Risk Factors for Road Traffic Injury-Related Mortality inIran; a Systematic Review and Meta-Analysis

Gathering information regarding the risk factors of mortality and disability due to road traffic in-juries can provide evidence for adopting effective interventions to reduce the burden of the injury. Therefore,the present study intends to identify the most important risk factors of road accident-related mortality in Iranby conducting a systematic review and meta-analysis.

Search was done in English and Persian elec-tronic databases, for articles published until the end of 2020. Cross-sectional, cohort and case-control studieswere included. Risk factors were divided into age and sex, road related factors, exceeding speed limit, road userbehaviors, vehicle related factors, weather condition, and light condition. Data were reported as adjusted oddsratio (OR) of death with 95% confidence interval (95% CI).

20 studies were included (2,682,434 trafficaccident victims and 23,272 deaths; mortality rate=1.28%). The risk of death in road traffic injuries in men was1.66 times higher than women (OR = 1.66; 95% CI: 1.03, 2.68) and with each year increase in age, the risk in-creased by 1% (OR = 0.01; 95% CI: 1.00, 1.01). In addition, accident in urban streets (OR = 1.76; 95% CI: 1.08,2.88), roadway defects (OR = 2.15, 95% CI: 1.59, 2.91), and not driving on a flat and straight road (OR = 1.60; 95%CI: 1.14, 2.24) were the most important road-related risk factors for mortality. Exceeding the speed limit wasanother risk factor of death (OR = 3.16; 95% CI: 2.83, 3.54). However, regarding exceeding safe speed, only threestudies have been included, which greatly reduces the power of analysis. Not maintaining focus on the road (OR= 2.99; 95% CI: 1.49, 6.04), not fastening seatbelt (OR = 3.11; 95% CI: 1.08, 8.91), and reckless overtaking (OR =4.04; 95% CI: 3.34, 4.89) were independent road user-related risk factors for mortality. Risk of pedestrian mor-tality in comparison with drivers and passengers is 2.07 times higher (OR = 2.07; 95% CI: 1.53, 2.58). In addition,risk of death in accidents occurring during daylight hours (OR = 0.26; 95% CI: 0.18, 0.37) is lower than that ofother hours. No significant relationship was present between mortality and vehicle types (four-wheeled vehicle:OR = 0.99; 95% CI: 0.050, 1.97; two-wheeled vehicle: OR = 0.75; 95% CI: 0.48, 1.16). In the case of vehicle-relatedfactors, only 2 studies were included, which also dealt only with the type of vehicle (two-wheeled/four-wheeled).Vehicle-related factors such as the car model, its safety rating, and safety standards were not mentioned in anystudy.

Low to very low-level evidence shows that there is a significant relationship between factorsrelated to age, sex, road, road user, exceeding the speed limit, and light condition with the mortality of trafficaccident victims. However, all studies included in the present study were retrospectively designed and the anal-yses were not adjusted for most of the key potential confounders. Therefore, it seems that despite years of effortby researchers in the field of traffic accidents in Iran, there is still no comprehensive and reliable picture of themost important risk factors for road accident mortalities in Iran.