Death rates from alcohol-associated road traffic crashes among vulnerable road users in 5 Brazilian capital cities

Background In Brazil, vulnerable road users (VRUs) including motorcyclists, pedestrians, and bicyclists, comprised more than half of all fatal road traffic injuries (RTIs) in 2010. Alcohol is a major risk factor for RTI, which is being targeted by the Global Road Safety Initiative (RS10) in five capitals. Few published studies on alcohol-associated RTI exist at the national level. Aims To analyze the prevalence of blood alcohol content among motorcyclists and pedestrians involved in fatal traffic crashes in five intervention Brazilian cities from 2000-2010: Palmas (North); Teresina (Northeast); Campo Grande (Midwest); Belo Horizonte (Southeast); and Curitiba (South). Methods Mortality rates were calculated based on Brazilian Ministry of Health data using ICD10 codes, and disaggregated by sex, age, and city. The prevalence of alcohol associated RTI mortality was estimated after applying the proportion of deaths found to be positive for alcohol in another Brazilian capital. Results The prevalence of blood alcohol content among VRUs was highest in Palmas and lowest in Belo Horizonte; compare 10.07/100,000 inhabitants and 5.95/100,000 inhabitants respectively. The rates observed in Palmas and Teresina (9.91) are well above the national rate of 6.9/100,000 inhabitants. The blood alcohol content among VRUS in Curitiba and Campo Grande (both 6.61) are slightly below the five Brazilian capital cities rate. Discussion and conclusions Blood alcohol content in fatal traffic crashes among VRUs indicates the need for policy reform and renewed enforcement, including increased breath testing. Further analyses can help target interventions toward at-risk groups. Introduction Alcohol is a major factor in traffic crashes worldwide and the consequences are more likely to result in injuries and deaths than crashes when alcohol is not a factor. The National Highway Traffic Safety Administration (NHTSA) informed 41% of people fatally injured in traffic were in alcohol-related crashes (Hingson, 2003). In Brazil the Road Traffic Accidents (RTA) has remained stable since the Brazilian Vehicle Code (BVC) in 1998 (around 20 deaths per 100,000 inhabitants). In Japan, Sweden and Canada the rates are around five to eight deaths per 100,000 (WHO, 2009). Studies demonstrate the occurrence of collisions and pedestrian accidents are reflections of cities that have grown in a disorganized way, with no enough urban planning and education to the changes in attitudes and behaviors needed (HSE, 2005). Among the RTI victims, the more vulnerable are motorcyclists, cyclists and pedestrians. That phenomenon is noticeably more intense in urban areas with higher population density (Minayo, 2003) which accumulate about 75% of total deaths caused by accidents and violence, which were the main causes responsible for Potential Years Loss of Life (PYLL). When studying the health indicator PYLL, the concentration of deaths in early ages and young adults, and the high values that they have, makes these causes the most important groups within the external causes (Mello and Latorre, 1994). Thus, large losses are resulting from traffic accidents among young people in large urban centers of our country. According to Rio de Janeiro Traffic Department 92% of deaths occur by human failings, of which 35% occur for alcohol abuse (DETRAN, 2004). The Blood Alcohol Concentration (BAC) >0.6 grams of alcohol per liter of blood is considered a criminal offense in Brazil, since 2008 with the Zero Tolerance law. After that, few studies suggested the new law was effective in the months immediately after the law came into force, but it was true just for a limited period (Mello, 2009; Moura, 2009). In Brazil, road traffic accidents will be the fourth leading cause of mortality according to the projected scenario for 2030 based on the Global Burden of Disease study prepared for the 1990 to 2020 period. These projections show perspectives on future trends based on the past, taking into account trends such as the ageing of the population, the epidemiological transition in the countries, economic and social development (Matters, 2005). With the objective to better understand the present scenery, this study aimed to analyze the estimated prevalence of blood alcohol content among VRUs involved in fatal traffic crashes in five RS-10 Brazilian cities.