2004 and 2020 showed that the death rate had decreased from 33.5 to 24.1/100,000 population. In contrast, from 2004 to 2015, the injury rate had decreased from 225.2 to 88.9/100,000 population, while it had increased to 128.6/100,000 population from 2016 to 2023. A previous study conducted in this region revealed that there has been a decreasing trend in road traffic deaths since 2005. However, low-income countries in the region have the highest number of road traffic deaths and injuries compared to the others, knowing that after 2015, the use of motorized vehicles in the region has an increasing trend while it has been tripled compared to the global standard.[77] It seems that an increase in the number of cars, the absence of other public transport modes (such as tram or train), quality of roads, traffic conditions, and old vehicles are all among the contributing factors in increasing injury and fatalities in low- and middle-income countries.[78],[79] In these countries, there is a disproportionately higher rate of pedestrians and motorcyclists.[79] Since most of the road users in low-income countries are composed of pedestrians, cyclists and motorcyclists, targeted policy, and safety legislation must be performed.

Among the most important issues affecting the possibility of crashes as well as the severity of their following consequences in the EMR are road safety challenges, including the control and design of road infrastructure and the vehicles themselves[80] while according to the WHO, many changes have been implied in the road safety law within the countries of the region.[81] On the other hand, despite the economic growth of many countries in the region, the access and quality of prehospital, inpatient, and posthospital care for traffic accident victims are not at the level of world standard,[82],[83] knowing that easy access to quality health-care services plays an important role in reducing mortality and improving the outcome of traffic crashes.[82],[83]

The results of this study showed that most traffic crashes occurred by four-wheeled vehicles and motorcycles in the EMR. In 2015, among the EMR countries, in terms of income level, the road traffic death rate caused by four-wheeled vehicles was different compared to other users, so that this rate was three times, three times and one and a half times more than others in high-, middle- and low-income countries, respectively. Since most of the obtained researches are from Iran and Iran is a middle-income country, the results of this study are consistent with the previous study conducted in the region.[77] In the countries of the region, including Iran, Morocco, and Tunisia, the most common transportation methods were using two-wheeled and three-wheeled vehicles instead of walking.[83] In these countries, the risk of crash and death in users of four-wheeled and two-wheeled vehicles increases due to the poor infrastructure, lack of special roads for high-risk users, including motorcyclists, cyclists, and pedestrians, and their absence from the view of other vehicle drivers.[11]

A major challenge for managers to react against road traffic crashes in the EMR is the lack of reliable information and data that can provide appropriate decisions to reduce the burden and injuries caused by such crashes.[5] It is also confirmed in this study as the highest (1810/100,000 people) and the lowest (0.21/100,000 people) rate of road traffic injury reported in the region was from Iran.[34],[37] Moreover, the highest (251/100,000 people) and the lowest (0.06/100,000 people) rates of road traffic deaths were reported from Iran[15],[55] and there were only two studies from Pakistan[74] and Qatar[76] on the burden of road traffic injury. In many countries in the region, there is neither an active data registry nor a monitoring system to track the consequences of road traffic crashes.[5] In such countries, police data are the primary source of information on traffic crashes, knowing that road traffic injuries and deaths are underreported there.[5] The reasons for this underreporting might be the incorrect classification of death reports, the challenges in defining 30-day deaths from official sources, as well as the neglecting and underestimating of the importance of registering road traffic accident data.

The results of this study revealed that head trauma was the most common cause of death and limb injury was the most common site of injury among the victims of road traffic crash. According to studies, not wearing a safety helmet in motorcyclists and cyclists, and not wearing seat belts in drivers and occupants of four-wheeled vehicles are among the causes of head injuries.[1],[3],[38],[81] Wearing a safety helmet reduces the risk of death by up to 40% and the risk of injury by up to 70%.[3],[81] However, in the EMR, the use of it varies from 6% to 90%.[85] In these countries, instructions should be developed to make more suitable and lighter helmet. Moreover, strict rules and laws should be reformed and implemented on the mandatory use of helmets and seat belts, response systems and coordination of prehospital and hospital emergency care for the injured should be reformed, and also timely and easy access to rehabilitation services for the injured should be considered.

The current study had some limitations: (1) Most of the data were obtained from the studies in Iran and we did not have access to the data from other countries. (2) Most of the reviewed studies were based on a registry system and there is a low probability of underreporting.


  Conclusion Top


The burden of road traffic crashes in the EMR is high and there is a high level of damage in traffic injuries. Improving systems for registering road traffic crash data and active monitoring to follow-up on the consequences of traffic crashes, improving response systems and managing prehospital and hospital emergency care for the injured, as well as improving access to rehabilitation services for the injured are among the acts that should be considered in the countries of this region.

Ethics approval

This study was approved by the Ethics Committee of Mashhad University of Medical Sciences (IR.MUMS.MEDICAL.REC.1399.703).

Financial support and sponsorship

The study was financially supported by Mashhad University of Medical Sciences.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Global Status Report on Road Safety 2018. Geneva: World Health Organization; 2018.  Back to cited text no. 1
    
2.
World Health Organization. Available from: https://www.who.int/news-room/fact-sheets/detail/the-top-10-causes-of-death2016. [Last accessed on 2020 09 Dec].  Back to cited text no. 2
    
3.
World Health Organization. WHO Global Status Report on Road Safety 2013: Supporting a Decade of Action. Geneva: World Health Organization; 2013.  Back to cited text no. 3
    
4.
World Health Organization. Global Status Report on Road Safety: Time for Action. Geneva: World Health Organization; 2009.  Back to cited text no. 4
    
5.
World Health Organization. Regional Office for the Eastern Mediterranean. Eastern Mediterranean Status Report on Road Safety: Call for Action. Cairo, Egypt; WHO Regional Office for the Eastern Mediterranean; 2010.  Back to cited text no. 5
    
6.
Soroosh D, Nematshahi M, Javadinia SA, Hesamifard M. Study of the pattern and frequency of road traffic injuries in car occupants in the eastern part of Iran. International Journal of Medical Toxicology and Forensic Medicine. 2020;10:28112.  Back to cited text no. 6
    
7.
Rezapur-Shahkolai F, Taheri M, Etesamifard T, Roshanaei G, Shirahmadi S. Dimensions of aberrant driving behaviors and their association with road traffic injuries among drivers. PLoS One 2020;15:e0238728.  Back to cited text no. 7
    
8.
Khatibi SR, Dinpanah H, Maajani K, Khodadost M, Khodadost B, Kakhki S, et al. The burden of road traffic injuries in the Northeast of Iran: The result of a population-based registry. J Inj Violence Res 2020;12:63-72.  Back to cited text no. 8
    
9.
Taheri Soodejani M, Mahmudimanesh M, Abedi L, Tabatabaei SM, Ghaderi A. Traffic accident mortality in Najafabad, Iran during 2011-2017. Trauma Monthly. 2020;25 (1):20-6.  Back to cited text no. 9
    
10.
Ghodsi Z, Saadat S, Barzegar A, Alaeddini F, Rahimi-Movaghar V, Zafarghandi M, et al. The completeness of the registration system and the economic burden of fatal injuries in Iran. Ulus Travma Acil Cerrahi Derg 2020;26:671-7.  Back to cited text no. 10
    
11.
Soori H, Khorasani-Zavareh D. Road traffic injuries measures in the Eastern Mediterranean Region: Findings from the global status report on road safety-– 2015. J Inj Violence Res 2019;11:149-58.  Back to cited text no. 11
    
12.
Shahbazi F, Soori H, Khodakarim S, Ghadirzadeh M, M, Nazari S. Analysis of mortality rate of road traffic accidents and its trend in 11 years in Iran. Archives of Trauma Research. 2019;8 (1):17-22.  Back to cited text no. 12
    
13.
Sepandi M, Alimohamadi Y, Mahmud F, Enaami M. Productivity and years of life lost due to fatal traffic injuries in Shiraz Shahid Rajaei Hospital during 2009-2013. Archives of Trauma Research. 2019;8 (3):160-4.  Back to cited text no. 13
    
14.
Roshanfekr P, Khodaie-Ardakani MR, Malek Afzali Ardakani H, Sajjadi H. Prevalence and socio-economic determinants of disabilities caused by road traffic accidents in Iran; a national survey. Bull Emerg Trauma 2019;7:60-6.  Back to cited text no. 14
    
15.
Rahmati F, Doosti M, Bahreini M. The cost analysis of patients with traffic traumatic injuries presenting to emergency department; a cross-sectional study. Adv J Emerg Med 2019;3:e2.  Back to cited text no. 15
    
16.
Roshanfekr P, Khodaie-Ardakani MR, Malek Afzali Ardakani H, Sajjadi H. Prevalence and socio-economic determinants of disabilities caused by road traffic accidents in Iran; a national survey. Bull Emerg Trauma 2019;7:60-6.  Back to cited text no. 16
    
17.
Lotfi S, Honarvar A, Gholamzadeh S. Analysis and identification the hidden relationships between effective factors in the mortality rate caused by road accidents: A case study of fars province, Iran. Chinese Journal of Traumatology. 2019;2222:233-9.  Back to cited text no. 17
    
18.
Jamali-Dolatabad M, Sadeghi-Bazargani H, Sarbakhsh P. Predictors of fatal outcomes in pedestrian accidents in Tabriz Metropolis of Iran: Application of PLS-DA method. Traffic Inj Prev 2019;20:873-9.  Back to cited text no. 18
    
19.
Hashempour R, Tahmasebi A, Veysi M, Amini M, Tavakoli N. Cost analysis of accidents according to demographic factors in Iran. Iran J Public Health 2019;48:1346-53.  Back to cited text no. 19
    
20.
Zangeneh A, Najafi F, Karimi S, Saeidi S, Izadi N. Spatial-temporal cluster analysis of mortality from road traffic injuries using geographic information systems in West of Iran during 2009-2014. J Forensic Leg Med 2018;55:15-22.  Back to cited text no. 20
    
21.
Shahbazi F, Soori H, Khodakarim S, Ghadirzadeh MR, Shojaei A, Hashemi Nazari SS. Investigation of the role of traffic police function in reducing geographical inequalities in mortality from road traffic accidents. Arch Trauma Res 2018;7:92-7.  Back to cited text no. 21
  [Full text]  
22.
Sadeghi-Bazargani H, Samadirad B, Moslemi F. A decade of road traffic fatalities among the elderly in North-West Iran. BMC Public Health 2018;18:111.  Back to cited text no. 22
    
23.
Parvareh M, Karimi A, Rezaei S, Woldemichael A, Nili S, Nouri B, et al. Assessment and prediction of road accident injuries trend using time-series models in Kurdistan. Burns Trauma 2018;6:9.  Back to cited text no. 23
    
24.
Mahdian M, Sehat M, Fazel M, Akbari H, Rahimi H, Mohammadzadeh M. Road traffic deaths in Kashan region, Iran: An eight-year study (2007-– 2013). Chinese Journal of Traumatology. 2018;21:54 -7.  Back to cited text no. 24
    
25.
Lotfi M, Montazer M, Lashkardoost H, Shamsi F, Askari M, Hamedi E, et al., Road traffic accidents in Yazd province, Iran: A longitudinal study (2012–2016). Archives of Trauma Research. 2018;7:68.  Back to cited text no. 25
    
26.
Homayoun SB, Bahram S, Mina G, Nasrin S, Milad J. Analysis of provincial mortalities among bus/minibus users over twelve years, East Azerbaijan, Iran. J Med Life 2018;11:312-9.  Back to cited text no. 26
    
27.
Hasani J, Khorshidi A, Erfanpoor S, Nazparvar B, Hashemi Nazari SS. Comparison of risk factors for pedestrian fatality in urban and suburban traffic accidents. Archives of Trauma Research. 2018;7 (2):39-44.  Back to cited text no. 27
    
28.
Sherafati F, Homaie-Rad E, Afkar A, Gholampoor-Sigaroodi R, Sirusbakht S. Risk factors of road traffic accidents associated mortality in Northern Iran; A single Center experience utilizing Oaxaca blinder decomposition. Bull Emerg Trauma 2017;5:116-21.  Back to cited text no. 28
    
29.
Khoramdad M, Izadi N, Najafi F. Years of life lost due to road traffic injuries in Kermanshah province. Trauma Monthly. 2017;22:64272.  Back to cited text no. 29
    
30.
Izadi N, Najafi F, Khosravi A. The burden of road traffic injuries in Kermanshah Province, Iran, in 2010-2011: GBD 2010 method. Int J Inj Contr Saf Promot 2017;24:435-43.  Back to cited text no. 30
    
31.
Hosseinpour M, Mohammadian-Hafshejani A, Esmaeilpour Aghdam M, Mohammadian M, Maleki F. Trend and seasonal patterns of injuries and mortality due to motorcyclists traffic accidents; a hospital-based study. Bull Emerg Trauma 2017;5:47-52.  Back to cited text no. 31
    
32.
Hatamabadi HR, Shojaee M, Kashani P, Forouzanfar MM, Aghajani Nargesi D, Amini Esfahani MR. Predictive factors of poor outcome in road traffic injures; a retrospective cohort study. Emerg (Tehran) 2017;5:e21.  Back to cited text no. 32
    
33.
Fararouei M, Sedaghat Z, Sadat SJ, Shahraki G. Risk factors for being the at-fault driver: A case-control study. Traffic Inj Prev 2017;18:262-6.  Back to cited text no. 33
    
34.
Fakharian E, Mohammadzadeh M, Saberi HR, Fazel MR, Rejali M, Akbari H, et al. Spinal injury resulting from car accident: Focus to prevention. Asian J Neurosurg 2017;12:180-4.  Back to cited text no. 34
[PUBMED]  [Full text]  
35.
Yousefzadeh-Chabok S, Ranjbar-Taklimie F, Malekpouri R, Razzaghi A. A time series model for assessing the trend and forecasting the road traffic accident mortality. Arch Trauma Res 2016;5:e36570.  Back to cited text no. 35
    
36.
Vakili M, Mirzaei M, Pirdehghan A, Sadeghian M, Jafarizadeh M, Alimi M, et al. The Burden of road traffic injuries in Yazd province – Iran. Bull Emerg Trauma 2016;4:216-22.  Back to cited text no. 36
    
37.
Sargazi A, Sargazi A, Nadakkavukaran Jim PK, Danesh H, Aval F, Kiani Z, et al. Economic burden of road traffic accidents; report from a single Center from South Eastern Iran. Bull Emerg Trauma 2016;4:43-7.  Back to cited text no. 37
    
38.
Rakhshani T, Rakhshani F, Asadi ZS, Hadiabasi M, Khorramdel K, Zarenezhad M. Study of the pattern of mortality caused by traffic accidents (TAs) in the South of Iran. J Pak Med Assoc 2016;66:644-9.  Back to cited text no. 38
    
39.
Rad M, Martiniuk AL, Ansari-Moghaddam A, Mohammadi M, Rashedi F, Ghasemi A. The pattern of road traffic crashes in South East Iran. Glob J Health Sci 2016;8:51677.  Back to cited text no. 39
    
40.
Mirzaei M, Mirzadeh M, Shogaei Far H, Mirzaei M. Trends in road traffic deaths in Yazd, Iran, 2004-2010. Arch Trauma Res 2016;5:e29266.  Back to cited text no. 40
    
41.
Masoumi K, Forouzan A, Barzegari H, Asgari Darian A, Rahim F, Zohrevandi B, et al. Effective factors in severity of traffic accident-related traumas; an epidemiologic study based on the Haddon Matrix. Emerg (Tehran) 2016;4:78-82.  Back to cited text no. 41
    
42.
Khorshidi A, Ainy E, Hashemi Nazari SS, Soori H. Temporal patterns of road traffic injuries in Iran. Arch Trauma Res 2016;5:e27894.  Back to cited text no. 42
    
43.
Ebrahemzadih M, Giahi O, Foroginasab F. Analysis of traffic accidents leading to death using tripod beta method in Yazd, Iran. PROMET Traffic Transp 2016;28:291-7.  Back to cited text no. 43
    
44.
Mohammadi M, Ansari Moghaddam A, Rad M, Hashemi Habybabady R, Tabasi MA. Seatbelt use and related factors among drivers involved in road crashes in Southeast Iran. Health Scope 2015;4:e30782.  Back to cited text no. 44
    
45.
Yazdani-Charati J, Siamian H, Ahmadi-Basiri E. Spatial analysis and geographic variation of fatal and injury crashes in mazandaran province from 2006 to 2010. Mater Sociomed 2014;26:177-81.  Back to cited text no. 45
    
46.
Shams Vahdati S, GhafarZad A, Rahmani F, Panahi F, Omrani Rad A. Patterns of road traffic accidents in North West of Iran during 2013 New Year holidays: Complications and casualties. Bull Emerg Trauma 2014;2:82-5.  Back to cited text no. 46
    
47.
Mohammadi G. Road crash injuries and fatalities in Isfahan, Iran from March 2006 to March 2009. Int J Inj Contr Saf Promot 2014;21:361-6.  Back to cited text no. 47
    
48.
Mehmandar M, Soori H, Amiri M, Norouzirad R, Khabzkhoob M. Risk factors for fatal and nonfatal road crashes in Iran. Iran Red Crescent Med J 2014;16:e10016.  Back to cited text no. 48
    
49.
Hasanzadeh J, Moradinazar M, Najafi F, Ahmadi-Jouybary T. Trends of mortality of road traffic accidents in Fars province, Southern Iran, 2004–2010. Iran J Public Health 2014;43:1259-65.  Back to cited text no. 49
    
50.
Davoudi-Kiakalayeh A, Mohammadi R, Yousefzade-Chabok S, Saadat S. Road traffic crashes in rural setting: An experience of a middle-income country. Chin J Traumatol 2014;17:327-30.  Back to cited text no. 50
    
51.
Ardalan A, Sepehrvand N, Pourmalek F, Masoumi G, Sarvar M, Mahmoudabadi A, et al. Deadly rural road traffic injury: A rising public health concern in I.R. Iran. Int J Prev Med 2014;5:241-4.  Back to cited text no. 51
    
52.
Paravar M, Hosseinpour M, Salehi S, Mohammadzadeh M, Shojaee A, Akbari H, et al. Pre-hospital trauma care in road traffic accidents in Kashan, Iran. Arch Trauma Res 2013;1:166-71.  Back to cited text no. 52
    
53.
Heydari ST, Hoseinzadeh A, Sarikhani Y, Hedjazi A, Zarenezhad M, Moafian G, et al. Time analysis of fatal traffic accidents in Fars Province of Iran. Chin J Traumatol 2013;16:84-8.  Back to cited text no. 53
    
54.
Mohammadi G. Road traffic crash injuries and fatalities in the city of Kerman, Iran. Int J Inj Contr Saf Promot 2013;20:184-91.  Back to cited text no. 54
    
55.
Bahadorimonfared A, Soori H, Mehrabi Y, Delpisheh A, Esmaili A, Salehi M, et al. Trends of fatal road traffic injuries in Iran (2004-2011). PLoS One 2013;8:e65198.  Back to cited text no. 55
    
56.
Mohammadi G. Pattern of deaths and injuries in road crashes on three main entrance roads in Kerman, Iran. Int J Inj Contr Saf Promot 2012;19:384-7.  Back to cited text no. 56
    
57.
Derakhshanfar H, Kalantari Meibodi M, Kariman H, Arhamidolatabadi A, Safari S. Substance abuse among drivers of motor vehicle collisions. Trauma Mon 2012;17:236-8.  Back to cited text no. 57
    
58.
Majdzadeh R, Eshraghian MR, Khalagi K, Motevalian A, Naraghi K. Crash-related factors associated with the severity of road traffic injuries in Iran. Int J Inj Contr Saf Promot 2011;18:175-80.  Back to cited text no. 58
    
59.
Hatamabadi HR, Vafaee R, Haddadi M, Abdalvand A, Soori H. Necessity of an integrated road traffic injuries surveillance system: A community-based study. Traffic Inj Prev 2011;12:358-62.  Back to cited text no. 59
    
60.
Vafaee-Najar A, Esmaeili H, Ibrahimipour H, Dehnavieh R, Nozadi MS. Motorcycle fatal accidents in Khorasan Razavi province, Iran. Iran J Public Health 2010;39:95-101.  Back to cited text no. 60
    
61.
Bigdeli M, Khorasani-Zavareh D, Mohammadi R. Pre-hospital care time intervals among victims of road traffic injuries in Iran. A cross-sectional study. BMC Public Health 2010;10:406.  Back to cited text no. 61
    
62.
Rahimi-Movaghar V, Zarei MR, Saadat S, Rasouli MR, Nouri M. Road traffic crashes in Iran from 1997 to 2007. Int J Inj Contr Saf Promot 2009;16:179-81.  Back to cited text no. 62
    
63.
Mohammadi G. Mobile phone and seat belt usage and its impact on road accident fatalities and injuries in southeast Iran. Int J Crashworthiness 2009;14:309-14.  Back to cited text no. 63
    
64.
Mohammadi G. Road traffic fatalities among pedestrians, bicyclists and motor vehicle occupants in Sirjan, Kerman, Iran. Chin J Traumatol 2009;12:200-2.  Back to cited text no. 64
    
65.
Mohammadi G. The pattern of fatalities by age, seat belt usage and time of day on road accidents. Int J Inj Contr Saf Promot 2009;16:27-33.  Back to cited text no. 65
    
66.
Jan Mohammadi N, Pourhossein M, Hashemi SR. Pattern of motorcyclist's mortality in Mazandran province, Northern Iran. Iran Red Crescent Med J 2009;11:81-4.  Back to cited text no. 66
    
67.
Bhalla K, Naghavi M, Shahraz S, Bartels D, Murray CJ. Building national estimates of the burden of road traffic injuries in developing countries from all available data sources: Iran. Inj Prev 2009;15:150-6.  Back to cited text no. 67
    
68.
Soroush AR, Ghahri-Saremi S, Rambod M, Malek-Hosseini SA, Nick-Eghbal S, Khaji A. Pattern of injury in Shiraz. Chin J Traumatol 2008;11:8-12.  Back to cited text no. 68
    
69.
Moharamzad Y, Taghipour H, Hodjati Firoozabadi N, Hodjati Firoozabadi A, Hashemzadeh M, Mirjalili M, et al. Mortality pattern according to autopsy findings among traffic accident victims in Yazd, Iran. Chin J Traumatol 2008;11:329-34.  Back to cited text no. 69
    
70.
Kadkhodaie MH. Three-year review of facial fractures at a teaching hospital in Northern Iran. Br J Oral Maxillofac Surg 2006;44:229-31.  Back to cited text no. 70
    
71.
Roudsari BS, Sharzei K, Zargar M. Sex and age distribution in transport-related injuries in Tehran. Accid Anal Prev 2004;36:391-8.  Back to cited text no. 71
    
72.
Montazeri A. Road-traffic-related mortality in Iran: A descriptive study. Public Health 2004;118:110-3.  Back to cited text no. 72
    
73.
Bener A, Bener OF. Mobile phone use while driving and risk of road traffic injury: Applying the lorenz curve and associated gini index. Advances in Transportation Studies. 2007;13:77-82.  Back to cited text no. 73
    
74.
Mehmood A, Khan IQ, Mir MU, Moin A, Jooma R. Vulnerable road users are at greater risk during Ramadan -- – Results from road traffic surveillance data. J Pak Med Assoc 2015;65:287-91.  Back to cited text no. 74
    
75.
Von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: Guidelines for reporting observational studies. Preventive Medicine. 2007;45 (4):247-51.  Back to cited text no. 75
    
76.
World Health Organization. Road Safety in the Eastern Mediterranean Region Highlights from WHO's Global Status Report on Road Safety 2018. Cairo, Egypt; Creative Commons Attribution-NonCommercial-ShareAlike; 2018.  Back to cited text no. 76
    
77.
Sengoelge M, Laflamme L, El-Khatib Z. Ecological study of road traffic injuries in the eastern Mediterranean region: Country economic level, road user category and gender perspectives. BMC Public Health 2018;18:236.  Back to cited text no. 77
    
78.
Heydari S, Hickford A, McIlroy R, Turner J, Bachani AM. Road safety in low-income countries: State of knowledge and future directions. Sustainability. 2019;11 (22):6249.  Back to cited text no. 78
    
79.
Mahmood SO, A Sallam S, H Wahdan I, Hama Ghareeb KA, Adil Hasan Y, Mohialdeen Gubari MI, et al. Survey on the causes of road traffic accidents in Sulaymaniyah, Kurdistan Region, Iraq. Int Electron J Med. 2020;9 (1):31-7.  Back to cited text no. 79
    
80.
Jamieson J. The Development of a Road Safety Strategy for the Gulf State of Qatar. Australasian Road Safety Research, Policing and Education Conference; 2008.  Back to cited text no. 80
    
81.
World Health Organization. Global Status Report on Road Safety 2015. Geneva: World Health Organization; 2015.  Back to cited text no. 81
    
82.
Noland RB. Medical treatment and traffic fatality reductions in industrialized countries. Accid Anal Prev 2003;35:877-83.  Back to cited text no. 82
    
83.
GBD 2015 Eastern Mediterranean Region Transportation Injuries Collaborators. Transport injuries and deaths in the Eastern Mediterranean region: Findings from the global burden of disease 2015 study. Int J Public Health 2018;63:187-98.  Back to cited text no. 83
    
84.
Beckett K, Earthy S, Sleney J, Barnes J, Kellezi B, Barker M, et al. Providing effective trauma care: The potential for service provider views to enhance the quality of care (qualitative study nested within a multicentre longitudinal quantitative study). BMJ Open 2014;4:e005668.  Back to cited text no. 84
    
85.
Abedi L, Sadeghi-Bazargani H. Epidemiological patterns and risk factors of motorcycle injuries in Iran and Eastern Mediterranean region countries: A systematic review. Int J Inj Contr Saf Promot 2017;24:263-70.  Back to cited text no. 85
    


    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5]
 
 
    Tables

  [Table 1], [Table 2]



 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Methods
Results
Discussion
Conclusion
References
Article Figures
Article Tables

 Article Access Statistics
    Viewed4820    
    Printed441    
    Emailed0    
    PDF Downloaded332    
    Comments [Add]    

Recommend this journal