Characteristics of road deaths and the distribution of healthcare resources in Thailand

Thailand, which is part of Southeast Asia, is a low- and middle-income country with more than 70 million people distributed unevenly across 77 provinces, and half of the registered vehicles are motorbikes. Gastrointestinal infections are the second leading cause of death in Thailand16Almost 30 out of every 100,000 people die from these accidents each year, with children accounting for more than 10% of these deaths. Over the 11 years of this study, motorcycles were the main vehicles participating in RTMs, followed by cars, and a significant difference was observed between mortality rates before and during the COVID-19 pandemic. There were significant disparities between hospital resource distribution and RTM rates across Thailand.

Inclusive

In 2010, respiratory infections were responsible for 334,815 deaths in Southeast Asia. RTMs were higher in middle-income countries than in low-income countries17. Thailand had an average of 30.34 deaths per 100,000 population from respiratory infections, and neighboring Malaysia reported similar death rates of 34.5 RTMs per 100,000 population.18. In contrast, death rates from gastrointestinal infections in two other Southeast Asian countries, Laos and Vietnam, were 11.6.19 and 20.320 per 100,000 population, respectively.

RTMs are a major health concern in the pediatric community. Studies analyzed injury rates for children involved in road traffic accidents, and low- and middle-income countries were found to be responsible for 95% of RTMs in children globally.21. Our study showed that the mortality rate of children participating in gastrointestinal infections was 19.08 per 100,000 and rose to 26 per 100,000 children. Previous studies in Thailand reported that 80% of the injured and deceased from brain injuries were motorcyclists22. Traffic accidents were the second most common child injury in Thailand, and head injuries were the most common cause of death23. For adolescents between the ages of 14 and 19, road accidents are reported as the number one cause of death.24. Malaysia reported that in 2013, the leading cause of death for males aged 10–24 years was transportation-related injuries, with people traveling by car and motorbike responsible for 20 and 5.5 per 100,000 all-cause deaths, respectively.25. In stark contrast, a study from Australia, a high-income country, showed RTI mortality rates between 6.3 and 10.3 per 100,000 residents.26Under-15 mortality rates in the United States ranged from 0.25 to 21.91 deaths per 100,000 children. The lower mortality rates were associated with the availability of trauma centers in the governorate27.

Early childhood deaths take a social as well as economic toll, with Thailand reporting that premature deaths contributed up to 88% of disability-adjusted life years due to gastrointestinal infections. This is high compared to other countries such as Australia (73%), Iran (62%) and Serbia (57%).11. Higher proportions of RTMs in low- and middle-income countries result from the popularity of motorcycles, which are more affordable in these countries. Thailand experienced a loss of about US$100 million in quality-adjusted life years or nearly US$300 million in statistical life years value from road traffic deaths between 2010 and 2012.24.

Lockdown policies during the COVID-19 pandemic have led to a sharp decline in traffic volumes and a global decline in RTIs28,29. Travel restrictions imposed during COVID-19 have resulted in a significant drop in vehicular traffic by more than 50% worldwide. Although relative increases in the severity of infections and the number of deaths have been noted, the epidemic has reduced the absolute number of interventional infections. Like other countries, Thailand has faced lockdown policies and reduced road use along with alcohol restrictions. These road use restrictions were implemented in April 2020, when people were not allowed to leave their homes between 10pm and 4am, and travel between cities was banned. The concomitant decrease in road usage hours, along with the alcohol-free period, has led to a significant drop in RTMs in Thailand during the COVID-19 pandemic. Interestingly, in 2021, about 21,000 people died due to COVID-19 infection, while the number of traffic deaths was about 12,000.

The average age of people dying from GI infections was 40, which is in the working age group. Productivity losses due to road traffic accidents are mainly concentrated in groups between the ages of 16 and 45 years. Road accident injuries and deaths among youth greatly affect the country’s GDP as youth bear the largest part of the economic burden10,22.

type of road accident

More populated areas do not necessarily have higher RTM devices. The distribution of RTMs by groups of road users has been shown to vary across countries. Motorcyclists account for most RTM vehicles in Southeast Asian regions, while four-wheel drive vehicles account for less than 20% of traffic-related fatalities.6, in line with the results of our study. Eighty-eight percent of two- or three-wheeled motorized vehicles are found in low- and middle-income countries, with 75% in Southeast Asia.30. Thailand has been noted to be highly two-wheeled as well as lax in law enforcement, causing a higher rate of deaths on two-wheelers compared to countries such as Japan where law enforcement is much stricter.4. The second most common ICD-10 diagnosis from our study of people injured in motor vehicle accidents was determined to be a motorcycle injury. Similarly, Laos reported that 76% of surgical injuries involved motorcyclists19.

RTMs across each province

Rayong and Chonburi were the two provinces with the highest ratio of motorcyclists at 62 and 49 per 100,000 inhabitants, possibly because they have the highest ratio of motorcycles per population; In fact, the number of registered motorcycles has exceeded the population of the provinces. Bangkok has about a tenth of the country’s population with RTMs in about a quarter of these two major provinces. This highlights the fact that more people do not necessarily mean more road accidents. Studies have found that less urbanized areas were associated with a higher mortality rate than large metropolitan areas27. Other risk factors involved in RTMs in Southeast Asia were the type of roads, the number of male motorcyclists, driving without a driver’s license, and not using helmets.31.

distribution of hospital resources

Both inpatient and prehospital care have been identified as factors affecting RTMs32,33,34,35,36,37. A paper from Iran showed that prehospital trauma care is unevenly distributed across the country and should be modified to reduce the number of RTMs32. The estimated number of lives that could be saved globally if a complete trauma system with 100% coverage were available in low- and middle-income countries is estimated to be around 200,000 annually. The presence of trauma centers and effective trauma teams has also been shown to reduce deaths from gastrointestinal infections38. Death rates from motorcyclist injuries in the UAE have decreased significantly due to improved pre-hospital and in-hospital trauma care39.

Our study looked further at the distribution of available hospital resources and found that they were unbalanced according to the death rates from respiratory infections in each province. A paper from Poland reported that poor HCRs were responsible for anomalies in road traffic fatality rates in every region9 and that the ORs were the least evenly distributed among all hospital resources. This is due to the intensive process required to provide the appropriate venues, as well as surgical teams and equipment, which makes it difficult to open operating theaters. In contrast, doctors in Thailand were distributed more evenly than other resources, and this may be because Thailand tries to allocate enough doctors to each province according to its population. Previously HCRs were allocated according to the number of people in each province, which is why Bangkok, which has the largest population, has the highest number of HCR per 100,000 inhabitants. Doctors and nurses can be appropriately reallocated, and the provision of other facilities, such as operating theaters and intensive care units, can be integrated into health care policies, taking into account the RTM rates in each province and focusing attention on trauma teams and facilities.

associated factors

Gross national income (GNI), speed limits in urban areas, road quality, and regular inspections of road infrastructure have been shown to be factors affecting the rate of RTM cycles.40,41,42,43,44. Countries with a GNI per capita have fewer deaths per 100,000 population despite having higher numbers of vehicles while countries with a GNI per capita have higher death rates per 100,000 population despite having fewer of vehicles4.

It has been repeatedly shown that traffic injuries follow trends in economic growth. Globally, a significant increase in the number of vehicles caused RTM to reach 135 cases per 100 vehicles in 2000, but this decreased to 64 cases per 100 vehicles in 2016.31. Other factors found from this study to correlate with RTMs are income, the number of vehicles registered, and the amount of precipitation. It has been proven that the business threads in Thailand are moving in the same direction as the country’s economy45.

Precipitation amounts did not match the RTMs in our study, in contrast to another study previously conducted in Thailand that found a significant increase in road accidents caused by heavy rainfall. These contradictory results may have been due to differences in data collection and analysis: our study calculated the amount of rain over the course of the year and found no correlation with RTMs while the previous study combined different rain intensities measured by daily averages of precipitation46.

Points of strength and weakness

One of the main strengths of this study is that it presented the largest available data on all 77 provinces in Thailand from various reliable government resources and collected over an 11-year period. We also divided the population into adults and children so that Thailand can have data on different age groups, which will be useful when allocating medical staff, because children and adults require different types of medical care.

Another strength of this study is that we showed hospital resources that were distributed unevenly in order to help prioritize which resources to adjust first.

The limitation of this paper was that although we had a number of RTMs for each county, we did not know exactly where the accidents occurred; Therefore, we were unable to assess factors such as the types of roads that were shown to be associated with RTM machines. We also had no details on levels of alcohol consumption or helmet use in reported RTMs, both of which influence mortality. We reported RTM rates for children but did not stratify physicians into pediatricians and emergency department physicians, so that we could not determine how effectively trauma cases were treated in each county. The times when the accidents occurred were not available, and we did not divide the period into weekdays, weekends, and long holidays, so we could not analyze these risk factors in RTM, as this was not within the scope of the study.

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