Brief report
The implications of the relative risk for road mortality on road safety programmes in Qatar Rafael J Consunji,1,2 Ruben R Peralta,1 Hassan Al-Thani,1 Rifat Latifi1,3 1
Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar 2 Study Group on Injury Prevention and Control, National Institutes of Health, University of the Philippines Manila, Manila, Philippines 3 Department of Surgery, University of Arizona, Tucson, Arizona, USA Correspondence to Dr Rafael J Consunji, Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar; [email protected], [email protected] This study was presented and recognised as a Poster of Exceptional Merit at the American College of Surgeons Annual Clinical Congress, October 2012 in Chicago, Illinois, USA. Received 24 June 2013 Revised 7 December 2013 Accepted 8 January 2014 Published Online First 28 January 2014
ABSTRACT The epidemiology of road deaths and in particular the relative risk for road mortality (RRRM) in Qatar has not been fully defined. This study will analyse and compare the proportionate mortality and age-specific death rates from road traffic injuries (RTIs) and make recommendations for targeted injury prevention programmes for road safety in Qatar. Data from the Qatar Statistics Authority (QSA), for the year 2010, was collected and analysed. All deaths classified as ‘ICD-10 (V89) Motor- or Nonmotor-Vehicle, Accident Type of Vehicle Unspecified’ were included. There were 247 RTI related deaths in Qatar in 2010. An overall death rate was computed at 14.4 deaths per 100 000 population. The RRRM varied over 10 times among different populations with Qatari males (QM) having an increased RRRM from 10 years of age, those aged 20–29 years had the highest RRRM of 10.2. The lowest RRRM was for Qatari females who did not have a single reported road fatality in 2010. Populations with a significantly elevated RRRM (ie, RRRM>1.0) were non-Qatari men older than 50 years and Qatari males from the age of 10 onward. Proven and definite programmes must be implemented to reduce these unnecessary deaths among the populations at the highest risk. Multidisciplinary approaches must be implemented and their efficacy evaluated.
INTRODUCTION
To cite: Consunji RJ, Peralta RR, Al-Thani H, et al. Inj Prev 2015;21: e105–e108.
Qatar is a high-income country in the Arabian Gulf with a rapidly growing economy and population driven by enormous fuel reserves and the rapid influx of expatriate workers.1 The epidemiology of deaths from road traffic injuries (RTIs) and their proportionate health burden in Qatar has not been fully described, despite numerous reports.2–6 A large, predominantly male, expatriate worker population, rapid motorisation2 and industrialisation as well as recognised numerous risky driver behaviours3–5 caused Qatar to have a road traffic mortality (RTM) rate of 34.0 deaths per 100 000 population in 2006.7 This problem has been recognised and is being addressed through a variety of road safety campaigns, the enactment and enforcement of new road safety laws by the Ministry of the Interior and the implementation of a nationwide trauma system. Some improvements have been reported,6 yet the RTM rate in Qatar is still high. This study will analyse and compare the age, nationality and gender-specific death rates from RTIs, apply public health burden indicators and make recommendations for targeted injury prevention programmes for road safety in Qatar.
METHODS Publicly accessible vital statistics data from the Qatar Statistics Authority (QSA), the VITAL STATISTICS ANNUAL BULLETIN (Births & Deaths), for the year 2010, was collected and analysed.7 This annual report is ‘a result of cooperation between Statistics Authority & Supreme Council of Health based on the agreed upon questionnaires ( presented in the annex) in accordance with the Law No. 5, 1982 regarding Vital Registration System’. The notifications of births and deaths are compiled by the Supreme Council of Health and furnished monthly to the QSA for encoding, processing and tabulation. The data covers the registered vital events for Qataris in Qatar and abroad, and the registered vital events for non-Qataris in Qatar.7 Data were classified by nationality, gender and age. All deaths classified by the WHO International Classification of Diseases, 10th edition (ICD-10) as ‘(V89) Motor- or Nonmotor-Vehicle, Accident Type of Vehicle Unspecified’ were included and compared with all deaths from all causes. Data were tabulated and analysed using Microsoft Excel software to compute for the following public health indicators: proportionate mortality, relative risk and age-specific death rate. Age-group populations were computed from age-specific crude death rates for the standard age groups as specified by the QSA. This secondary data analysis using publicly accessible information from an official government agency did not require institutional review board approval.
RESULTS The general population of Qatar in 2010 was reported as 1 718 375. Of this, 236 024 (13.7%) were Qatari and 1 314 671 (76.5%) were male. The Qatari population was 52% male and the non-Qatari population was 80.5% male.7 There were 1970 reported deaths, from all causes, in 2010. Of these, 672 (34.2%) were Qatari. RTIs were the leading attributable cause of death in Qatar in 2010, causing 247 deaths (12.5% proportionate mortality); 237 (96.4%) of the victims were male and 73 (29.6%) were Qatari. No Qatari females died from RTIs in 2010.7 Table 1 shows the proportionate mortality from RTIs (PMRTI) classified by nationality, gender and age group. The subpopulations with PMRTI greater than 12.5% bear a disproportionate burden from motor vehicle collision (MVC) death when compared to the general population. An overall RTI death rate was computed at 14.4 deaths per 100 000 population, for both genders
Consunji RJ, et al. Inj Prev 2015;21:e105–e108. doi:10.1136/injuryprev-2013-040939
e105
Brief report Table 1 Proportionate mortality from road traffic injuries, by gender, by nationality and age group, Qatar (Qatar Statistics Authority, 2010) Total population
Qatari population
Non-Qatari population
Age group, years
All
Males
Females
All
Males
Females
All
Males
Females
0–4 5–9 10–19 20–29 30–39 40–49 >50 All ages
2.4 25.0 52.8 33.1 24.6 10.9 3.3 12.5
3.4 23.1 58.7 36.2 26.1 12.4 5.8 16.2
1.3 33.3 14.3 7.7 11.5 0 0.3 1.8
1.6 40.0 60.6 61.2 28.6 15.6 1.5 10.8
3.1 40.0 66.7 76.9 35.3 20.6 2.8 17.9
0 0 0 0 0 0 0 0
2.9 18.2 40.0 25.7 24.3 10.0 4.6 13.4
3.5 12.5 43.8 26.9 25.3 11.1 7.8 15.5
2.2 33.3 25.0 12.5 13.6 0 0.8 3.8
Subpopulations with proportionate mortality from road traffic injuries (PMRTI) greater than 12.5% are shown in bold.
and all age groups. The age-specific death rates for RTI deaths (ASDRRTI) are tabulated in table 2, by nationality, gender and age group. The subpopulations with ASDRRTI greater than 14.4 deaths per 100 000 bear a disproportionate risk from MVC death when compared to the general population (table 2). The national RTI death rate, for the general population, was the reference for computing the relative risk and 95% CI for RTI death of the study subpopulations (table 3). The subpopulations at a significantly increased risk for RTI death, that is, with RR >1 and CI >1 and not intersecting 1, are shown in bold. Qatari males, from the age of 10 onwards, and older non-Qatari men are the subpopulations with a significantly increased risk for RTI death in Qatar.
DISCUSSION The PMRTI in Qatar is 12.5%. One in eight deaths, from all causes, is due to a road traffic injury. RTIs are the leading cause of death in Qatar. When analysing the data for all age groups, the PMRTI for males is higher than females and for non-Qatari populations when compared to Qatari populations, of both genders and all ages. When age and nationality are taken into the analysis, young Qatari men (aged 20–29) have the highest PMRTI of 76.9%. The ASDRRTI for Qatari males, from the age of 10 onwards was from 2.76–10.1 times that of the general population. Using the risk for RTI death of the general population as a reference, Qatari males from the age of 10 onwards are at a significantly increased risk for RTI death. Non-Qatari men older than 50 years are the only other subpopulation that shares this significantly increased relative risk for RTI death with the aforementioned group.
This is an analysis of the most recent and complete national mortality dataset from the QSA, compiled and used for health policy planning by the Supreme Council of Health. This study reports the differential risks for death from a road traffic injury among this country’s diverse populations by taking into account available age and nationality data. It is intended as a supplementary tool that will guide the prioritisation of preventive and research programmes for road safety in Qatar. This study shares its limitations with other analyses of RTI deaths from a large or national dataset. For example, the potential for miscoding the cause of death due to late deaths happening beyond 30 days and for underreporting of deaths in RTI victims directly attributable to ‘other causes’, such as pneumonia or sepsis, cannot be overlooked. In 2010 there were no recorded MVC deaths among Qatari females; this is not a yearly occurrence, potentially making the data on female MVC deaths for this year an outlier. Qatar does not have a national trauma registry that links ambulance service, emergency room and trauma centre data with national mortuary and traffic police data to serve as a cross-reference for the mortality data of the QSA. There have been reports of reductions in the number of road deaths in Qatar as the result of various initiatives, such as the installation of speed cameras, increased issuance of traffic citations and improvements in trauma care.6 8 9 However, there is a need for better and unified data on motor vehicle crash injuries and mortalities.10 11 This study analyses mortality outcomes from RTIs, identifies high-risk groups that need targeted interventions and adds to the existent data on risk factors for RTIs.3–5 Its findings are in agreement with global data that consistently show the
Table 2 Age-specific death rates for motor vehicle collision (MVC) deaths, by gender, by nationality and age group, Qatar (Qatar Statistics Authority, 2010) Total population
Qatari population
Non-Qatari population
Age group, years
All
Males
Females
All
Males
Females
All
Males
Females
0–9 10–19 20–29 30–39 40–49 >50 All ages
4.6 22.1 16.4 12.8 10.4 27.1 14.4
5.0 39.9 20.2 17.9 12.6 34.7 17.9
3.0 1.7 2.0 3.2 0.0 3.1 2.2
4.9 36.5 72.1 19.2 29.3 27.4 30.9
7.3 72.3 145.1 39.7 61.7 58.3 60.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0
4.4 11.1 11.1 12.3 8.7 27.1 11.7
3.8 17.5 12.9 14.0 10.2 31.5 13.8
4.6 3.1 2.6 3.8 0.0 5.3 3.1
Subpopulations with age-specific death rates for road traffic injuries (ASDRRTI) greater than 14.4 deaths per 100 000 are shown in bold.
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Consunji RJ, et al. Inj Prev 2015;21:e105–e108. doi:10.1136/injuryprev-2013-040939
Brief report Table 3 Age-specific relative risk (95% CI) for road traffic injury (RTI) death, by gender, by nationality and age group, Qatar (Qatar Statistics Authority, 2010) Total population
Qatari population
Age group, years
Male
Female
0–9 10–19 20–29 30–39 40–49 >50
0.35 (0.15 to 0.78) 2.78 (1.87 to 4.13) 1.40 (1.08 to 1.81) 1.04 (0.79 to 1.37) 0.82 (0.56 to 1.19) 2.41 (1.70 to 3.42)
0.21 0.12 0.14 0.22 0 0.05
(0.05 to (0.02 to (0.03 to (0.07 to
0.84) 0.83) 0.56) 0.69)
(0.0 to 0.36)
Non-Qatari population
Male
Female
Male
Female
0.58 (0.18 to 1.80) 5.03 (3.19 to 7.93) 10.08 (6.90 to 14.72) 2.76 (1.23 to 6.20) 4.29 (2.02 to 9.09) 4.05 (1.91 to 8.59)
0 0 0 0 0 0
0.26 (0.08 to 0.83) 1.21 (0.57 to 2.55) 0.89 (0.65 to 1.23) 0.98 (0.73 to 1.31) 0.71 (0.47 to 1.08) 2.19 (1.49 to 3.22)
0.32 0.21 0.18 0.26 0 0.37
(0.08 to (0.03 to (0.04 to (0.08 to
1.29) 1.53) 0.73) 0.82)
(0.05 to 2.13)
Subpopulations at a significantly increased risk for RTI death, that is, with RR >1 and CI >1 and not intersecting 1, are shown in bold.
disproportionate risk for RTI deaths borne by males.11 As there are no laws that restrict females from driving in Qatar, the gender discrepancy that exists should be studied further in the light of the potential differential road exposures and driving behaviours between the genders. Burgut et al5 reported that 26.6% of all Qatari drivers they surveyed were involved in a crash and that being young (aged 25–34 years) and male predisposed to higher involvement in a crash. This study demonstrates that the disproportionate mortality (not only crash) burden is also borne by a young population of Qatari males, aged 10–29, who have a 5–10 times higher RTI mortality rates when compared to the general population. Given that 92% of pedestrians injured are non-Qataris12 and 32% of RTI deaths are pedestrians13 14 then most of the deaths among the Qatari are young male passengers or drivers. If their ASDRRTI is compared with that of their counterparts in the US, 26.7 deaths per 100 000 population of 20–29-year-old men in 2010,15 it can be observed that young Qatari males have 5.4 times their death rate. If this same rate were applied to this US population, it would result in 25 633 more deaths from RTIs every year and urgent calls for immediate action from government agencies to tackle such a deadly issue. This is further evidence of the need to target interventions to this high-risk group in the form of proven road safety initiatives such as graduated driver licensing programmes16 17 and the enforcement of laws to reduce known risk factors such as distracted driving as declared in the Qatar National Development Strategy 2011– 2016.13 14 While risky behaviours have been previously identified as predisposing to RTM,3–5 it is still unclear from our study why there is such a high rate of death in this particular segment of the population. An analysis of the road risk exposure (ie, vehicle km travelled) of the diverse populations in Qatar can further describe and explain the differential burden of each subpopulation. If anything, this study under-reports the true magnitude of the problem, as we have not studied the disabilities that result from non-fatal MVCs, the numerous lives permanently affected and dollars spent on rehabilitation and long-term care. There is a need for further studies in this high-risk population to inform the creation of targeted injury prevention programmes. Expatriates, that is, non-Qataris, are not at a significantly increased risk for death from an RTI when compared to the general population. This can be partially explained by the findings from the study of Bener et al18 who found that Qatari drivers were significantly more likely to engage in ‘careless driving or excessive speeding’ when compared to drivers from Jordan, India or the Philippines. The fact that many non-Qataris are vulnerable (ie, non-motorised) road users can Consunji RJ, et al. Inj Prev 2015;21:e105–e108. doi:10.1136/injuryprev-2013-040939
explain why they comprise a great majority of the pedestrian victims presenting to the country’s level 1 trauma centre.12 We conducted this study because the diverse and transitory nature of the population of Qatar makes the description of the epidemiology of road traffic deaths difficult to report and challenging to address from an injury prevention standpoint. Conventional public health indicators, such as death rates, are reported for the entire population, despite the fact that Qatar’s subpopulations do not share the same exposures, risk factors or epidemiological characteristics. This ‘lumping’ of data may lead to erroneous conclusions as the real effect of RTI deaths in high-risk populations may be reduced or diluted. Our findings highlight the fact that, despite reported improvements in road fatality rates in Qatar, there are still subpopulations at a disproportionately high risk for RTI death. These high-risk groups need a proportionate response in terms of injury prevention programmes, public education and law enforcement measures in order to reduce the unnecessary RTI deaths in this very young population.
What is already known on the subject ▸ Road traffic injuries (RTIs) are a public health priority for Qatar. ▸ RTI deaths have decreased in Qatar due to improvements in traffic enforcement and trauma care.
What this study adds ▸ The leading cause of death in Qatar is RTIs; they are responsible for one in eight (12.5%) deaths from all causes for the entire population. ▸ The rate for death from RTIs in Qatar varies 10-fold among Qatar’s diverse subpopulations. ▸ Qatari males bear a disproportionate death burden from RTIs starting from the age of 10; as much as 77% of deaths in 20–29 year olds are due to RTIs. ▸ Urgent analysis of risk factors for RTI deaths in young road users and the implementation of best practice programmes to address these risk factors are needed. e107
Brief report CONCLUSIONS RTIs are the leading cause of death in Qatar with one in eight deaths from all causes due to RTIs. Qatari males have an increased risk of an RTI death from the age of 10 onward and bear a disproportionate mortality burden from RTIs. Future research must be conducted on this population to identify prevalent risk factors and implement best practice programmes to reduce unnecessary deaths among the populations at the highest risk for road traffic injury death in Qatar.
5
6
7 8
9
Acknowledgements The authors would like to acknowledge the support from all of the members of the Trauma Surgery Section, Department of Surgery, Hamad General Hospital. Contributors All of the authors participated and contributed to the conception and design, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content and final approval of the version to be published. All authors included on this paper fulfil the criteria of authorship and there is no one else who fulfils the criteria but has not been included as an author.
10
11 12
Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed.
13
REFERENCES
14
1
2 3
4
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Gulf Times, 14 April 2013. Population Up 92% In Six Years. http://www.gulf-times. com/Mobile/Qatar/178/details/347919/-Population-up-92%25-in-six-years (accessed 8 Jun 2013). Lane K. Driving In Qatar. http://www.keithlane.com/page26.htm (accessed 15 May 2013). Bener AB, Ozkanc T, Lajunen T. The Driver Behaviour Questionnaire in Arab Gulf Countries: Qatar and United Arab Emirates. Accid Anal And Prev 2008;40:1411–17. Bener A, Burgut HR, Sidahmed H, et al. Determinants of road traffic injuries in drivers in a rapid highly economically developing country: a major global public health crisis. Inj Prev 2010;16(Suppl 1):A1–A289.
15 16
17 18
Burgut HR, Bener A, Sidahmed H, et al. Risk factors contributing to road traffic crashes in a fast developing country: the neglected health problem. Inj Prev 2010;16(Suppl 1):A1–A289. Mamtani R, Al-Thani MH, Al-Thani AM, et al. Motor vehicle injuries in Qatar: time trends in a rapidly developing Middle Eastern nation. Inj Prev 2011;18:130e132. Vital Statistics Annual Bulletin (Births & Deaths) (2010) Qatar Statistics Authority, 2010. http://www.qsa.gov.qa/eng/index.htm (accessed 15 May 2013). Gulf Times, 15 February 2013. Road sensors to give a fillip to traffic studies. http:// www.gulf-times.com/qatar/178/details/342240/road-sensors-to-give-a-fillip-totraffic-studies (accessed 8 Jun 2013). Qatar Tribune, 25 July 2012. HMC Trauma Centre cuts fatality by 50% in 5 years. http://www.qatar-tribune.com/data/20120725/content.asp?section=nation1_1 (accessed 18 Jun 2013). The Peninsula, 23 November 2012. 13pc rise in traffic accidents in 2011. http:// thepeninsulaqatar.com/news/215292-13pc-rise-in-traffic-accidents-in-2011.html (accessed 18 Jun 2013). Global Status Report on Road Safety 2013: supporting a decade of action. Geneva, Switzerland: World Health Organization, 2013. Latifi R, El-Menyar A, Al-Thani H, et al. Traffic-related pedestrian injuries amongst expatriate workers in Qatar: a need for cross-cultural injury prevention programme. Int J Inj Contr Saf Promot. 6 Jan 2014. Epub ahead of print. Qatar Tribune, 4 October 2012. Qatar national road safety strategy soon. http:// www.qatar-tribune.com/data/20121004/content.asp?section=first1_2 (accessed on 18 Jun 2013). Qatar National Development Strategy 2011–2016. Qatar General Secretariat for Development Planning, 2011. Centers for Disease Control. Web-based Injury Statistics Query and Reporting System. http://www.cdc.gov/injury/wisqars/index.html (accessed on 20 Jun 2013). Russell KF, Vandermeer B, Hartling L. Graduated driver licensing for reducing motor vehicle crashes among young drivers. Cochrane Database Syst Rev 2011;(10): CD003300. Toroyan T, Peden M. eds, Youth and Road Safety. Geneva, World Health Organization, 2007. Bener A, Verjee M, Dafeeah EE, et al. A cross ‘Ethnical’ comparison of the Driver Behaviour Questionnaire (DBQ) in an economically fast developing country. Global J Health Sci 2013;5:165–75.
Consunji RJ, et al. Inj Prev 2015;21:e105–e108. doi:10.1136/injuryprev-2013-040939
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The implications of the relative risk for road mortality on road safety programmes in Qatar Rafael J Consunji,1,2 Ruben R Peralta,1 Hassan Al-Thani,1 Rifat Latifi1,3 1
Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar 2 Study Group on Injury Prevention and Control, National Institutes of Health, University of the Philippines Manila, Manila, Philippines 3 Department of Surgery, University of Arizona, Tucson, Arizona, USA Correspondence to Dr Rafael J Consunji, Trauma Surgery Section, Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha 3050, Qatar; [email protected], [email protected] This study was presented and recognised as a Poster of Exceptional Merit at the American College of Surgeons Annual Clinical Congress, October 2012 in Chicago, Illinois, USA. Received 24 June 2013 Revised 7 December 2013 Accepted 8 January 2014 Published Online First 28 January 2014
ABSTRACT The epidemiology of road deaths and in particular the relative risk for road mortality (RRRM) in Qatar has not been fully defined. This study will analyse and compare the proportionate mortality and age-specific death rates from road traffic injuries (RTIs) and make recommendations for targeted injury prevention programmes for road safety in Qatar. Data from the Qatar Statistics Authority (QSA), for the year 2010, was collected and analysed. All deaths classified as ‘ICD-10 (V89) Motor- or Nonmotor-Vehicle, Accident Type of Vehicle Unspecified’ were included. There were 247 RTI related deaths in Qatar in 2010. An overall death rate was computed at 14.4 deaths per 100 000 population. The RRRM varied over 10 times among different populations with Qatari males (QM) having an increased RRRM from 10 years of age, those aged 20–29 years had the highest RRRM of 10.2. The lowest RRRM was for Qatari females who did not have a single reported road fatality in 2010. Populations with a significantly elevated RRRM (ie, RRRM>1.0) were non-Qatari men older than 50 years and Qatari males from the age of 10 onward. Proven and definite programmes must be implemented to reduce these unnecessary deaths among the populations at the highest risk. Multidisciplinary approaches must be implemented and their efficacy evaluated.
INTRODUCTION
To cite: Consunji RJ, Peralta RR, Al-Thani H, et al. Inj Prev 2015;21: e105–e108.
Qatar is a high-income country in the Arabian Gulf with a rapidly growing economy and population driven by enormous fuel reserves and the rapid influx of expatriate workers.1 The epidemiology of deaths from road traffic injuries (RTIs) and their proportionate health burden in Qatar has not been fully described, despite numerous reports.2–6 A large, predominantly male, expatriate worker population, rapid motorisation2 and industrialisation as well as recognised numerous risky driver behaviours3–5 caused Qatar to have a road traffic mortality (RTM) rate of 34.0 deaths per 100 000 population in 2006.7 This problem has been recognised and is being addressed through a variety of road safety campaigns, the enactment and enforcement of new road safety laws by the Ministry of the Interior and the implementation of a nationwide trauma system. Some improvements have been reported,6 yet the RTM rate in Qatar is still high. This study will analyse and compare the age, nationality and gender-specific death rates from RTIs, apply public health burden indicators and make recommendations for targeted injury prevention programmes for road safety in Qatar.
METHODS Publicly accessible vital statistics data from the Qatar Statistics Authority (QSA), the VITAL STATISTICS ANNUAL BULLETIN (Births & Deaths), for the year 2010, was collected and analysed.7 This annual report is ‘a result of cooperation between Statistics Authority & Supreme Council of Health based on the agreed upon questionnaires ( presented in the annex) in accordance with the Law No. 5, 1982 regarding Vital Registration System’. The notifications of births and deaths are compiled by the Supreme Council of Health and furnished monthly to the QSA for encoding, processing and tabulation. The data covers the registered vital events for Qataris in Qatar and abroad, and the registered vital events for non-Qataris in Qatar.7 Data were classified by nationality, gender and age. All deaths classified by the WHO International Classification of Diseases, 10th edition (ICD-10) as ‘(V89) Motor- or Nonmotor-Vehicle, Accident Type of Vehicle Unspecified’ were included and compared with all deaths from all causes. Data were tabulated and analysed using Microsoft Excel software to compute for the following public health indicators: proportionate mortality, relative risk and age-specific death rate. Age-group populations were computed from age-specific crude death rates for the standard age groups as specified by the QSA. This secondary data analysis using publicly accessible information from an official government agency did not require institutional review board approval.
RESULTS The general population of Qatar in 2010 was reported as 1 718 375. Of this, 236 024 (13.7%) were Qatari and 1 314 671 (76.5%) were male. The Qatari population was 52% male and the non-Qatari population was 80.5% male.7 There were 1970 reported deaths, from all causes, in 2010. Of these, 672 (34.2%) were Qatari. RTIs were the leading attributable cause of death in Qatar in 2010, causing 247 deaths (12.5% proportionate mortality); 237 (96.4%) of the victims were male and 73 (29.6%) were Qatari. No Qatari females died from RTIs in 2010.7 Table 1 shows the proportionate mortality from RTIs (PMRTI) classified by nationality, gender and age group. The subpopulations with PMRTI greater than 12.5% bear a disproportionate burden from motor vehicle collision (MVC) death when compared to the general population. An overall RTI death rate was computed at 14.4 deaths per 100 000 population, for both genders
Consunji RJ, et al. Inj Prev 2015;21:e105–e108. doi:10.1136/injuryprev-2013-040939
e105
Brief report Table 1 Proportionate mortality from road traffic injuries, by gender, by nationality and age group, Qatar (Qatar Statistics Authority, 2010) Total population
Qatari population
Non-Qatari population
Age group, years
All
Males
Females
All
Males
Females
All
Males
Females
0–4 5–9 10–19 20–29 30–39 40–49 >50 All ages
2.4 25.0 52.8 33.1 24.6 10.9 3.3 12.5
3.4 23.1 58.7 36.2 26.1 12.4 5.8 16.2
1.3 33.3 14.3 7.7 11.5 0 0.3 1.8
1.6 40.0 60.6 61.2 28.6 15.6 1.5 10.8
3.1 40.0 66.7 76.9 35.3 20.6 2.8 17.9
0 0 0 0 0 0 0 0
2.9 18.2 40.0 25.7 24.3 10.0 4.6 13.4
3.5 12.5 43.8 26.9 25.3 11.1 7.8 15.5
2.2 33.3 25.0 12.5 13.6 0 0.8 3.8
Subpopulations with proportionate mortality from road traffic injuries (PMRTI) greater than 12.5% are shown in bold.
and all age groups. The age-specific death rates for RTI deaths (ASDRRTI) are tabulated in table 2, by nationality, gender and age group. The subpopulations with ASDRRTI greater than 14.4 deaths per 100 000 bear a disproportionate risk from MVC death when compared to the general population (table 2). The national RTI death rate, for the general population, was the reference for computing the relative risk and 95% CI for RTI death of the study subpopulations (table 3). The subpopulations at a significantly increased risk for RTI death, that is, with RR >1 and CI >1 and not intersecting 1, are shown in bold. Qatari males, from the age of 10 onwards, and older non-Qatari men are the subpopulations with a significantly increased risk for RTI death in Qatar.
DISCUSSION The PMRTI in Qatar is 12.5%. One in eight deaths, from all causes, is due to a road traffic injury. RTIs are the leading cause of death in Qatar. When analysing the data for all age groups, the PMRTI for males is higher than females and for non-Qatari populations when compared to Qatari populations, of both genders and all ages. When age and nationality are taken into the analysis, young Qatari men (aged 20–29) have the highest PMRTI of 76.9%. The ASDRRTI for Qatari males, from the age of 10 onwards was from 2.76–10.1 times that of the general population. Using the risk for RTI death of the general population as a reference, Qatari males from the age of 10 onwards are at a significantly increased risk for RTI death. Non-Qatari men older than 50 years are the only other subpopulation that shares this significantly increased relative risk for RTI death with the aforementioned group.
This is an analysis of the most recent and complete national mortality dataset from the QSA, compiled and used for health policy planning by the Supreme Council of Health. This study reports the differential risks for death from a road traffic injury among this country’s diverse populations by taking into account available age and nationality data. It is intended as a supplementary tool that will guide the prioritisation of preventive and research programmes for road safety in Qatar. This study shares its limitations with other analyses of RTI deaths from a large or national dataset. For example, the potential for miscoding the cause of death due to late deaths happening beyond 30 days and for underreporting of deaths in RTI victims directly attributable to ‘other causes’, such as pneumonia or sepsis, cannot be overlooked. In 2010 there were no recorded MVC deaths among Qatari females; this is not a yearly occurrence, potentially making the data on female MVC deaths for this year an outlier. Qatar does not have a national trauma registry that links ambulance service, emergency room and trauma centre data with national mortuary and traffic police data to serve as a cross-reference for the mortality data of the QSA. There have been reports of reductions in the number of road deaths in Qatar as the result of various initiatives, such as the installation of speed cameras, increased issuance of traffic citations and improvements in trauma care.6 8 9 However, there is a need for better and unified data on motor vehicle crash injuries and mortalities.10 11 This study analyses mortality outcomes from RTIs, identifies high-risk groups that need targeted interventions and adds to the existent data on risk factors for RTIs.3–5 Its findings are in agreement with global data that consistently show the
Table 2 Age-specific death rates for motor vehicle collision (MVC) deaths, by gender, by nationality and age group, Qatar (Qatar Statistics Authority, 2010) Total population
Qatari population
Non-Qatari population
Age group, years
All
Males
Females
All
Males
Females
All
Males
Females
0–9 10–19 20–29 30–39 40–49 >50 All ages
4.6 22.1 16.4 12.8 10.4 27.1 14.4
5.0 39.9 20.2 17.9 12.6 34.7 17.9
3.0 1.7 2.0 3.2 0.0 3.1 2.2
4.9 36.5 72.1 19.2 29.3 27.4 30.9
7.3 72.3 145.1 39.7 61.7 58.3 60.0
0.0 0.0 0.0 0.0 0.0 0.0 0.0
4.4 11.1 11.1 12.3 8.7 27.1 11.7
3.8 17.5 12.9 14.0 10.2 31.5 13.8
4.6 3.1 2.6 3.8 0.0 5.3 3.1
Subpopulations with age-specific death rates for road traffic injuries (ASDRRTI) greater than 14.4 deaths per 100 000 are shown in bold.
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Consunji RJ, et al. Inj Prev 2015;21:e105–e108. doi:10.1136/injuryprev-2013-040939
Brief report Table 3 Age-specific relative risk (95% CI) for road traffic injury (RTI) death, by gender, by nationality and age group, Qatar (Qatar Statistics Authority, 2010) Total population
Qatari population
Age group, years
Male
Female
0–9 10–19 20–29 30–39 40–49 >50
0.35 (0.15 to 0.78) 2.78 (1.87 to 4.13) 1.40 (1.08 to 1.81) 1.04 (0.79 to 1.37) 0.82 (0.56 to 1.19) 2.41 (1.70 to 3.42)
0.21 0.12 0.14 0.22 0 0.05
(0.05 to (0.02 to (0.03 to (0.07 to
0.84) 0.83) 0.56) 0.69)
(0.0 to 0.36)
Non-Qatari population
Male
Female
Male
Female
0.58 (0.18 to 1.80) 5.03 (3.19 to 7.93) 10.08 (6.90 to 14.72) 2.76 (1.23 to 6.20) 4.29 (2.02 to 9.09) 4.05 (1.91 to 8.59)
0 0 0 0 0 0
0.26 (0.08 to 0.83) 1.21 (0.57 to 2.55) 0.89 (0.65 to 1.23) 0.98 (0.73 to 1.31) 0.71 (0.47 to 1.08) 2.19 (1.49 to 3.22)
0.32 0.21 0.18 0.26 0 0.37
(0.08 to (0.03 to (0.04 to (0.08 to
1.29) 1.53) 0.73) 0.82)
(0.05 to 2.13)
Subpopulations at a significantly increased risk for RTI death, that is, with RR >1 and CI >1 and not intersecting 1, are shown in bold.
disproportionate risk for RTI deaths borne by males.11 As there are no laws that restrict females from driving in Qatar, the gender discrepancy that exists should be studied further in the light of the potential differential road exposures and driving behaviours between the genders. Burgut et al5 reported that 26.6% of all Qatari drivers they surveyed were involved in a crash and that being young (aged 25–34 years) and male predisposed to higher involvement in a crash. This study demonstrates that the disproportionate mortality (not only crash) burden is also borne by a young population of Qatari males, aged 10–29, who have a 5–10 times higher RTI mortality rates when compared to the general population. Given that 92% of pedestrians injured are non-Qataris12 and 32% of RTI deaths are pedestrians13 14 then most of the deaths among the Qatari are young male passengers or drivers. If their ASDRRTI is compared with that of their counterparts in the US, 26.7 deaths per 100 000 population of 20–29-year-old men in 2010,15 it can be observed that young Qatari males have 5.4 times their death rate. If this same rate were applied to this US population, it would result in 25 633 more deaths from RTIs every year and urgent calls for immediate action from government agencies to tackle such a deadly issue. This is further evidence of the need to target interventions to this high-risk group in the form of proven road safety initiatives such as graduated driver licensing programmes16 17 and the enforcement of laws to reduce known risk factors such as distracted driving as declared in the Qatar National Development Strategy 2011– 2016.13 14 While risky behaviours have been previously identified as predisposing to RTM,3–5 it is still unclear from our study why there is such a high rate of death in this particular segment of the population. An analysis of the road risk exposure (ie, vehicle km travelled) of the diverse populations in Qatar can further describe and explain the differential burden of each subpopulation. If anything, this study under-reports the true magnitude of the problem, as we have not studied the disabilities that result from non-fatal MVCs, the numerous lives permanently affected and dollars spent on rehabilitation and long-term care. There is a need for further studies in this high-risk population to inform the creation of targeted injury prevention programmes. Expatriates, that is, non-Qataris, are not at a significantly increased risk for death from an RTI when compared to the general population. This can be partially explained by the findings from the study of Bener et al18 who found that Qatari drivers were significantly more likely to engage in ‘careless driving or excessive speeding’ when compared to drivers from Jordan, India or the Philippines. The fact that many non-Qataris are vulnerable (ie, non-motorised) road users can Consunji RJ, et al. Inj Prev 2015;21:e105–e108. doi:10.1136/injuryprev-2013-040939
explain why they comprise a great majority of the pedestrian victims presenting to the country’s level 1 trauma centre.12 We conducted this study because the diverse and transitory nature of the population of Qatar makes the description of the epidemiology of road traffic deaths difficult to report and challenging to address from an injury prevention standpoint. Conventional public health indicators, such as death rates, are reported for the entire population, despite the fact that Qatar’s subpopulations do not share the same exposures, risk factors or epidemiological characteristics. This ‘lumping’ of data may lead to erroneous conclusions as the real effect of RTI deaths in high-risk populations may be reduced or diluted. Our findings highlight the fact that, despite reported improvements in road fatality rates in Qatar, there are still subpopulations at a disproportionately high risk for RTI death. These high-risk groups need a proportionate response in terms of injury prevention programmes, public education and law enforcement measures in order to reduce the unnecessary RTI deaths in this very young population.
What is already known on the subject ▸ Road traffic injuries (RTIs) are a public health priority for Qatar. ▸ RTI deaths have decreased in Qatar due to improvements in traffic enforcement and trauma care.
What this study adds ▸ The leading cause of death in Qatar is RTIs; they are responsible for one in eight (12.5%) deaths from all causes for the entire population. ▸ The rate for death from RTIs in Qatar varies 10-fold among Qatar’s diverse subpopulations. ▸ Qatari males bear a disproportionate death burden from RTIs starting from the age of 10; as much as 77% of deaths in 20–29 year olds are due to RTIs. ▸ Urgent analysis of risk factors for RTI deaths in young road users and the implementation of best practice programmes to address these risk factors are needed. e107
Brief report CONCLUSIONS RTIs are the leading cause of death in Qatar with one in eight deaths from all causes due to RTIs. Qatari males have an increased risk of an RTI death from the age of 10 onward and bear a disproportionate mortality burden from RTIs. Future research must be conducted on this population to identify prevalent risk factors and implement best practice programmes to reduce unnecessary deaths among the populations at the highest risk for road traffic injury death in Qatar.
5
6
7 8
9
Acknowledgements The authors would like to acknowledge the support from all of the members of the Trauma Surgery Section, Department of Surgery, Hamad General Hospital. Contributors All of the authors participated and contributed to the conception and design, or analysis and interpretation of data, drafting the article or revising it critically for important intellectual content and final approval of the version to be published. All authors included on this paper fulfil the criteria of authorship and there is no one else who fulfils the criteria but has not been included as an author.
10
11 12
Competing interests None. Provenance and peer review Not commissioned; externally peer reviewed.
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Consunji RJ, et al. Inj Prev 2015;21:e105–e108. doi:10.1136/injuryprev-2013-040939
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