Road injuries kill more people than AIDS globally

Worried about what to worry about? Accidents should move higher up your list. Worldwide, road injuries kill more people than AIDS. Falls kill nearly three times as many people as brain cancer. Drowning claims more lives than mothers dying in childbirth. Both fire and poisonings have many times more fatal victims than natural disasters. In 2013, the combined death toll from all unintentional injuries was 3.5 million people. Only heart disease and stroke were greater killers.

 These findings, published in the British medical journal The Lancet, are from the “Global Burden of Disease” study, an international collaboration led by the Institute for Health Metrics and Evaluation at the University of Washington, which tracks the annual toll of 240 causes of death for men and women in 20 age groups across 188 countries. 

The study is not mere morbid fascination. Look beneath the top-level results and you see huge variations among countries that are economic peers. This is encouraging news: It means that some countries have figured out a better way to curb accidental deaths - and that other countries might be able to follow suit. 

In France and Spain, according to the study’s authors, people die from transport injuries at roughly the same rate, but the French are twice as likely to die from falls, even adjusting for the country’s older population. In Britain and the United States, deaths from falls are almost equivalent, but Americans are twice as likely to die from poisonings, again adjusted for age differences. Why? If Russia could emulate Brazil, it would cut age-standardised deaths per capita from fire by 80 per cent. If India could copy China, it would cut age-standardised deaths per capita from drowning by 30 per cent. How? 

The Global Burden of Disease study does not answer these questions, but it makes clear where to start looking for best practices. Individual countries can see in what areas they’re leading or lagging, often for the first time, then look to peers for advice or vice versa. Injury prevention may get one of the biggest boosts because global public health leaders have often ignored injuries as health risks. 

Take drowning. For decades, it has been one of the 20 biggest killers worldwide, but the World Health Organisation issued its first report dedicated to drowning only in November 2014. Effective prevention strategies include teaching swimming, providing life jackets, fencing off open water and training emergency medical responders. Drowning deaths also tend to decline as countries urbanise and when income and education increase. 

China, which both urbanised and started prevention programmes, saw drowning deaths plunge from 1,90,000 in 1990 to 64,000 in 2013, Global Burden found. In India, drowning deaths barely budged, falling from an estimated 91,000 to 88,000 in the same period. David Meddings, an epidemiologist who was executive editor of the WHO report, noted that China’s gains may partly reflect changes in the way deaths are reported, but that the improvement was still powerful. 

Progress in reducing the 2,37,000 global deaths a year from fire is equally variable. It makes sense that more Russians than Brazilians die from fire: Russia has fearsome winters, and many fires are caused by heaters. But climate does not explain why the age-standardised death rate from fire was halved between 1990 and 2013 in Brazil, according to Global Burden figures, while in Russia, where more than 10,000 people die every year from fire, it did not decline at all. 

Poisonings kill fewer people than drowning or fire worldwide – about 98,000 in 2013 – but are still a major health threat, claiming roughly 2,200 lives annually in the United States alone, according to Global Burden data. The puzzle is why the age-standardised death rate from poisonings in the United States is so much higher than in Britain.
 Healthcare system“Is it because we have more availability of things that other countries have locked down?” said Jay Schauben, a clinical toxicologist, director of the Florida/USVI Poison Information Centre in Jacksonville, Florida, and president of the American Association of Poison Control Centres. “Is it we sell things here that other countries have banned? Is it a difference in the healthcare system, or because people are afraid of seeking healthcare because of the cost, and therefore they stay at home and die? Is it a difference in the population and behavioural use patterns?” 

Any one – or all – of these factors could explain the vastly different poisoning numbers, said Schauben, who is unaffiliated with the Global Burden of Disease study. The Global Burden study exists, in part, to provide this kind of all-encompassing view of global, regional and national health, as well as to track progress or setbacks place by place, population by population. 

The largest category of fatal accidents is transport injuries. In 1990, according to Global Burden figures, these were the 10th-leading global killer. By 2013, they were fifth, ahead of malaria, diabetes, chronic obstructive pulmonary disease, cirrhosis or any kind of cancer. In part, this is because of progress against disease. But it also because as incomes have risen worldwide, more people are buying - and crashing – motorbikes and cars. 

Research on transport injury prevention shows that collective action is as important as individual efforts. Motorcycle helmets, car seat belts and sober drivers are important, but so are safe vehicles, consistent law enforcement and reliable infrastructure. At stake are the lives of more than 1.4 million people who die annually in transit. “Now that somebody’s done the work and we recognise that there’s a difference we may not have seen before, we can go to work and ask why,” Schauben said.