Abstract
A systematic understanding of population-level trends in deaths due to road injuries at the subnational level over time for India's 1.4 billion people, by age, sex, and type of road user is not readily available; we aimed to fill this knowledge gap.
Methods
As part of the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the rate of deaths due to road injuries in each state of India from 1990 to 2017 based on several verbal autopsy data sources. We calculated the number of deaths and death rate for road injuries by type of road user, and assessed the age and sex distribution of these deaths over time. Based on the trends of the age-standardized death rate from 1990 to 2017, we projected the age-standardized death rate to 2030 to assess if the states of India would meet the Sustainable Development Goal (SDG) target to halve the death rate for road injuries from 2015 by 2020 or 2030. We calculated 95% uncertainty intervals (UIs) for the point estimates.
Findings
In 2017, 218,876 deaths (95% UI 201,734 to 231,141) due to road injuries occurred in India, with an age-standardized death rate for road injuries of 17.2 deaths (15.7 to 18.1) per 100,000 population, which was much higher in males (25.7 deaths [23.5 to 27.4] per 100,000) than in females (8.5 deaths [7.2 to 9.1] per 100,000). The number of deaths due to road injuries in India increased by 58.7% (43.6 to 74.7) from 1990 to 2017, but the age-standardized death rate decreased slightly, by 9.2% (0.6 to 18.3). In 2017, pedestrians accounted for 76,729 (35.1%) of all deaths due to road injuries, motorcyclists accounted for 67,524 (30.9%), motor vehicle occupants accounted for 57,802 (26.4%), and cyclists accounted for 15,324 (7.0%). India had a higher age-standardized death rate for road injury among motorcyclists (4.9 deaths [3.9–5.4] per 100,000 population) and cyclists (1.2 deaths [0.9–1.4] per 100,000 population) than the global average. Road injury was the leading cause of death in males aged 15 to 39 years in India in 2017, and the second leading cause in this age group for both sexes combined. The overall age-standardized death rate for road injuries varied by up to 2.6 times between states in 2017. Wide variations were seen between the states in the percentage change in age-standardized death rate for road injuries from 1990 to 2017, ranging from a reduction of 38.2% (22.3 to 51.7) in Delhi to an increase of 17.0% (0.6 to 34.7) in Odisha. If the trends estimated up to 2017 were to continue, no state in India or India overall would achieve the SDG 2020 target in 2020 or even in 2030.
Interpretation
India's contribution to the global number of deaths due to road injuries is increasing, and the country is unlikely to meet the SDG targets if the trends up to 2017 continue. India needs to implement evidence-based road safety interventions, promote strong policies and traffic law enforcement, have better road and vehicle design, and improve care for road injuries at the state level to meet the SDG goal.
