Estimating Road Transport trauma in the Australian indigenous population

First, road crashes account for a greater proportion of all deaths in the Indigenous population than the non-Indigenous population. Secondly, based on the Australian Indigenous road death estimates the road death rate in the Indigenous population may be three times higher than that of the non-Indigenous population.

Since 1994, the Australian Bureau of Statistics has published data on the causes of death in the Indigenous populations of Western Australia, South Australia and the Northern Territory. Over the period 1994 to 1997, road crashes represented 5.6% of all deaths in the combined Indigenous populations of these jurisdictions. This is comparable to diabetes (6.7%) and stroke (6.3%) as a major cause of death. In contrast, road crashes are the lowest ranking of the main causes of death for the non-Indigenous populations in the same jurisdictions, making up only 1.7% of all causes of death.

The number of deaths for every 100,000 population is a measure of public health risk associated with road use. The available mortality data is used in conjunction with population data to generate road death rates for the Indigenous and non-Indigenous populations in Western Australia, South Australia and the Northern Territory. The total road crash death rate over the four years is 39 deaths per 100,000 Indigenous persons and 12 deaths per 100,000 non-Indigenous persons.

The available road death data and the estimated Indigenous population for each of Australia’s States and Territories were then used to estimate the number of Indigenous road deaths Australia-wide. Two methods were employed. The first is a simple pro-rata method and the second (preferred method) takes into account possible differences in the road death rates between each of the States and Territories.

Using the second method it is estimated that in 1997 there were 31 Indigenous deaths per 100,000 population. This is three times the estimate for the non-Indigenous population (10 deaths per 100,000 population). The simple pro-rata method results in a slightly higher estimate of Indigenous deaths (35 deaths per 100,000 population).

Reliable data on the extent of road trauma are required to develop adequate road safety countermeasures. There is a clear need for improved information on the extent of involvement of Indigenous people in serious road crashes. The Commonwealth is currently supporting an initiative which should assist in meeting this goal. The National Coronial Information System, under development by Monash University, will allow the identification Australia-wide of injury deaths involving Indigenous people.

Bicycle helmets and Injury Prevention of road Transport

Bicycle helmet efficacy is quantified using a formal meta-analytic approach based on peer-reviewed studies. Though several reviews have already been published advocating the use of helmets, this approach provides summary estimates of efficacy in terms of head injury, brain injury and facial injury based on studies of cyclists involved in crashes in which injury and helmet information is available for each individual. It also provides evidence concerning neck injury and fatal injury. These topics have only been partially addressed previously due to the small numbers of cases involved.

The results are based on studies conducted in Australia, the USA, Canada and the United Kingdom, published in the epidemiological and public health literature in the period 1987- 1998. The summary odds ratio estimate for efficacy is 0.40 (95% confidence interval 0.29, 0.55) for head injury, 0.42 (0.26, 0.67) for brain injury, 0.53 (0.39, 0.73) for facial injury and 0.27 (0.10, 0.71) for fatal injury. This indicates a statistically significant protective effect of helmets. Three studies provided neck injury results that were unfavourable to helmets with a summary estimate of 1.36 (1.00, 1.86), but this result may not be applicable to the lighter helmets currently in use.

In conclusion, the evidence is clear that bicycle helmets prevent serious injury and even death. Despite this, the use of helmets is sub-optimal. Helmet use for all riders should be further encouraged to the extent that it is uniformly accepted.

Transport drivers using Alcohol fatalities

Over the past 18 years, the incidence of drink driving has substantially reduced. Table 1 shows that during 1981, 44 per cent of all drivers and motorcycle riders killed in road crashes had a blood alcohol concentration (BAC) of 0.050 gm/100ml or greater. This has reduced to 26 per cent in 1998. This reduction in alcohol-related road trauma has come about as a result of strengthened legislation and enforcement in conjunction with high profile media and public education activities. These efforts have had a significant impact on public attitudes towards drink driving. The result for 1998 represents a substantial improvement on the previous year (28%). It comes after a long period in the 1990s where further reductions in the incidence of alcohol related road fatalities appeared to have stalled.

Sleep and Car driving in young adults

Sleepiness is a significant contributor to car crashes and sleepiness related crashes have higher mortality and morbidity than other crashes. Young adult drivers are at particular risk for sleepiness related car crashes. It has been suggested that this is because young adults are typically sleepier than older adults because of chronic sleep loss, and more often drive at times of increased risk of acute sleepiness. This project aimed to determine the relationship between sleep and driving patterns in young adult drivers. Three estimates of the risk of driving while sleepy were calculated from the data:

1) a model incorporating known circadian and sleep factors influencing sleepiness,
2) time-of-day accident statistics;
3) self-reported sleepiness.