Public Health (1990), 104, 55--64
© The Societyof Public Health, 1990
Road T r a f f i c A c c i d e n t s in a S w e d i s h M u n i c i p a l i t y L. S c h e l p I and R. Ekman 2
National Board of Health and Welfare. Stockholm, Karolinska Institute, Department of Social Medicine, Kronan Health Centre; 2Primary Health Care, S-531 85 LidkOping, Sweden
A continuous all embracing registration of acute, in-patient and out-patient visits at hospitals and primary health care centres, was conducted in Skaraborg County in western Sweden. A special focus was directed at accident cases which account for 20% of the total number of acute visits. The accidents were divided up by environment: home, work, traffic and other. Cases of road traffÉc accidents have been mapped out in more detail with the help of standardised and structured surveys via telephone interviews, information from hospital records, and death certificates. This study aimed at achieving an increased understanding and knowledge about the accident pattern in the traffic environment in a municipality. Road traffic accidents accounted for 6.5% of all accidents. Cyclists, car drivers, car passengers and pedestrians were the most common victims. Children showed a high frequency of bicycle accidents. There was an increased risk of injury for young car-drivers. Thirty-six per cent were single-accidents. Cars and bicycles dominated among injury-inducing vehicles. Head, arm and knee injuries were most common. Twenty-six per cent of the victims were hospitalized. Safety devices were not used in 10% of cases where they should have been used according to legislation. A comparison of our registration system for road traffic accidents with the official statistics of Sweden reveals a substantial under-reporting of road traffic accidents in the latter. Consequently, a need exists for the surveillance of injuries by the public health services as a basis of injury control.
Introduction An important health problem involving daily risk are accidents occurring in different environments such as at home, at work, in traffic and in the leisure-time environment. Each year a large number o f people are seriously injured or killed in road traffic accidents. During the last few decades, more and more medical resources have been invested in the treatment o f personal injuries caused by road traffic accidents. Official Statistics o f Sweden show that 27% ofaU fatal injuries and 8% o f hospital treated injuries are due to road traffic accidents. ~ There are many ways o f studying road traffic accidents. The use o f hospital records is one way, z3 and in-depth studies o f all accidents from a representative part o f the country is another. 4 A further possibility is to use insurance information? '6 Measures to avoid accidents and measures to prevent personal injuries in accidents are the two major possibilities o f reducing the number o f injured and fatal injured in road traffic accidents. A prerequisite condition for injury prevention is the knowledge of the incidence o f the individual accidents. In Sweden, as in other countries, the official statistics Correspondence: L. Schelp, The National Board of Health and Welfare, Department of Health Protection and Epidemiology, S-106 30 Stockholm, Sweden.
56
L. Schelp and R. Ekman
are usually based on information on traffic accidents reported by the police. 7 These statistics, however, do not seem to be valid. 4'8 In the health plan for Skaraborg County, priority was given to accident prevention and investigations into accidents in the county. 9
Objectives This article is part of a prospective epidemiological study o f all accident cases leading to any contact with the primary or secondary health care services in a defined population and geographical area. The questions that are o f interest include: when, where, and how traffic accidents occur; which individuals or groups are affected; and which types o f accidents are the most common. The goal is to identify groups and areas that ought to be given high priority in an intervention programme.
Definitions
In this study, an accident is defined as a sudden unexpected series o f undesired occurrences in interplay between individual, object and environment which leads to personal injury.t° A traffic accident is an event which has occurred in traffic on a road in which at least one vehicle in motion has been involved and which event has entailed personal injury. Accidents which have occurred within a fenced-in area such as barrack yards, industrial sites, hospital grounds, sports grounds or other similar areas are excluded. Classified as a road are: - road, street, square and other thoroughfare generally used for m o t o r traffic; - passage devised for bicycle traffic; - foot-path or riding-ground along passage or grounds referred to in the above paragraphs.
Material
Study area The study area is the Lidk6ping Municipality in Skaraborg County in western Sweden, comprising rural areas, more densely populated areas and an urban population centre. Its total geographical area is 689 sq. km.
Study population The study comprises all individuals parish-registered in the municipality during the period o f the study and who sought some type o f health care due to injury. The municipality's average population during 1984 was 35,205 inhabitants.
Method
An all-age-all-injury reporting system for injuries was implemented by a joint effort between primary care and hospital care services in two municipalities in Skaraborg CountyY Accidents that resulted in out-patient care in hospitals and in health centres, as
Road Traffic Accidents in Sweden
57
well as those that led to hospitalisation were recorded on a special emergency report form. In order to obtain information about fatal accidents, an examination o f the death certificates and the register o f deaths o f the Central Bureau o f Statistics was undertaken in the study area. Injuries not registered are those treated by the victim himself or which have been treated only by nurses or care units other than the medical care centres in the study area and the County Hospital, as well as dental injuries in cases where the victim has been in contact only with a dentist. In order to obtain better knowledge and detailed mapping o f traffic accidents, telephone surveys were carried out within four weeks after the accident events. The interview form included 27 items and was characterised by standardisation and a high degree o f structuring. The questionnaire covered such factors as the victim's age and sex, place o f the accident, light conditions, road-surface, road condition, weather, type o f vehicle involved, restraining devices, type o f accident and injury, treatment. There is a descriptive account o f each registered accident. The study period referred to in this article included the 12 months between January 1, 1984, through December 31, 1984.
Statistical methods The optimum test for comparing two Poisson distributions was used in the analysis o f the results. 12 Two-tailed tests were used, and P-values less than 0.05 were considered significant.
Drop-out Two per cent o f the victims (n = 4) were unable or unwilling to participate in the study. Less than 1% o f the questionnaires were incompletely filled in. Results
Road traffic accidcnts accounted for 6.5% o f all registered accidents during the study period. The number of injured persons treated in health care was 186. O f these, 182 victims are included in this study. The number o f injuries was 253. One person died at the scene o f the accident: a 72-year-old cyclist (male) who had a collision with a car. The distribution o f road traffic accidents by age and sex and the incidence are shown in Table I. 109 out o f 182 victims belonged to the age-group 0-24 years. The probability o f having a road traffic accident can be estimated to 9.5 per 1000 per year in that age-group and to 3.1 per 1000 per year for persons over the age o f 24 years. There were no sex differences. The incidence for males was 5.3 compared with 5.0 per 1000 per year for females. The most frequent site o f occurrence was the municipality where the patients were parish registered (82%). Eight per cent o f the accidents occurred in other municipalities within the County of Skaraborg and 1% outside the county. In 9% there was no information about the site occurrence. The most c o m m o n road surfaces were asphalt (59%) and gravel (12%). Dry surface conditions could be analysed in 110 cases (60%). The light conditions prevailing at the accident were daylight (67%) and darkness (15%).
58
L. Schelp and R. Ekman Table I
Traffic accidents by age and sex Number injured per 1000 population per year
Sex Age (years)
M
F
Total
%
0-14 15-24 25-34 35-44 45-54 55~4 65-74 75 +
25 34 8 5 8 3 6 3
27 23 3 9 7 l0 9 2
52 57 11 14 15 13 15 5
28.6 31.3 6.0 7.7 8.2 7.1 8.2 2.8
8.0 11.0 2.4 3.0 4.0 3.2 4.0 2.3
Total
92
90
182
100
5.2
(M = male, F = female)
Table II shows the distribution o f road traffic accidents by type o f activity and age. Cyclists (48.9 %), car drivers (15.4%), car passengers (13.2 %) and pedestrians (6 %) were the most c o m m o n victim.s. Children (0-14) have a high frequency o f cycle accidents: 33 (37%). 62% o f all road traffic accidents among children happened when cycling. These accidents are most c o m m o n in the age-group 13-14 years (29%), followed by the age-group 7-9 years (15%) and the age-group 10-12 years (12%). There is a significantly increased risk o f injury for young car drivers (18-24 years) per mile (Table III), assuming that the older age-group (25-54 years) drives on average as long as the younger. Sixty-six road traffic accidents (36%) were classified as single accidents (Table IV). Cars (26%) and cycles (9%) were the most frequent injury-inducing vehicles. Table V shows the distribution o f the victim's activity (traffic category) and the main part o f body injured. Head (25%), arm (19%) and knee (17%) injuries dominated and show high frequences among cyclists. The type o f injury is shown in Table VI. Most frequent were soft tissue injuries, fractures and contusions. The type o f medical care at the first consultation is specified in Table VII. The mean treatment per injury at the first consultation was 1.4. The number o f hospitalised patients was 47 (26%), o f which 9 were children (17%) aged 0-14 years. Fifty-eight per cent o f the gainfully employed patients showed sick-leave days. Permanent disability was observed in 39 cases (21%). Safety devices such as crash helmets and safety belts were not used in 10% o f cases where they should have been according to Swedish legislation. Fifty per cent of all victims were o f the opinion that the accident event could have been prevented. A comparison of our road traffic accidents from the health sector with current official statistics based on police reports and from the National Road Administration is shown in Table VIII.
Road Traffic Accidents in Sweden
0
+ cq
c~
© The Societyof Public Health, 1990
Road T r a f f i c A c c i d e n t s in a S w e d i s h M u n i c i p a l i t y L. S c h e l p I and R. Ekman 2
National Board of Health and Welfare. Stockholm, Karolinska Institute, Department of Social Medicine, Kronan Health Centre; 2Primary Health Care, S-531 85 LidkOping, Sweden
A continuous all embracing registration of acute, in-patient and out-patient visits at hospitals and primary health care centres, was conducted in Skaraborg County in western Sweden. A special focus was directed at accident cases which account for 20% of the total number of acute visits. The accidents were divided up by environment: home, work, traffic and other. Cases of road traffÉc accidents have been mapped out in more detail with the help of standardised and structured surveys via telephone interviews, information from hospital records, and death certificates. This study aimed at achieving an increased understanding and knowledge about the accident pattern in the traffic environment in a municipality. Road traffic accidents accounted for 6.5% of all accidents. Cyclists, car drivers, car passengers and pedestrians were the most common victims. Children showed a high frequency of bicycle accidents. There was an increased risk of injury for young car-drivers. Thirty-six per cent were single-accidents. Cars and bicycles dominated among injury-inducing vehicles. Head, arm and knee injuries were most common. Twenty-six per cent of the victims were hospitalized. Safety devices were not used in 10% of cases where they should have been used according to legislation. A comparison of our registration system for road traffic accidents with the official statistics of Sweden reveals a substantial under-reporting of road traffic accidents in the latter. Consequently, a need exists for the surveillance of injuries by the public health services as a basis of injury control.
Introduction An important health problem involving daily risk are accidents occurring in different environments such as at home, at work, in traffic and in the leisure-time environment. Each year a large number o f people are seriously injured or killed in road traffic accidents. During the last few decades, more and more medical resources have been invested in the treatment o f personal injuries caused by road traffic accidents. Official Statistics o f Sweden show that 27% ofaU fatal injuries and 8% o f hospital treated injuries are due to road traffic accidents. ~ There are many ways o f studying road traffic accidents. The use o f hospital records is one way, z3 and in-depth studies o f all accidents from a representative part o f the country is another. 4 A further possibility is to use insurance information? '6 Measures to avoid accidents and measures to prevent personal injuries in accidents are the two major possibilities o f reducing the number o f injured and fatal injured in road traffic accidents. A prerequisite condition for injury prevention is the knowledge of the incidence o f the individual accidents. In Sweden, as in other countries, the official statistics Correspondence: L. Schelp, The National Board of Health and Welfare, Department of Health Protection and Epidemiology, S-106 30 Stockholm, Sweden.
56
L. Schelp and R. Ekman
are usually based on information on traffic accidents reported by the police. 7 These statistics, however, do not seem to be valid. 4'8 In the health plan for Skaraborg County, priority was given to accident prevention and investigations into accidents in the county. 9
Objectives This article is part of a prospective epidemiological study o f all accident cases leading to any contact with the primary or secondary health care services in a defined population and geographical area. The questions that are o f interest include: when, where, and how traffic accidents occur; which individuals or groups are affected; and which types o f accidents are the most common. The goal is to identify groups and areas that ought to be given high priority in an intervention programme.
Definitions
In this study, an accident is defined as a sudden unexpected series o f undesired occurrences in interplay between individual, object and environment which leads to personal injury.t° A traffic accident is an event which has occurred in traffic on a road in which at least one vehicle in motion has been involved and which event has entailed personal injury. Accidents which have occurred within a fenced-in area such as barrack yards, industrial sites, hospital grounds, sports grounds or other similar areas are excluded. Classified as a road are: - road, street, square and other thoroughfare generally used for m o t o r traffic; - passage devised for bicycle traffic; - foot-path or riding-ground along passage or grounds referred to in the above paragraphs.
Material
Study area The study area is the Lidk6ping Municipality in Skaraborg County in western Sweden, comprising rural areas, more densely populated areas and an urban population centre. Its total geographical area is 689 sq. km.
Study population The study comprises all individuals parish-registered in the municipality during the period o f the study and who sought some type o f health care due to injury. The municipality's average population during 1984 was 35,205 inhabitants.
Method
An all-age-all-injury reporting system for injuries was implemented by a joint effort between primary care and hospital care services in two municipalities in Skaraborg CountyY Accidents that resulted in out-patient care in hospitals and in health centres, as
Road Traffic Accidents in Sweden
57
well as those that led to hospitalisation were recorded on a special emergency report form. In order to obtain information about fatal accidents, an examination o f the death certificates and the register o f deaths o f the Central Bureau o f Statistics was undertaken in the study area. Injuries not registered are those treated by the victim himself or which have been treated only by nurses or care units other than the medical care centres in the study area and the County Hospital, as well as dental injuries in cases where the victim has been in contact only with a dentist. In order to obtain better knowledge and detailed mapping o f traffic accidents, telephone surveys were carried out within four weeks after the accident events. The interview form included 27 items and was characterised by standardisation and a high degree o f structuring. The questionnaire covered such factors as the victim's age and sex, place o f the accident, light conditions, road-surface, road condition, weather, type o f vehicle involved, restraining devices, type o f accident and injury, treatment. There is a descriptive account o f each registered accident. The study period referred to in this article included the 12 months between January 1, 1984, through December 31, 1984.
Statistical methods The optimum test for comparing two Poisson distributions was used in the analysis o f the results. 12 Two-tailed tests were used, and P-values less than 0.05 were considered significant.
Drop-out Two per cent o f the victims (n = 4) were unable or unwilling to participate in the study. Less than 1% o f the questionnaires were incompletely filled in. Results
Road traffic accidcnts accounted for 6.5% o f all registered accidents during the study period. The number of injured persons treated in health care was 186. O f these, 182 victims are included in this study. The number o f injuries was 253. One person died at the scene o f the accident: a 72-year-old cyclist (male) who had a collision with a car. The distribution o f road traffic accidents by age and sex and the incidence are shown in Table I. 109 out o f 182 victims belonged to the age-group 0-24 years. The probability o f having a road traffic accident can be estimated to 9.5 per 1000 per year in that age-group and to 3.1 per 1000 per year for persons over the age o f 24 years. There were no sex differences. The incidence for males was 5.3 compared with 5.0 per 1000 per year for females. The most frequent site o f occurrence was the municipality where the patients were parish registered (82%). Eight per cent o f the accidents occurred in other municipalities within the County of Skaraborg and 1% outside the county. In 9% there was no information about the site occurrence. The most c o m m o n road surfaces were asphalt (59%) and gravel (12%). Dry surface conditions could be analysed in 110 cases (60%). The light conditions prevailing at the accident were daylight (67%) and darkness (15%).
58
L. Schelp and R. Ekman Table I
Traffic accidents by age and sex Number injured per 1000 population per year
Sex Age (years)
M
F
Total
%
0-14 15-24 25-34 35-44 45-54 55~4 65-74 75 +
25 34 8 5 8 3 6 3
27 23 3 9 7 l0 9 2
52 57 11 14 15 13 15 5
28.6 31.3 6.0 7.7 8.2 7.1 8.2 2.8
8.0 11.0 2.4 3.0 4.0 3.2 4.0 2.3
Total
92
90
182
100
5.2
(M = male, F = female)
Table II shows the distribution o f road traffic accidents by type o f activity and age. Cyclists (48.9 %), car drivers (15.4%), car passengers (13.2 %) and pedestrians (6 %) were the most c o m m o n victim.s. Children (0-14) have a high frequency o f cycle accidents: 33 (37%). 62% o f all road traffic accidents among children happened when cycling. These accidents are most c o m m o n in the age-group 13-14 years (29%), followed by the age-group 7-9 years (15%) and the age-group 10-12 years (12%). There is a significantly increased risk o f injury for young car drivers (18-24 years) per mile (Table III), assuming that the older age-group (25-54 years) drives on average as long as the younger. Sixty-six road traffic accidents (36%) were classified as single accidents (Table IV). Cars (26%) and cycles (9%) were the most frequent injury-inducing vehicles. Table V shows the distribution o f the victim's activity (traffic category) and the main part o f body injured. Head (25%), arm (19%) and knee (17%) injuries dominated and show high frequences among cyclists. The type o f injury is shown in Table VI. Most frequent were soft tissue injuries, fractures and contusions. The type o f medical care at the first consultation is specified in Table VII. The mean treatment per injury at the first consultation was 1.4. The number o f hospitalised patients was 47 (26%), o f which 9 were children (17%) aged 0-14 years. Fifty-eight per cent o f the gainfully employed patients showed sick-leave days. Permanent disability was observed in 39 cases (21%). Safety devices such as crash helmets and safety belts were not used in 10% o f cases where they should have been according to Swedish legislation. Fifty per cent of all victims were o f the opinion that the accident event could have been prevented. A comparison of our road traffic accidents from the health sector with current official statistics based on police reports and from the National Road Administration is shown in Table VIII.
Road Traffic Accidents in Sweden
0
+ cq
c~
