The objective of this study was to do an epidemiological and costs analysis of the impact of road traffic injuries on the demand for emergency room services at hospitals located in the city of Cuernavaca, Mexico. The studied population included injured people who demanded medical attention at the emergency room for injuries due to events in public places, occurring between February and April 2001. Trained interviewers collected the data at the emergency room, 24 h a day. The statistical analysis included simple and bivariate analysis using χ2 odds ratio (OR), and a confidence interval of 95%. The costs analysis included the expenses during the process of searching for and finding care for injuries. There were 433 injured people, 233 (54%) were victims of road traffic accidents, 72% of crashes, and 28% were injured pedestrian and cyclists. Variables associated with the demand of emergency care due to road traffic injuries in comparison with other accidents, were: severity of injuries (OR 2.60, CI 1.44–4.71), and thorax injury (OR 4.64, CI 1.03–20.89). Pedestrians had higher costs for health care and 80% of them had to pay out-of-pocket (P<0.05). Differences between patients injured by crashes or as a pedestrian, were: age under 14 years (OR 5.9, CI 2.5–13.9), being unemployed (OR 2.1, CI 1.20–3.96), and being an elementary school student (OR 13.9, CI 3.08–63.13). The present study is, so far, the only one in Mexico to include an epidemiological and costs analysis in approaching the problem of road traffic injuries. Similar methods must be used, especially in developing countries, to reduce this important public health problem.
As countries modernize and develop, motorization increases, often with an impact on road safety (Castillo and Reyes, 1997 and Roberts, 2001). In Mexico, since 1989, injuries caused by traffic accidents rank third among the ten leading causes of death and are the leading cause of death for persons between ages 1 and 64 (Secretarı́a de Salud, 1995).
Traditionally, road traffic injuries, including occupants of motor vehicles, cyclists, motorcyclists and pedestrians, have been considered as a single problem. That is, vulnerability, exposure conditions, and risk factors involved in their occurrence were considered to be the same (Mohan, 2000). An example of the need for a distinction in factors is the fact that in Mexico City, 54% of deaths by road traffic injuries are pedestrian injuries (Hı́jar et al., 2000), mainly to adults in productive ages. The number of non fatal, medically attended pedestrian injuries is estimated to be about 13 for each death; that means that about 9500 injured pedestrians a year require medical attention (Hı́jar et al., 2001).
The study of road traffic injuries as a single item, using aggregated measurements, or making regional comparisons, is not very useful and excludes any possible identification of the magnitude of the problem for individual traffic users, their spatial and local characteristics, thus limiting the analysis of their determining factors. This is specially true in developing countries like Mexico where users, mainly pedestrians, street vendors and cyclists, share and compete for road space with motor vehicles.
It is important not to forget that the public health problem which is the object of this article has clear and profound repercussions in daily life, as a cause of death, and also generating consequences and disabilities, since in most cases, the victims do not die, but will need to adapt to changes in roles and in their daily activities during several weeks or months, and in some cases permanently, as a consequence of the accident. Summarizing, this event leaves a deep mark in people who are involved, as a pedestrian or as a driver, due to all the affected spheres, which go from physical to emotional, economic, family and social areas. Thus, it is very important to include the costs analysis approach to know how populations can afford the expenses generated during the process of searching for and finding care for a road traffic-related injury.
Since this phenomenon is mainly present in urban areas, this paper presents an analysis of the problem of road traffic injuries in an urban area of Mexico. Its main objective is to analyze, using an epidemiological and costs analysis approach, the impact of road traffic injuries on the demand for services at hospital emergency rooms in Cuernavaca, Mexico.
