Magnitude and temporal evolution of traffic injuries and deaths in Brazil, 2001 to 2021

Abstract

This study aimed to analyze the temporal trend the profile road traffic accidental injuries and deaths in Brazil from 2001 to 2021, using data on hospitalizations and deaths. Data from land transport accidents (ICD-10 codes V01-V99) from the Hospital Information System and the Mortality Information System were analyzed. Hospitalization and mortality rates were calculated by gender and age group, and the proportional distribution by race/skin color was assessed. The temporal trend was verified using the Prais-Winsten model. Hospitalization rates in Brazil increased from 51.2 to 84.0 per 100,000 inhabitants from 2001 to 2021, with a male predominance. Deaths increased from 2001-2006 to 2007-2012 and then decreased. The highest rates were among men. For hospitalizations, there is a significant upward trend in thirteen capitals and a downward trend in five. Regarding mortality, no series showed an increasing trend, and 11 series showed a decreasing trend. Despite data indicating that the country is progressing in preventing traffic deaths, many capitals still have increasing hospitalization trends.

Key words:
Transport accidents; Mortality; Morbidity; Temporal trend

Resumo

Objetivou-se analisar a tendência temporal do perfil das vítimas lesionadas e mortas no trânsito no Brasil, no período de 2001 a 2021. Foram analisados dados de acidentes de transporte terrestre (CID-10 códigos V01-V99) do Sistema de Informações Hospitalares e do Sistema de Informação sobre Mortalidade. Foram calculadas as taxas de internações e mortalidade, por sexo e faixa etária e a distribuição proporcional segundo raça/cor. A tendência temporal foi verificada pelo modelo de Prais-Winsten. As taxas de internação no Brasil aumentaram de 51,2 para 84,0 por 100.000 habitantes entre 2001 e 2021, com predominância masculina. Já as mortes aumentaram de 2001-2006 para 2007-2012, caindo depois. As maiores taxas foram entre homens. Para as internações, observa-se tendência significativa de crescimento nas séries de treze capitais e de queda em cinco. Para a mortalidade, nenhuma série mostrou tendência de crescimento e 11 séries exibiram tendência decrescente. Apesar dos dados indicarem que o país está avançando na prevenção das mortes no trânsito, nas internações ainda há muitas capitais com tendência crescente.

Palavras-chave:
Acidentes de transporte; Mortalidade; Morbidade; Tendência temporal

Resumen

Este estudio tuvo como objetivo analizar la tendencia temporal en el perfil de las víctimas de accidentes de tránsito lesionadas y fallecidas en Brasil de 2001 a 2021. Se analizaron datos sobre accidentes de transporte terrestre (códigos CIE-10 V01-V99) del Sistema de Información Hospitalaria y del Sistema de Información de Mortalidad. Se calcularon las tasas de hospitalización y mortalidad por sexo y grupo de edad, así como la distribución proporcional por raza/color. La tendencia temporal se verificó mediante el modelo de Prais-Winsten. Las tasas de hospitalización en Brasil aumentaron de 51,2 a 84,0 por 100.000 habitantes entre 2001 y 2021, con predominio masculino. Las muertes aumentaron de 2001-2006 a 2007-2012, disminuyendo posteriormente. Las tasas más altas se dieron entre los hombres. En cuanto a las hospitalizaciones, se observó una tendencia ascendente significativa en la serie para trece capitales y una tendencia descendente en cinco. En cuanto a la mortalidad, ninguna serie mostró una tendencia ascendente y 11 series mostraron una tendencia descendente. Si bien los datos indican que el país está avanzando en la prevención de muertes por accidentes de tránsito, las hospitalizaciones en muchas capitales aún muestran una tendencia al alza.

Palabras clave:
Accidentes de tránsito; Mortalidad; Morbilidad; Tendencia temporal

Introduction

The World Health Organization estimates that approximately 1.19 million lives are lost annually as a result of traffic accidents, and that between 20 and 50 million people suffer non-fatal injuries, many of them resulting in some form of disability¹.

Road Traffic Accidents (RTAs) are among the ten leading causes of death worldwide². It is estimated that they will be the seventh leading cause of death by 2030 if nothing is done³.

Low- and middle-income countries account for 90% of all traffic deaths worldwide, despite accounting for only 54% of the vehicle fleet. Comparing high-, low-, and middle-income countries, the latter have more than twice the mortality rates per 100,000 population^3,4.

Between 2015 and 2030, the impacts of RTAs on the macroeconomic burden will total US$ 1.8 trillion for 166 of the 193 UN signatory countries. This figure includes job losses due to mortality and morbidity, as well as healthcare expenses that could have been used for savings or investment. Projections equate to an annual tax of 0.12% of global GDP and an average per capita burden of US$ 231 during this period, according to estimates by Chen et al.².

In Brazil, the costs of RTAs on highways were estimated at around R$ 40 billion per year, and accidents in urban areas cost around BRL 10 billion. Loss of productivity accounts for the largest portion of this cost, followed by hospital costs, representing 1% to 3% of GDP. Therefore, there is a close relationship between road safety and economic and social development^2,5,6.

In 2019, 31,945 traffic deaths were recorded in Brazil, making the rate of 15.2 deaths per 100,000 inhabitants one of the lowest in the last five years, as per data from the Department of Information Technology of the Unified Health System (DATASUS)⁷. However, proportionally, traffic represents the third leading cause of premature deaths in the country, with motorcyclists (33%) and pedestrians (18%) accounting for more than half of the victims, and young men being the most vulnerable. In this context, traffic deaths were second only to ischemic heart disease and interpersonal violence⁷.

In Brazil, the reduction in deaths and injuries was attributed to the implementation of the first version of the UN global plan - Decade of Action for Road Safety 2011-2020⁸. After the plan’s launch, deaths dropped 28% in Brazil and its macro-regions. However, the target set out in the Sustainable Development Goals was 50%⁷. One of the strategic initiatives for implementing this plan in Brazil was the creation of the Vida no Trânsito (Life in Transit) Program (PVT), in partnership with the WHO and the Bloomberg Foundation. The Ministry of Health coordinated this intersectoral effort and involves institutions and agencies engaged in the issue. It began in 2010 in Curitiba, Belo Horizonte, Campo Grande, Teresina, and Palmas. It has expanded and now exists in almost all state capitals and cities that have joined this initiative.

Andrade and Antunes⁸ state that, on average, at least twelve people suffer non-fatal injuries for every person who dies in an accident on a federal highway. Non-fatal incidents, like deaths, cause psychological distress and economic costs to victims, their families, and society, resulting from healthcare costs for rehabilitation and lost productivity due to permanent and disabling after-effects^2,3.

This article aims to analyze the temporal trend of the profile of injured people and deaths in traffic accidents in Brazil from 2001 to 2021.

Methods

We used data on land transport accidents (ICD-10 codes V01-V99) from the Hospital Information System (SIH/MS) and the Mortality Information System (SIM/MS) to characterize the victim profile and the temporal trend of hospitalizations and deaths from traffic injuries. Data on railway accidents (ICD-10 codes V05, V15, V25, V35, V45, V55, V65, and V75) were excluded from the analysis. The analysis covered the 2001-2021 historical series for Brazilian capitals and the Federal District, regions, and the country as a whole.

The descriptive analysis involved calculating hospitalization and death rates by gender and age group, and the proportional distribution by race/skin color. Rates were calculated per 100,000 inhabitants, using as the denominator the population estimates by gender and age group provided by the Brazilian Institute of Geography and Statistics (IBGE) for the 2001-2021 period.

The temporal period was divided into three six-year periods (2001-2006; 2007-2012; 2013-2018) and one three-year period (2019-2021). Additionally, a temporal trend analysis (stable, increasing, and decreasing series) was performed using the Prais-Winsten technique. We applied the logarithmic transformation or the square root transformation to meet the assumptions of the Prais-Winsten models when normality of the residuals was not identified in the original series. The data were organized in Excel spreadsheets for rate calculation, and the model fitting was implemented in R software version 4.1.3.

As this is publicly accessible secondary data, ethical approval was not required in accordance with Resolution N° 510/2016 of the National Health Council.

Results

Hospitalization rates for the country increased over the years analyzed, up from 51.2 in the first period to 84.0 hospitalizations per 100,000 in the last period. Male rates predominated, with nearly four male hospitalizations for every female hospitalization. A similar situation is observed for regional data, namely an increase from the first to the last period and a male predominance. In the North, we highlight the rates in Porto Velho, Rio Branco, Boa Vista, Macapá, and Palmas (in the last two periods); in the Northeast, notable were São Luís, Teresina, Fortaleza, Natal, and João Pessoa; in the Southeast, throughout the period, in all capitals, rates exceeded 100 hospitalizations per 100,000 at some point, whether for the general population, the male population, or both; in the South, Porto Alegre had the highest rates, and Cuiabá, Goiânia, and Brasília stood out in the Midwest (Table 1).

Table 1
Hospitalization (per 100,000 inhabitants) and gender ratio for road traffic injuries. Brazil, regions and capitals, 2001-2021.

Major Regions and capitals	Hospitalizations
	2001-2006		2007-2012		2013-2018		2019-2021
	Total	M/F Ratio	Total	M/F Ratio	Total	M/F Ratio	Total	M/F Ratio
Brazil	51.2	3.5	62.3	3.8	79.3	3.8	84.0	4.0
North	25.2	3.0	40.6	3.0	77.1	3.1	80.6	3.1
Porto Velho	34.8	3.4	87.7	3.5	92.9	2.9	136.0	3.1
Rio Branco	42.3	3.4	122.3	3.4	135.6	3.3	98.5	3.2
Manaus	10.3	2.3	4.1	2.7	13.4	3.4	19.8	4.3
Boa Vista	84.9	3.3	187.2	2.6	451.3	2.5	307.9	2.6
Belém	13.3	2.8	3.3	3.5	24.2	4.2	37.0	4.2
Macapá	74.9	3.4	74.9	3.1	91.1	2.6	59.7	3.2
Palmas	2.2	2.4	3.4	3.1	138.0	3.4	295.2	3.0
Northeast	46.5	3.4	59.0	4.0	83.9	4.2	87.7	4.4
São Luís	486.0	2.9	154.4	3.3	50.1	3.5	6.3	3.9
Teresina	53.1	5.3	88.4	5.1	269.7	4.9	297.3	4.9
Fortaleza	74.0	4.6	131.4	3.6	124.4	4.4	113.2	4.2
Natal	43.6	4.9	54.6	5.2	55.0	5.2	102.2	5.9
João Pessoa	59.3	5.1	114.6	5.3	127.8	5.0	141.3	5.2
Recife	1.7	3.5	7.5	3.8	41.3	3.7	26.9	4.3
Maceió	77.2	2.5	17.4	2.4	9.1	3.4	2.3	8.8
Aracaju	19.2	3.7	20.4	4.0	50.7	4.4	70.2	3.3
Salvador	40.3	4.0	35.0	4.9	44.2	5.1	64.7	5.2
Southeast	63.2	3.6	71.0	3.9	80.9	4.0	83.9	4.4
Belo Horizonte	54.7	4.7	81.7	4.9	134.4	5.0	125.2	5.5
Vitória	80.2	4.3	43.6	4.3	106.8	3.8	150.1	4.6
Rio de Janeiro	79.6	2.5	51.1	3.1	44.2	3.6	29.6	5.2
São Paulo	61.9	4.4	86.8	4.8	71.3	5.0	77.5	6.0
South	38.6	3.4	48.3	3.4	58.5	3.4	59.1	3.6
Curitiba	8.5	3.4	24.1	4.4	31.8	3.4	31.8	4.2
Florianópolis	69.0	4.5	57.6	4.0	25.4	4.2	17.8	4.7
Porto Alegre	118.5	2.9	93.5	2.9	77.3	3.5	66.0	4.6
Midwest	52.7	3.4	76.9	3.5	95.8	3.3	121.3	3.4
Campo Grande	13.9	3.4	15.8	3.5	36.3	3.4	267.2	3.8
Cuiabá	40.4	4.4	90.6	4.3	216.2	4.1	95.5	3.5
Goiânia	90.2	4.5	146.7	3.8	180.3	3.6	211.3	3.5
Brasília	51.2	3.7	61.3	4.1	63.1	3.8	79.2	5.0

• Source: Authors.

In Brazil, deaths from traffic injuries increased from the first period (2001-2006) to the second period analyzed (2007-2012), and decreased in the following periods (Table 2). This same behavior was observed in the Southeast, South, and Midwest. However, in the North and Northeast, mortality rates increased throughout the first three periods analyzed, with a decrease only in the last. In males, they ranged from 4.3 deaths per 100,000 men in Macapá, in 2007-2012, to 44.9 deaths per 100,000 men in Palmas, in 2001-2006. In females, the rates ranged from 1.0 deaths per 100,000 women in Natal, in 2019-2021, to 14.5 deaths per 100,000 women in Palmas, in 2001-2006.

Table 2
Death rates (per 100.000 inhabitants) and gender ratio for road traffic injuries. Brazil, regions and capitals, 2001-2021.

Major Regions and capitals	Deaths
	2001-2006		2007-2012		2013-2018		2019-2021
	Total	M/F Ratio	Total	M/F Ratio	Total	M/F Ratio	Total	M/F Ratio
Brazil	13.1	4.4	16.0	4.6	14.8	4.7	12.2	5.2
North	11.5	4.1	13.6	4.2	14.3	4.6	11.2	4.4
Porto Velho	6.6	3.7	11.1	3.7	16.6	4.3	12.5	3.2
Rio Branco	10.0	2.9	3.8	3.5	12.0	3.5	5.0	5.4
Manaus	11.6	4.0	11.4	3.6	12.0	4.3	10.7	4.5
Boa Vista	20.3	4.0	26.5	3.8	21.7	3.8	14.1	3.4
Belém	11.1	4.1	11.8	3.9	8.6	4.0	5.8	3.7
Macapá	22.9	4.7	2.8	3.1	11.2	3.9	7.6	3.3
Palmas	29.6	3.1	21.5	3.8	25.1	3.6	19.7	4.9
Northeast	12.0	5.2	15.2	5.5	16.0	6.1	13.2	6.5
São Luís	9.7	3.9	10.3	3.9	6.4	4.8	6.1	5.1
Teresina	12.4	4.7	20.4	5.5	21.1	5.4	15.6	5.6
Fortaleza	18.3	5.4	14.5	5.2	11.6	4.9	5.1	4.9
Natal	7.0	4.1	6.8	5.5	5.1	4.6	3.4	6.1
João Pessoa	11.3	4.1	11.0	5.6	12.0	5.3	7.5	7.0
Recife	9.9	4.5	10.3	5.0	8.9	4.2	6.3	4.4
Maceió	14.5	5.1	6.6	4.3	5.7	6.0	7.2	4.6
Aracaju	16.9	4.3	19.9	4.8	13.2	6.2	9.7	7.9
Salvador	5.6	3.6	7.7	4.7	6.9	4.8	4.1	5.8
Southeast	11.5	4.2	14.4	4.4	11.8	4.4	9.3	4.9
Belo Horizonte	11.2	3.6	14.1	3.9	10.6	3.9	7.0	3.5
Vitória	16.5	3.5	14.7	3.9	11.3	4.7	6.1	8.1
Rio de Janeiro	12.7	3.7	10.1	3.5	6.2	2.8	3.1	2.5
São Paulo	8.2	3.4	11.5	4.4	7.6	3.9	5.3	4.5
South	17.7	4.3	20.2	4.2	18.3	4.0	16.3	4.6
Curitiba	16.1	3.9	17.2	4.0	11.5	3.6	9.5	5.5
Florianópolis	16.7	4.6	14.1	4.4	13.3	4.4	8.5	3.4
Porto Alegre	10.2	3.5	10.4	3.1	9.6	2.7	5.8	3.2
Midwest	20.0	4.2	23.0	4.2	21.4	4.1	17.5	4.6
Campo Grande	15.5	4.2	23.6	4.4	18.1	3.7	16.8	4.3
Cuiabá	22.1	4.0	23.2	4.2	20.2	4.4	14.9	6.9
Goiânia	17.4	3.7	17.8	4.1	16.2	4.6	13.5	4.1
Brasília	20.2	4.3	19.1	4.2	13.9	4.0	9.0	4.8

• Source: Authors.

An analysis of hospitalization data by age group shows high numbers from the youngest group (up to 9 years) to the last group considered (60 years and over). However, the highest values are observed in the 20-29 age group in all periods. Rates above 100 hospitalizations per 100,000 population are observed in all regions for the 20-39 age group, from 2013-2018. When analyzing the data by capital, rates above 100 are observed for some age groups and time periods. In some cases, they exceeded 300 hospitalizations per 100,000 (Graph 1a).

Graph 1
Hospitalization (a) and mortality (b) rate due to traffic injuries, by age group. Brazil, 2001-2021.

The age groups with the highest traffic injury mortality rates in Brazil were those aged 20-29 and 60 and over in the first three periods analyzed, and those aged 20-29 and 30-39 in 2019-2021. People aged 60 and over had the highest rate in 2001-2006, followed by those aged 20-29. In the following two periods, the situation reversed, with the 20-29 age group showing the highest rates, followed by those aged 60 and over. Regarding the regions, the lowest mortality rate due to land transport accidents was observed in the Southeast for children up to 9 (1.1 deaths per 100,000) in 2019-2021, and the highest in the Midwest for people aged 60 and over (37.3 deaths per 100,000) in 2007-2012 (Graph 1b). In this last age group, noteworthy are the rates of Macapá (59.6) and Cuiabá (56.7 per 100,000 inhabitants) in 2001-2006, and those of Palmas in the age groups of 20-29 years (42.5), 30-39 years (40.1), 40-59 years (41.3) and 60 and over (43.4 per 100,000 inhabitants) in the same period.

Regarding the distribution by race/skin color, there was a predominance of hospitalizations among white people in 2008-2012, and brown people in the subsequent periods (Graph 2). In the North and Northeast, brown people stood out in all periods. In the South, white people had higher rates. In the Southeast, the percentage of white people was higher in the first two periods, but brown people prevailed in the last. In the Midwest, there was an equal percentage of white and brown people in the first period (2008-2012), with brown people standing out in the second and third periods.

Graph 2
Proportional distribution of hospitalizations (a) and deaths (b) due to road traffic injuries, by race/skin color and by Region. Brazil, 2001-2021.

The high percentage of hospitalizations with missing information on race/skin color stood out, especially in some capitals of the North, Northeast, and Midwest. In the Southeast, from 2007 to 2012, these percentages were high in Vitória and Rio de Janeiro, with improvements in subsequent periods. However, in Rio de Janeiro, a significant percentage of missing information on race/skin color persists (36.1%). In the Midwest, cases in which skin color was not recorded exceeded 90% from 2007 to 2012 in Cuiabá, Goiânia, and Brasília. We observed improvements in subsequent periods. However, these percentages remained high in Cuiabá and Brasília, at 75.8% and 72.9%, respectively (capital data not shown).

In Brazil, deaths from road traffic accidents among white people were highest in 2001-2006 and 2007-2012, followed by those of brown people (Graph 2). In 2013-2018 and 2019-2021, this relationship reversed, resulting in a higher proportion of deaths among brown individuals. In the North, Northeast, and Midwest, we identified an increase in the proportion of deaths from road traffic accidents among brown people and a decrease in this proportion among white people over the periods studied. In the South, the proportion of deaths due to RTAs among white people increased from the first to the second period, followed by a decrease in subsequent periods, and the proportion of deaths among brown people increased in all periods. In contrast, this proportion decreased among white people and increased among brown people in the Southeast over time.

Fortaleza, Maceió, Vitória, and Aracaju had proportions of deaths due to RTAs without information on race/skin color above 20.0% in 2001-2006, reaching 54.1% in Fortaleza. The lack of information on this variable decreased throughout the periods analyzed; however, in Fortaleza, it remained high until 2013-2018 (37.5%). In the last period (2019-2021), Vitória, João Pessoa, and Maceió were the capitals with the highest proportions of records without information on race/skin color, 11.9%, 8.6%, and 3.2%, respectively.

The application of the Prais-Winsten model allowed the classification of time series as increasing (?), decreasing (?), and stationary (--). Regarding hospitalizations, a significant growth trend was observed in the time series of thirteen capitals: Porto Velho, Palmas, Teresina, Natal, João Pessoa, Recife, Aracaju, Belo Horizonte, Vitória, Curitiba, Campo Grande, Goiânia, and Brasília. Nine capitals had stable rates: Rio Branco, Manaus, Boa Vista, Belém, Macapá, Fortaleza, Salvador, São Paulo, and Cuiabá. Significantly decreasing series are observed only in São Luís, Maceió, Rio de Janeiro, Florianópolis, and Porto Alegre. Regarding deaths, no capital showed a significant increasing trend, while eleven series showed a significant decreasing trend (Table 3).

Table 3
Application of the Prais-Winsten models to hospitalization and death rates from traffic injuries in Brazilian capitals, 2001-2021.

Capital	Hospitalizations			Deaths
	∆ 2001-2021	Trend	∆ 2001-2021	Trend
Porto Velho	240.1	↑	149.8	--
Rio Branco	12.5	--	-99.0	--****
Manaus	-2.8	--	-26.2	--
Boa Vista	156.5	--**	-61.3	--
Belém	51.2	--	-35.4	↓
Macapá	-60.3	--	-73.2	--****
Palmas	7135.6	↑	-19.4	--
São Luís	-99.9	↓	-7.7	--
Teresina	1229.0	↑	56.1	--
Fortaleza	153.1	--	-77.3	↓
Natal	136.3	↑	-7.2	↓
João Pessoa	657.2	↑	19.9	--
Recife	1242.6	↑**	-41.1	↓
Maceió	-97.1	↓	-74.3	↓**
Aracaju	358.7	↑	-46.0	↓**
Salvador	28.1	--	-6.0	--****
Belo Horizonte	118.3	↑	-44.0	--
Vitória	285.3	↑	-59.8	↓**
Rio de Janeiro	-80.7	↓**	-88.6	↓
São Paulo	56.1	--	-76.6	--
Curitiba	262.7	↓	-29.2	--
Florianópolis	-58.6	↓**	-49.8	↓
Porto Alegre	-37.8	↓	5.1	--
Campo Grande	6683.2	↑	76.7	--****
Cuiabá	11.8	--	-17.6	↓
Goiânia	242.8	↑	-6.5	--
Brasília	56.8	↑	-62.2	↓

• Notes: **Logarithmic transformation; ***Square root transformation, ****Violated the assumption of normality of residuals. ? Significant upward trend; ? Significant downward trend; -- Stability trend.
• Source: Authors.

Discussion

This article aimed to present the profile of victims and the temporal trend of hospitalizations and deaths from traffic injuries. The data show that victims of injuries and deaths that occur on the roads in our country are predominantly male, aged 20-29, with a highly scattered distribution of this last variable in hospitalizations. White people initially predominate, but subsequently, brown people begin to show the highest percentages. However, this varies across the country’s major regions and does not apply to the South, where white people remain the most frequently victimized by traffic injuries and deaths.

An ecological study using data from the Hospital Information System, aimed at describing hospitalization rates due to road traffic accidents in Brazil and estimating costs and length of stay, showed a higher frequency of hospitalizations among males (78.2%), individuals aged 20-39 (48.6%), and motorcyclists (51.9%). The observed hospitalization rate was 85.0 per 100,000 inhabitants, with an estimated cost of BRL 231,469,333.13 and an average length of stay of 6.3 days⁹.

The present study found a gradual increase in hospitalization rates for the country, rising from 51.2 hospitalizations per 100,000 population in 2001-2006 to 84 hospitalizations per 100,000 in 2019-2021, also with a significant predominance of men and people aged 20-39. Souza¹⁰ also showed an increase in hospitalization rates for traffic accidents from 2008 to 2019, rising from 49.7 to 91.5 per 100,000. The author states that all age groups were impacted, but men and those aged 20-29 were particularly affected. Another important finding was the 85% increase in these rates for both genders.

The highest DALY (Disability-Adjusted Life Years) burden due to RTAs was estimated at 70 million years lost in 2015, which is because premature death and disabling injuries primarily affect the young population (20-29 age group)².

In Brazil, including the young population in the world of work is characterized by substandard labor relations and rights, which impacts the country’s DALY, as can be seen in the study on youth, work, and health based on data from the 2019 PNS¹¹.

In 2019, 93,600 respondents aged 20-29 and primarily Black reported having suffered bodily injuries as a result of traffic accidents, 37.4% of which occurred while commuting to work (19%). Furthermore, 49% of these young people were in informal employment, and their mean income was BRL 1,555.00 (lower than that of the general working population, which was BRL 2,406.00). A portion of 2.7% of those who responded to the PNS reported having some type of permanent physical injury as a result of a traffic accident¹¹.

We should underscore that 60% of the injured respondents to the 2019 PNS reported having received their first healthcare treatment from the public sector, either through a hospital outpatient clinic, Emergency Care Unit (UPA), or another type of public emergency¹¹.

The trend analysis for hospitalization rates due to traffic injuries showed five capitals with decreasing series (São Luís, Maceió, Rio de Janeiro, Florianópolis, and Porto Alegre) and thirteen capitals with increasing series (Porto Velho, Palmas, Teresina, Natal, João Pessoa, Recife, Aracaju, Belo Horizonte, Vitória, Curitiba, Campo Grande, Goiânia, and Brasília).

Regarding the analysis of mortality trends, no capital showed an upward trend, and the trend was downward in eleven of them (Belém, Fortaleza, Natal, Recife, Maceió, Aracaju, Vitória, Rio de Janeiro, Florianópolis, Cuiabá, and Brasília). Although these data show that the country is making progress in preventing traffic deaths, many capitals still show an increasing number of hospitalizations, which indicates that investment and scaled-up prevention actions are necessary to achieve the target of reducing these deaths by 50% by 2030, as recommended by the Sustainable Development Goals (SDGs) in the Global Plan for the Decade of Action for Road Safety in its updated version for 2021-2030⁴.

The specialized literature in public health has highlighted three main conditions related to structural problems that would explain traffic violence in the country: (i) economic dynamism, which provided an increase in the population’s purchasing power, long-term credit lines for access to motor vehicles, including the introduction of the motorcycle as a means of passenger transport and work tool, all contributing to a growing fleet; (ii) subjectivity-linked attitudes, which refer to adopting a drink-and-drive behavior, failing to use front and rear safety equipment and helmets, and disregarding road signs; and (iii) urban densification, mainly linked to the lack of infrastructure for construction, conservation, and road signage suitable for traffic planning^12,13.

Notably, there is a “direct relationship” between the first two indicators (Gross Domestic Product (GDP) per capita and attitudes linked to subjectivity) and the absolute number of injuries and fatalities due to RTAs, as they share the same denominator (inhabitants).

Indeed, the direct relationship between GDP and behavior-related injuries gave rise to the concept of diseases of affluence, proposed by Van Beeck et al.¹⁴ to understand the interdependence between GDP and RTAs in the European context. The metric applied by the authors found that economic growth drove the increase in the vehicle fleet, recording a positive association with fatal traffic accident deaths until the mid-1960s. From 1970 onward, economic growth persisted, and the mortality trend reversed, even with the increase in vehicle ownership. The authors attribute the resulting reversal of the association to a higher level of social development that transformed economic growth into road safety. This situation did not occur uniformly across the 21 member countries of the Organization for Economic Cooperation and Development (OECD), as Greece and Spain preserved a positive association¹⁴.

The application of the concept of diseases of affluence in Brazil found a positive association in 2005 and 2010. However, in 2015, the last year analyzed by the authors, the association between GDP and deaths from RTAs became negative¹⁵.

This study showed that a lower mortality rate accompanied an increase in the morbidity rate. The expansion of human, political, technical, and financial resources, especially in the health sector, promoted by the Unified Health System (SUS), such as the National Policy for Reducing Morbimortality from Accidents and Violence and the Mobile Emergency Care Service (SAMU), curbed immediate deaths. However, the condition of injured individuals after hospital discharge is unknown, as many of them incur some permanent disability^1,9,16,17.

Noteworthy is the high percentage of missing information on race/skin color in hospitalization data, especially in capital cities. This also occurs, albeit to a lesser extent, in death certificates. Recording of this information in the SIH/SUS started in 2008 and has been decreasing, as reported in a study on primary care-sensitive conditions.¹⁸ These authors state that, in 2008, 35.4% of all hospitalizations in Brazil lacked race/skin color information, a percentage that fell to 23.3% in 2021. For that same year, they highlight regional differences: the South (12.3%) and Southeast (19.3%) had the lowest values, which points to inequalities in access to health services, the quality of health care, and the quality of health information. This article corroborates these results.

The movement of people, vehicles, and goods constitutes a complex system that exceeds the Health sector’s actions. However, a political agenda for a National Plan to Reduce Traffic Deaths and Injuries⁷, integrated with the National Urban Mobility Policy¹⁹ and the National Traffic Policy²⁰, should prioritize actions related to the flow of vehicles and goods, road and highway infrastructure, vehicle safety, and personal safety equipment. The unacceptable and preventable deaths of 1.25 million people on the world’s roads each year, as well as the severe injuries (estimated at between 20-50 million)¹⁰, need to be subject to comprehensive measures to prevent injuries, sequelae, and deaths from traffic incidents⁶.

References

• ¹ World Health Organization (WHO). Road traffic injuries. Health Topics [Internet]. 2023 [cited 2024 dez 13]. Available from: https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
  » https://www.who.int/news-room/fact-sheets/detail/road-traffic-injuries
• ² Chen S, Kuhn M, Prettner K, Bloom DE. The global macroeconomic burden of road injuries: estimates and projections for 166 countries. Lancet Planetary Health 2019; 3(9):390-398.
• ³ Bachani AM, Peden M, Gururaj G, Norton R, Hyder AA. Lesões no Trânsito Rodoviário. Capítulo 3. In: Mock CN, Nugent R, Kobusingye O. Prevenção de Lesões e Saúde Ambiental. 3ª ed. Washington D.C.: Banco Internacional de Reconstrução e Desenvolvimento/Banco Mundial; 2017.
• ⁴ Organização Mundial de Saúde (OMS). Plano global década de ação pela segurança no trânsito 2021-2030. Genebra: OMS; 2021.
• ⁵ Carvalho CHR. Custos dos acidentes de trânsito no Brasil: Estimativa simplificada com base na atualização das pesquisas do Ipea sobre custos de acidentes nos aglomerados urbanos e rodovias. Brasília: Ipea; 2020.
• ⁶ The World Bank. The High Toll of Traffic Injuries: Unacceptable and Preventable. Washington D.C.: The World Bank; 2017.
• ⁷ Plano Nacional de Redução de Mortes e Lesões no Trânsito (PNATRANS). Proposta de revisão. Brasília: Ministério dos Transporte; 2021.
• ⁸ Andrade FR, Antunes JLF. Tendência do número de vítimas em acidentes de trânsito nas rodovias federais brasileiras antes e depois da Década de Ação pela Segurança no Trânsito. Cad Saude Publica 2019; 35(8):e00250218.
• ⁹ Andrade SSCA, Jorge MHPM. Internações hospitalares por lesões decorrentes de acidente de transporte terrestre no Brasil, 2013: permanência e gastos. Epidemiol Serv Saude 2017; 26(1):31-38.
• ¹⁰ Souza CRL. Internações Hospitalares por Acidentes de Transporte Terrestre no Brasil: Estudo de Séries Temporais Interrompidas, 2008-2019 [dissertação]. Brasília: Universidade de Brasília; 2021.
• ¹¹ Leandro B, Sobrinho A, Abramo H, organizadores. Panorama da situação de saúde de jovens brasileiros: Intersecções entre Juventude, Saúde e Trabalho: 2016 a 2022. Rio de Janeiro: EPSJV/Cooperação Social da Presidência/Fiocruz/SUS/MS/Governo Federal Brasil União e Reconstrução; 2024.
• ¹² Medeiros MS. Notes about the modalities of social intervention facing lesions and deaths caused by traffic accidents related to the consumption of alcoholic beverages. Saude Soc 2017; 26(2):556-570.
• ¹³ Malta DC, Mascarenhas MDM, Bernal RTI, Silva MMA, Pereira CA, Minayo MCS, Morais-Neto OL. Análise das ocorrências das lesões no trânsito e fatores relacionados segundo resultados da Pesquisa Nacional por Amostra de Domicílios (PNAD) - Brasil, 2008. Cien Saude Colet 2011; 16(9):3679-3687.
• ¹⁴ Van Beeck EF, Borsboom GJ, Mackenbach JP. Economic development and traffic accident mortality in the industrialized world, 1962-1990. Int J Epidemiol 2000; 29(3):503-509.
• ¹⁵ Pinheiro PC, Teixeira RA, Ribeiro ALP, Malta DC. Relationship between GDP per capita and traffic accidents in Brazilian municipalities in 2005, 2010 and 2015. Rev Bras Epidemiol 2021; 24(Supl. 1):1-6.
• ¹⁶ Brasil. Portaria MS/GM nº 737, de 16 de maio de 2001. Aprova a Política Nacional de Redução da Morbimortalidade por Acidentes e Violência. Diário Oficial da União 2001; 18 maio.
• ¹⁷ Brasil. Decreto nº 5.055, de 27 de abril de 2004. Institui o serviço de atendimento móvel de urgencia (SAMU), em municípios e regiões do território nacional, e dá outras providências. Diário Oficial da União 2004; 28 abr.
• ¹⁸ Carvalho CC, Viacava F, Oliveira RD, Martins M, Abrahão LD. Internações por Condições Sensíveis à Atenção Primária (ICSAP): análise do quesito raça/cor. Boletim Informativo Proadess 2022; 10:1.
• ¹⁹ Brasil. Lei nº 12.587, de 3 de janeiro de 2012. Institui as diretrizes da Política Nacional de Mobilidade Urbana. Diário Oficial da União 2012; 4 jan.
• ²⁰ Brasil. Resolução nº 514 de 18 de dezembro de 2014. Aprova a Política Nacional de Trânsito no que diz respeito ao planejamento, organização, normalização, execução e controle das ações de trânsito do país. Diário Oficial da União 2014; 18 maio.

• Funding
  This study is nested in the Evaluative Research on the Implementation of the National Policy for Reducing Morbimortality from Accidents and Violence, supported by the Ministério da Saúde, and the Technical Cooperation Agreement between Fiocruz and the Fundação de Vigilância e Saúde do Estado do Amazonas - Rosemary Costa Pinto.
• Data availability statement
  The data sources used in the research are indicated in the body of the article.

• Chief editors:
  Maria Cecília de Souza Minayo, Romeu Gomes, Antônio Augusto Moura da Silva, Vania de Matos Fonseca

Data availability

The data sources used in the research are indicated in the body of the article.

Publication Dates

• Publication in this collection
  10 Nov 2025
• Date of issue
  Oct 2025

History

• Received
  10 Dec 2023
• Accepted
  11 Aug 2025
• Published
  13 Aug 2025