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We greatly appreciate the attention brought to the growing problem of road traffic injuries in your journal and especially welcome the focus on socioeconomic differentials in the distribution of such injuries.1,2 However, we feel that the impact of road traffic injuries is far greater in the developing world and feel the need to raise the following issues for consideration by colleagues around the world.
Road traffic injuries are estimated to be the ninth leading cause of death for all ages globally and are expected to become the third leading cause by 2020.3 The loss of healthy life from injuries (measured in terms of disability adjusted life years per 100 000 people) is four times greater in low to middle income countries than in high income nations. Moreover, fatality rates from road traffic injuries are highest in the developing world, especially Africa.
Empirical work is now being done in the developing world to understand the burden of road traffic injuries and its distribution related to population characteristics.4 Our work at national level in Pakistan has demonstrated that injuries are the fifth leading cause of loss of healthy life, and the second leading cause of disability.5 A 40 year analysis of public sector data in Pakistan demonstrates the public health impact—mortality, morbidity, and costs—to society in the developing nation.6 While a national health survey in Pakistan demonstrated the overlapping frequencies of childhood injuries and diarrhoea in children for the first time in the early 1990s.7
We have conducted one of the first nationally representative injury surveys in Pakistan focusing on this neglected public health issue.8 Highlights of this sample of nearly 29 000 people interviewed in rural and urban areas will soon be published in a peer reviewed journal. The survey indicates that 70% of childhood injuries occurred to children whose mothers had no education, and this variable was used to reflect some measure of social and economic status. In addition, the relative risk of transport injuries was three time higher in those with manual labour as a profession, compared with those in the service sector.8 These findings reflect the beginnings of the type of inequality analysis proposed by Hasselberg et al, which is a challenge in resource poor settings.
Such work from the developing world indicates the great need for better data on road traffic injuries, and especially disaggregated data that permit subanalysis. It is therefore critical that researchers in developing countries ensure that their study designs include aspects of equity analysis.