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.