Date of Award

4-2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Institute of Public Health

First Advisor

Michal Grivna

Second Advisor

Fikri Abu-Zidan

Abstract

Road traffic collisions (RTCs) cause 1.35 million deaths per year worldwide. Approximately 50% of these deaths were among pedestrians and motorized 2-3-wheeler users. In the United Arab Emirates (UAE), RTC deaths were higher compared to other high-income countries (HICs). The United Nations (UN) Decade of Action for road safety 2011-2020, aimed to reduce road traffic deaths by 50% by the year 2020. The aim of this dissertation was to investigate factors affecting changes in RTC-related injuries and deaths over time at global and UAE levels. Multiple research methods were used to investigate the research questions. Global data on pedestrian and motorized 2-3-wheeler users were retrieved from World Health Organization (WHO) Global Status Reports on Road Safety (GSRRS), published from 2009 to 2018. The primary data on the impact of the COVID- 19 pandemic on RTCs for the UAE and the data on the impact of trauma system development on motorcycle-related deaths were obtained from the trauma registries of the two major hospitals in Al-Ain: Al-Ain and Tawam hospitals. A mixed linear model and univariate and multivariate regression analysis were performed. Global pedestrian mortality decreased by 28% over the 10-year period of the study. Factors that reduced pedestrian death rates included time, gross national income (GNI), and vehicle/person ratio. There was a significant drop over time in both HICs and middle-income countries (MICs), but not in low-income countries (LICs). In contrast, the global mean motorized 2-3-wheeler-related death rates increased from 2.37/100,000 population to 3.23/100,000 population during the same period (a relative ratio of 1.36) which was not statistically significant. Factors that affected motorized 2-3-wheeler-related mortality included GNI, motorized 2-3-wheelers/person ratio, helmet wearing rate, and the interaction between vehicle/person ratio and motorized 2-3-wheelers/person ratio. A significant increase in motorized 2-3-wheeler-related death rates was observed over time in LICs and MICs, compared to a significant decrease in the rate in HICs. The incidence of hospitalized RTC trauma patients was significantly reduced by 33.5% during the COVID-19 pandemic. Nevertheless, mortality from RTCs increased significantly during the pandemic. The factors that predicted mortality were low Glasgow Coma Scale (GCS), admission to the Intensive Care Unit (ICU), and high Injury Severity Score (ISS). The COVID-19 pandemic had a strong tendency for increases in mortality due to RTC. The trauma system development in Al-Ain has reduced the incidence of motorcycle injuries by 37% over 15 years. It has significantly decreased mortality in Al-Ain. This study is the first attempt to identify potential factors and conditions – including previously unknown ones (such as the COVID-19 pandemic) that change RTC-related injuries and deaths at the global and UAE levels over time, mainly during the Decade of Action for Road Safety 2011-2020. Our findings can serve as a baseline for future evaluations of RTCs and for improvements in road traffic-related injury prevention and intervention strategies during both normal and pandemic periods. The economic disparities between countries, the maturity of the trauma system, and the COVID-19 pandemic restriction measures, along with the obtained results are consistent to give a clearer picture in understanding the difference in RTC-related deaths and injuries locally and globally over time, both during normal times and pandemic periods.

Arabic Abstract

ﺗﺘﺴﺒﺐ ﺣﻮادث اﻟﻄﺮق (RTCs) ﻓﻲ ﺣﻮاﻟﻰ 1.35 ﻣﻠﯿﻮن ﺣﺎﻟﺔ وﻓﺎة ﺳﻨﻮﯾﺎ ﻓﻲ ﺟﻤﯿﻊ أﻧﺤﺎء اﻟﻌﺎﻟﻢ. وﻣﺎ ﯾﻘﺎرب الـ 50٪ ﻣﻦ ھﺬه اﻟﻮﻓﯿﺎت ﺗﺤﺪث ﺑﯿﻦ اﻟﻤﺸﺎة وﺳﺎﺋﻘﻲ اﻟﻤﺮﻛﺒﺎت ذات اﻟﻌﺠﻠﺘﯿﻦ أو اﻟﺜﻼث. أﻣﺎ ﻓﻲ اﻹﻣﺎرات اﻟﻌﺮﺑﯿﺔ اﻟﻤﺘﺤﺪة، ﻓﻘﺪ ﻛﺎن ﻣﻌﺪل وﻓﯿﺎت ﺣﻮادث اﻟﻄﺮق أﻋﻠﻰ ﻣﻘﺎرﻧﺔ ﺑﺎﻟﺒﻠﺪان اﻷﺧﺮى ذات اﻟﺪﺧﻞ اﻟﻤﺮﺗﻔﻊ (HICs). وﻛﺎن ﻋﻘﺪ اﻷﻣﻢ اﻟﻤﺘﺤﺪة (UN) ﻟﻠﻌﻤﻞ ﻣﻦ أﺟﻞ اﻟﺴﻼﻣﺔ ﻋﻠﻰ اﻟﻄﺮق (2011-2020)، ﯾﮭﺪف إﻟﻰ ﺗﻘﻠﯿﻞ اﻟﻮﻓﯿﺎت اﻟﻨﺎﺟﻤﺔ ﻋﻦ ﺣﻮادث اﻟﻤﺮور ﻋﻠﻰ اﻟﻄﺮق ﺑﻨﺴﺒﺔ 50% ﺑﺤﻠﻮل اﻟﻌﺎم 2020. إن اﻟﮭﺪف ﻣﻦ ھﺬه اﻟﺪراﺳﺔ ھﻮ اﻟﺘﺤﻘﯿﻖ ﻓﻲ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﺆﺛﺮ ﻋﻠﻰ اﻟﺘﻐﯿﺮات ﻓﻲ اﻹﺻﺎﺑﺎت واﻟﻮﻓﯿﺎت اﻟﻤﺮﺗﺒﻄﺔ ﺑﺤﻮادث اﻟﻤﺮور (RTC) ﻣﻊ ﻣﺮور اﻟﻮﻗﺖ، وذﻟﻚ ﻋﻠﻰ اﻟﻤﺴﺘﻮﯾﯿﻦ اﻟﻌﺎﻟﻤﻲ واﻹﻣﺎراﺗﻲ. ﺗﻢ اﺳﺘﺨﺪام طﺮق ﺑﺤﺚ ﻣﺘﻌﺪدة ﻟﻠﺘﺤﻘﯿﻖ ﻓﻲ أﺳﺌﻠﺔ اﻟﺒﺤﺚ. ﺗﻢ اﺳﺘﺮﺟﺎع اﻟﺒﯿﺎﻧﺎت اﻟﻌﺎﻟﻤﯿﺔ ﻋﻦ ﻣﺴﺘﺨﺪﻣﻲ اﻟﻤﺸﺎة واﻟﻤﺮﻛﺒﺎت ذات اﻟﻌﺠﻼت 2-3 ﻣﻦ اﻟﺘﻘﺎرﯾﺮ اﻟﻌﺎﻟﻤﯿﺔ ﻟﻤﻨﻈﻤﺔ اﻟﺼﺤﺔ اﻟﻌﺎﻟﻤﯿﺔ ﺑﺸﺄن اﻟﺴﻼﻣﺔ ﻋﻠﻰ اﻟﻄﺮق (GSRRS)، واﻟﺘﻲ ﻧُﺸﺮت ﻓﻲ اﻟﻔﺘﺮة ﻣﻦ 2009 إﻟﻰ 2018. اﻟﺒﯿﺎﻧﺎت اﻷوﻟﯿﺔ ﻋﻦ ﺗﺄﺛﯿﺮ وﺑﺎء أﻧﻔﻠﻮﻧﺰا اﻟﻜﻮروﻧﺎ COVID-19 على ﺣﻮادث اﻟﻄﺮق ﻓﻲ دوﻟﺔ اﻹﻣﺎرات اﻟﻌﺮﺑﯿﺔ اﻟﻤﺘﺤﺪة، واﻟﺒﯿﺎﻧﺎت اﻟﻤﺘﻌﻠﻘﺔ ﺑﺘﺄﺛﯿﺮ ﺗﻄﻮﯾﺮ ﻧﻈﺎم ﺗﺴﺠﯿﻞ اﻹﺻﺎﺑﺎت اﻟﺮﺿﯿﺔ ﻋﻠﻰ ﻣﻌﺪل اﻟﻮﻓﯿﺎت اﻟﻤﺮﺗﺒﻄﺔ ﺑﺎﻟﺪراﺟﺎت اﻟﻨﺎرﯾﺔ، ﺗﻢ اﻟﺤﺼﻮل ﻋﻠﯿﮭﺎ ﻣﻦ ﺳﺠﻼت اﻹﺻﺎﺑﺎت اﻟﺮﺿﯿﺔ ﻓﻲ ﻣﺴﺘﺸﻔﯿﯿﻦ رﺋﯿﺴﯿﯿﻦ ﻓﻲ اﻟﻌﯿﻦ: ﻣﺴﺘﺸﻔﻰ اﻟﻌﯿﻦ وﻣﺴﺘﺸﻔﻰ ﺗﻮام. ﺗﻢ دراﺳﺔ ﺗﺤﻠﯿﻞ اﻻﻧﺤﺪار ﺑﺎﺳﺘﺨﺪام ﻧﻤﻮذج ﺧﻄﻲ ﻣﺨﺘﻠﻂ ﻣﻊ ﺗﺤﻠﯿﻞ اﻻﻧﺤﺪار أﺣﺎدي اﻟﻤﺘﻐﯿﺮ وﻣﺘﻌﺪد اﻟﻤﺘﻐﯿﺮات. اﻧﺨﻔﺾ ﻣﻌﺪل وﻓﯿﺎت اﻟﻤﺸﺎة ﻋﺎﻟﻤﯿﺎ ﺑﻨﺴﺒﺔ 28% ﺧﻼل ﻓﺘﺮة اﻟﺪراﺳﺔ اﻟﺒﺎﻟﻐﺔ 10 ﺳﻨﻮات. وﺷﻤﻠﺖ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺳﺎھﻤﺖ ﻓﻲ ﺧﻔﺾ ﻣﻌﺪﻻت وﻓﯿﺎت اﻟﻤﺸﺎة : اﻟﻮﻗﺖ، واﻟﺪﺧﻞ اﻟﻘﻮﻣﻲ اﻹﺟﻤﺎﻟﻲ (GNI)، وﻧﺴﺒﺔ اﻟﻤﺮﻛﺒﺎت/ﻋﺪد اﻟﺴﻜﺎن. ﻛﺎن ھﻨﺎك اﻧﺨﻔﺎض ﻛﺒﯿﺮ ﺑﻤﺮور اﻟﻮﻗﺖ ﻓﻲ ﻛﻞ ﻣﻦ اﻟﺒﻠﺪان ﻣﺮﺗﻔﻌﺔ اﻟﺪﺧﻞ واﻟﺒﻠﺪان ﻣﺘﻮﺳﻄﺔ اﻟﺪﺧﻞ (MICs)، وﻟﻜﻦ ﻟﯿﺲ ﻓﻲ اﻟﺒﻠﺪان ﻣﻨﺨﻔﻀﺔ اﻟﺪﺧﻞ (LICs). وﻓﻲ اﻟﻤﻘﺎﺑﻞ، ارﺗﻔﻊ اﻟﻤﻌﺪل اﻟﻌﺎﻟﻤﻲ ﻟﻠﻮﻓﯿﺎت اﻟﻤﺮﺗﺒﻄﺔ ﺑﺎﻟﻤﺤﺮﻛﺎت ذات اﻟﻌﺠﻠﺘﯿﻦ أو اﻟﺜﻼث ﻣﻦ 2.37 / 100،000 ﻧﺴﻤﺔ إﻟﻰ 3.23/100،000 ﻧﺴﻤﺔ ﺧﻼل ﻧﻔﺲ اﻟﻔﺘﺮة (ﺑﻨﺴﺒﺔ 1.36) واﻟﺘﻲ ﻟﻢ ﺗﺮﻗﻲ اﻟﻰ دﻻﻟﺔ إﺣﺼﺎﺋﯿﺔ. اﻟﻌﻮاﻣﻞ اﻟﺘﻲ أﺛﺮت ﻋﻠﻰ ﻣﻌﺪل اﻟﻮﻓﯿﺎت ذات اﻟﺼﻠﺔ ﺑﺎﻟﻤﺤﺮﻛﺎت ذات اﻟﻌﺠﻠﺘﯿﻦ أو اﻟﺜﻼث ﺷﻤﻠﺖ اﻟﺪﺧﻞ اﻟﻘﻮﻣﻲ اﻹﺟﻤﺎﻟﻲ، وﻧﺴﺒﺔ اﻟﻤﺮﻛﺒﺎت اﻵﻟﯿﺔ ذات اﻟﻌﺠﻠﺘﯿﻦ أو اﻟﺜﻼث ﻟﻜﻞ ﺷﺨﺺ، وﻣﻌﺪل ارﺗﺪاء اﻟﺨﻮذة، واﻟﺘﻔﺎﻋﻞ ﺑﯿﻦ ﻧﺴﺒﺔ اﻟﺴﯿﺎرة/ﻋﺪد اﻟﺴﻜﺎن وﻧﺴﺒﺔ اﻟﻤﺮﻛﺒﺎت اﻵﻟﯿﺔ ذات اﻟﻌﺠﻠﺘﯿﻦ أو اﻟﺜﻼث إﻟﻰ ﻋﺪد اﻟﺴﻜﺎن. وﻟﻮﺣﻈﺖ زﯾﺎدة ﻛﺒﯿﺮة ﻓﻲ ﻣﻌﺪل اﻟﻮﻓﯿﺎت اﻟﻤﺮﺗﺒﻄﺔ ﺑﺎﻟﻤﺤﺮﻛﺎت ذات اﻟﻌﺠﻠﺘﯿﻦ أو اﻟﺜﻼث ﺑﻤﺮور اﻟﻮﻗﺖ ﻓﻲ اﻟﺒﻠﺪان ﻣﻨﺨﻔﻀﺔ اﻟﺪﺧﻞ واﻟﺒﻠﺪان اﻟﻤﺘﻮﺳﻄﺔ اﻟﺪﺧﻞ، ﻣﻘﺎرﻧﺔً ﺑﺎﻧﺨﻔﺎض ﻛﺒﯿﺮ ﻓﻲ ﻧﻔﺲ اﻟﻤﻌﺪل في اﻟﺒﻠﺪان اﻟﻤﺮﺗﻔﻌﺔ اﻟﺪﺧﻞ. اﻧﺨﻔﺾ ﻣﻌﺪل ﺣﺪوث اﻹﺻﺎﺑﺎت ﻟﺪى ﺿﺤﺎﯾﺎ اﻹﺻﺎﺑﺎت اﻟﺮﺿﯿﺔ ﻓﻲ اﻟﻤﺴﺘﺸﻔﻰ ﺑﺸﻜﻞ ﻛﺒﯿﺮ ﺑﻨﺴﺒﺔ 33.5% ﺧﻼل ﺟﺎﺋﺤﺔ ﻛﺮوﻧﺎ COVID-19، وﻣﻊ ذﻟﻚ، ازداد ﻣﻌﺪل اﻟﻮﻓﯿﺎت ﻓﻲ ﺣﻮادث اﻟﻤﺮور ﺑﺸﻜﻞ ﻣﻠﺤﻮظ أﺛﻨﺎء اﻟﺠﺎﺋﺤﺔ. ﻛﺎﻧﺖ اﻟﻌﻮاﻣﻞ اﻟﺘﻲ ﺗﻨﺒﺄت ﺑﺎﻟﻮﻓﯿﺎت ھﻲ اﻧﺨﻔﺎض ﻣﻘﯿﺎس ﻏﻼﺳﻜﻮ ﻟﻠﻐﯿﺒﻮﺑﺔ (GCS)، وﺳﺮﻋﺔ اﻟﻘﺒﻮل ﻓﻲ وﺣﺪة اﻟﻌﻨﺎﯾﺔ اﻟﻤﺮﻛﺰة (ICU) وارﺗﻔﺎع درﺟﺔ ﺧﻄﻮرة اﻹﺻﺎﺑﺔ (ISS). وﻛﺎن ﻟﻮﺑﺎء COVID-19 ﺗﺄﺛﯿﺮ ﻗﻮي ﻋﻠﻰ ﺳﺮﻋﺔ دﺧﻮل اﻟﻤﺴﺘﺸﻔﻰ وزﯾﺎدة اﻟﻮﻓﯿﺎت ﺑﺴﺒﺐ ﺣﻮادث اﻟﻄﺮق. وﻗﺪ أدى ﺗﻄﻮﯾﺮ ﻧﻈﺎم ﺗﺴﺠﯿﻞ اﻹﺻﺎﺑﺎت اﻟﺮﺿﯿﺔ ﻓﻲ اﻟﻌﯿﻦ إﻟﻰ ﺗﻘﻠﯿﻞ ﺣﺪوث إﺻﺎﺑﺎت اﻟﺪراﺟﺎت اﻟﻨﺎرﯾﺔ ﺑﻨﺴﺒﺔ 37% ﻋﻠﻰ ﻣﺪار 15 عاماً. ﻓﻘﺪ أدى إﻟﻰ اﻧﺨﻔﺎض ﻛﺒﯿﺮ ﻓﻲ ﻣﻌﺪل اﻟﻮﻓﯿﺎت ﻓﻲ اﻟﻌﯿﻦ. ھﺬه اﻟﺪراﺳﺔ ھﻲ اﻟﻤﺤﺎوﻟﺔ اﻷوﻟﻰ ﻟﺘﺤﺪﯾﺪ اﻟﻌﻮاﻣﻞ واﻟﻈﺮوف اﻟﻤﺤﺘﻤﻠﺔ - ﺑﻤﺎ ﻓﻲ ذﻟﻚ ﻏﯿﺮ اﻟﻤﻌﺮوﻓﺔ ﺳﺎﺑﻘًﺎ، ﻣﺜﻞ وﺑﺎء COVID-19 اﻟﺘﻲ ﺗﻐﯿﺮ اﻹﺻﺎﺑﺎت واﻟﻮﻓﯿﺎت اﻟﻤﺮﺗﺒﻄﺔ ﺑﺤﻮادث اﻟﻄﺮق ﻋﻠﻰ اﻟﻤﺴﺘﻮﯾﯿﻦ اﻟﻌﺎﻟﻤﻲ واﻹﻣﺎراﺗﻲ ﺑﻤﺮور اﻟﻮﻗﺖ، ﺧﺎﺻﺔ ﺧﻼل ﻋﻘﺪ اﻟﻌﻤﻞ ﻣﻦ أﺟﻞ اﻟﺴﻼﻣﺔ ﻋﻠﻰ اﻟﻄﺮق 2011-2020. وﻗﺪ ﺗﻜﻮن اﻟﻨﺘﺎﺋﺞ اﻟﺘﻲ ﺗﻮﺻﻠﻨﺎ إﻟﯿﮭﺎ ﺑﻤﺜﺎﺑﺔ اﻷﺳﺎس ﻟﻠﺘﻘﯿﯿﻤﺎت اﻟﻤﺴﺘﻘﺒﻠﯿﺔ ﻟﻠﻮﻓﯿﺎت اﻟﻨﺎﺟﻤﺔ ﻋﻦ ﺣﻮادث اﻟﻄﺮق وﻟﺘﺤﺴﯿﻦ اﺳﺘﺮاﺗﯿﺠﯿﺎت اﻟﻮﻗﺎﯾﺔ ﻣﻦ اﻹﺻﺎﺑﺎت اﻟﻤﺘﻌﻠﻘﺔ ﺑﺎﻟﻄﺮق وﺑﺮاﻣﺞ اﻟﺴﻼﻣﺔ اﻟﻤﺮورﯾﺔ ﺧﻼل اﻷوﻗﺎت اﻟﻌﺎدﯾﺔ وأوﻗﺎت اﻟﻮﺑﺎﺋﯿﺎت. اﻟﻔﻮارق اﻻﻗﺘﺼﺎدﯾﺔ ﺑﯿﻦ اﻟﺒﻠﺪان، واﻋﺘﻤﺎد ﻧﻈﺎم ﺗﺴﺠﯿﻞ اﻹﺻﺎﺑﺎت اﻟﺮﺿﯿﺔ، وﺗﺪاﺑﯿﺮ اﻟﺤﺪ ﻣﻦ ﺟﺎﺋﺤﺔ ﻛﺮوﻧﺎ COVID-19، إﻟﻰ ﺟﺎﻧﺐ اﻟﻨﺘﺎﺋﺞ اﻟﺘﻲ ﺗﻢ اﻟﺤﺼﻮل ﻋﻠﯿﮭﺎ، ﻣﺘﺴﻘﺔ ﻹﻋﻄﺎء ﺻﻮرة أوﺿﺢ ﻓﻲ ﻓﮭﻢ اﻻﺧﺘﻼف ﻓﻲ اﻟﻮﻓﯿﺎت واﻹﺻﺎﺑﺎت اﻟﻤﺮﺗﺒﻄﺔ ﺑـﺤﻮادث اﻟﻄﺮق ﻣﺤﻠﯿًﺎ وﻋﺎﻟﻤﯿاً ﺑﻤﺮور اﻟﻮﻗﺖ، ﺳﻮاء ﺧﻼل اﻷوﻗﺎت اﻟﻌﺎدﯾﺔ وأوﻗﺎت اﻟﻮﺑﺎﺋﯿﺎت .

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