Distribution of road traffic deaths by road user group: a global comparison.

BACKGROUND Road traffic deaths are a major global health and development problem. An understanding of the existing burden of road traffic deaths in the population is necessary for developing effective interventions. OBJECTIVE To outline systematically the global distribution of road traffic deaths by road user groups (pedestrians, bicyclists, motorcyclists, motorised four-wheeler occupants). METHODS Comprehensive searches of PubMed, Google, Google Scholar, TransportLink, grey literature and reference lists and communication with experts from international organisations and country-level institutions were conducted to identify eligible studies and data sources. All data sources that provided a breakdown of road traffic deaths by road user group at the national or sub-national level were eligible for inclusion. A breakdown of road traffic deaths by road user group was constructed for 14 epidemiologically defined World Health Organization (WHO) sub-regions in addition to World Bank income categories. In addition, the total number of road traffic fatalities by road user group in low-income, middle-income and high-income countries was estimated. RESULTS The breakdown of road traffic deaths by road user group varies dramatically across epidemiological WHO sub-regions. The magnitude of pedestrian fatalities ranges from more than half in African sub-region AfrE (55%) to 15% or less in AmrA or EurA. The distribution also varies across low-income, middle-income and high-income countries. 45% of road traffic fatalities in low-income countries are among pedestrians, whereas an estimated 29% in middle-income and 18% in high-income countries are among pedestrians. The burden of road traffic injuries on vulnerable road users differs substantially across income levels. An estimated total of 227,835 pedestrians die in low-income countries, as opposed to 161,501 in middle-income countries and 22,500 in high-income countries each year. CONCLUSIONS Ameliorating road safety requires the implementation of context-specific solutions. This review of the road traffic injury literature provides strong evidence that the distribution of road traffic fatalities varies dramatically across different parts of the world. Therefore, context-appropriate and effective prevention strategies that protect the particular at-risk road user groups should be carefully investigated.