Economic development's effect on road transport-related mortality among different types of road users: a cross-sectional international study.

The relationship between a country's stage of economic development and its motor vehicle crash (MVC) mortality rate is not defined for different road users. This paper presents a cross-sectional regression analysis of recent national mortality in 44 countries using death certificate data provided by the World Health Organization. For five types of road users, MVC mortality is expressed as deaths per 100,000 people and per 1000 motor vehicles. Economic development is measured as gross national income (GNI) per capita in U.S. dollars and as motor vehicles per 1000 people. Results showed overall MVC mortality peaked among low-income countries at about US$ 2000 GNI per capita and at about 100 motor vehicles per 1000 people. Overall mortality declined at higher national incomes up to about US$ 24,000. Most changes in MVC mortality associated with economic development were explained by changes in rates among nonmotorized travelers, especially pedestrians. Overall MVC rates were lowest when pedestrian exposure was low because there were few motor vehicles or few pedestrians, and were highest during a critical transition to motorized travel, when many pedestrians and other vulnerable road users vied for use of the roadways with many motor vehicles.