Introduction Road traffic accidents (RTA) with their serious social and economic consequences, though preventable, comprise an important cause of death and disability in developing countries, where the problem is increasing rapidly due to rapid motorisation. Nearly three-quarters of road deaths occur in developing countries. It is estimated that RTA will be the second leading cause of disability-adjusted life years in developing countries in the year 2020. This study aims to describe quantitatively the RTAs related mortality in Alexandria, and to identify their trends through 2000–2009.

Methods Data were collected from records of the information and decision support center in Alexandria. Statistical analyses were performed using SPSS 18.0 for windows software. Trends were evaluated using time series seasonal decomposition and ARIMA analyses. Different risks were determined using Poisson regression.

Results RTA mortality followed a significant rising trend (cubic model) with the highest incidence rate being in 2008 and 2009. Months from July to October showed the highest seasonal factors. Males were more than three times at risk than females. RTA mortality occurred with a higher incidence for ages above 60 years old and youth (university ages). Also higher rates were calculated for poor and remote districts.

Conclusion Policy makers in Alexandria, Egypt need to recognise Road Traffic Accidents (RTA) as a growing public health crisis, design appropriate policy responses and implement urgent interventions for road safety applicable to the particular mix of Egyptian road use.