Traffic related injuries among young people in Scotland: An epidemiological perspective

Introduction Traffic related injury (TRI) is a common cause of mortality and morbidity among young people in the industrialised world. However, there are few epidemiological studies specifically examining TRIs among young people to establish whether this is also the case in Scotland. Further, there has been recent interest in the injury field in developing new methods of data synthesis and analysis using existing data sources. There are two population- based official data sources in Scotland that could be used to build an epidemiological picture of TRIs among young people. Aim The aim of this study was to examine the trends and patterns of TRIs among young people (15-24 years) in Scotland. The study had four key objectives. Firstly, to examine the temporal and socio-economic trends in TRIs among Scottish young people. Secondly, to compare TRI rates in Scottish young people with their European Union counterparts. Thirdly, to establish the location, time and circumstances in which TRIs occur. Lastly, to establish the completeness of official data sources using capture-recapture and to calculate ascertainment- coiTected rates. Ten research questions were formulated to address these objectives. Method: Mortality and hospital discharge (SMRl) data coded as injuries were obtained from the Registrar General for Scotland and the Information and Statistics Division (ISD) of the Scottish Health Service for 15-24 year olds between 1986 and 1995. Results TRIs accounted for over one third of all injury deaths (39%) between 1986 and 1995. However, there was a significant linear decrease in these fatalities over the study period. Rates in Scotland appear to be around average for the EU, but are higher than those observed elsewhere in the UK. Motor vehicle occupant (driver or passenger) fatalities accounted for more than half of the TRI fatalities. A disproportionate number of males and young people residing in more affluent areas sustained TRIs. However, those residing in areas of relatively greater deprivation were more likely to sustain TRIs as pedestrians. Traumatic brain injury was the principal diagnosis among young people admitted to hospital and the leading cause of death after admission to hospital. Conclusions: The study clearly demonstrates that TRIs were the leading cause of injury mortality and a significant contributor to injury morbidity in Scottish young people between 1986 and 1995. This reflects findings from elsewhere in the industrialised world. There appear to be sound economic and social reasons for investing in TRI prevention and the study identified those most at risk. The available evidence on approaches to prevention is relatively weak. Some of the environmental approaches and multi-disciplinary approaches to prevention show promise and could potentially be used to tackle further the relatively high rates of TRIs among young people identified in this study. The capture-recapture exercise clearly demonstrated that data on fatalities from either official source can be used with confidence. However, the databases holding information on non-fatal (serious) TRIs are less complete and users of these data should be aware of this limitation and the biases inherent in each data source. The ascertainment-corrected rates calculated using the capture-recapture technique should be viewed with caution. Using capture-recapture in human epidemiology challenges some of the underlying assumptions associated with the technique including the need for a 'closed' population, the relationship between the datasets and requirement for equal probability from capture to recapture