Traffic Deaths: Recent Evolution and Regional Differences in Bahia State, Brazil
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ARTIGO ARTICLE 131 Traffic deaths: recent evolution and regional differences in Bahia State, Brazil Mortes no trânsito: evolução recente e diferenças regionais na Bahia, Brasil Muertes de tráfi co: evolución reciente y diferencias regionales en Bahía, Brasil Polianna Alves Andrade Rios 1,2 Eduardo Luiz Andrade Mota 2 Abstract Resumo 1 Universidade Estadual do This study describes the temporal evolution of O estudo descreve a evolução temporal da mor- Sudoeste da Bahia, Jequié, Brasil. mortality due to traffic accidents in regions with- talidade por acidentes de trânsito em regiões da 2 Instituto de Saúde Coletiva, in Bahia State, Brazil, from 1996 to 2007, using Bahia, Brasil, entre 1996 e 2007, a partir de da- Universidade Federal da data from the Brazilian Mortality Information dos do Sistema de Informação sobre Mortalidade. Bahia, Salvador, Brasil. System. We calculated overall rates of mortality Foram calculadas taxas globais de mortalidade Correspondence due to traffic accidents and specific rates by type por acidentes de trânsito e específicas por tipo P. A. A. Rios of victim. Temporal evolution was analyzed by de vítima. A evolução foi analisada por meio de Universidade Estadual do Sudoeste da Bahia. means of correlations between rates and years of correlação entre essas taxas e os anos do estudo, Avenida José Moreira Sobrinho study, as well as polynomial regression models to além de modelos de regressão polinomial para s/n, Jequié, Ba 45206-190, evaluate trends. During the study period, the re- avaliar tendência. No período, as regiões estuda- Brasil. [email protected] gions analyzed accounted for 60% of deaths due das concentraram 60% das mortes por acidentes to traffic accidents in Bahia. Excess mortality de trânsito ocorridas no estado. Foram observa- among males and superior percentage of deaths dos sobremortalidade masculina e maior percen- in young individuals were observed. Overall, the tual de óbitos em indivíduos jovens. No geral, a evolution of global rates showed decreases begin- evolução das taxas globais mostrou decréscimo a ning in 1998, but growth resumption in 2000, al- partir de 1998, mas teve retomada de crescimento though the trend was not statistically significant. em 2000, sem revelar tendência. As diferenças re- Regional differences were more marked when gionais foram mais marcantes quando as taxas analyzing rates according to type of victim. How- foram analisadas segundo tipos de vítima, no ever, a growing trend was observed in most loca- entanto, na maioria dos locais, foi observada tions for rates of accidents involving motorcy- tendência crescente para taxas de acidentes com clists, which, in conjunction with other findings, motociclistas, sustentando, com outros achados, substantiates concerns regarding the current sit- as preocupações com a conjuntura atual das uation of increased deaths involving motorcycles mortes envolvendo motocicletas no país. in Brazil. Acidentes de Trânsito; Mortalidade; Causas Traffic Accidents; Mortality; External Causes Externas Cad. Saúde Pública, Rio de Janeiro, 29(1):131-144, jan, 2013 132 Rios PAA, Mota ELA Introduction since 2001, suggesting a trend of gradual dimin- ishment of the effect of this legislation 8. Traffic is one of the expressions of urban contexts This situation is no longer exclusive to large that strongly influences the life and health of the urban centers, considering the important trend population. Among its negative consequences, of interiorization, whereby external causes pre- traffic accidents grow ever more prominent as viously restricted to metropolitan areas have a serious public health problem of global scale. progressively become more common in the inte- This situation is taking shape as an “epidemic of rior of the country during the last decade. Stud- modernity,” since the number of fatal and nonfa- ies 9,10 highlight until 1999 the dynamic hubs of tal casualties, public sector costs, compromised violence were located in capital cities and major quality of life for affected individuals, and loss of metropolitan areas. However, since that time the production due to premature deaths and their participation of small municipalities in the oc- consequences are shown to be growing expo- currence of homicides and traffic accidents has nentially 1,2,3. risen, while the share of capital cities and met- The intersection of different fields of knowl- ropolitan areas has gradually fallen. In 2002, edge and intervention in the composition of the for example, metropolitan areas accounted for “transit” environment, such as traffic engineer- less than 25% of traffic accident deaths nation- ing, urban planning, law, education, and oth- wide 9, and in 2004 there was a higher concentra- ers, gives the occurrence of traffic accidents a tion of such deaths in municipalities with fewer complex and multidimensional character. Fur- than 100,000 inhabitants 11. thermore, the strong connotation of random- Bahia State stands out in terms of the volume ness presented in popular culture by the term of accidents and fatalities. In fact, data from the “accident” contributes to the naturalization of State Health Department show that among the these events 4. For this reason, recent interna- northeastern Brazilian states, Bahia was second tional literature has avoided that designation in in the absolute number of deaths from this cause order to separate the problem from the stigma of in 2005, and the eighth when compared to all unpredictability. In Brazil, despite the use of the states nationwide. Moreover, increased rates of term, transport/traffic accidents are considered mortality have been observed in recent years 12. unintentional but avoidable 5,6. Accordingly, this study aims to describe the In general, questions of the intensification temporal evolution of traffic accident mortality of motorization, increasing industrialization, in different regions of Bahia, identifying differ- migration processes and their consequent un- ences in this event between locations according planned urbanization over time are visualized as to evolutionary behavior and type of victim. It is part of the emergence and worsening of traffic believed that knowledge of regional inequalities accidents 6. The situation appears more serious in the distribution of deaths from accidents may in developing countries because investments in indicate elements essential to the implementa- road safety and urban planning are unable to tion of public policies and control actions. match the pace of growth of vehicle fleets. More- over, in the context of contributing human fac- tors, certain lifestyles and the behaviors of spe- Methods cific groups stand out, such as young men who associate daring traffic attitudes with virility and This is a descriptive study of ecological design power and so-called modern, accelerated, and using secondary data of traffic accident deaths hyper-consumerist lifestyles, which generate for the period 1996 to 2007 in the most populous fragile interpersonal relationships prone to the geographical microregions of Bahia State, which culture of individualism and intolerance 6,7. are regions with resident populations of 500,000 The impact of accidents on morbi-mortality inhabitants or more throughout the entire histor- of populations is reflected in high frequencies of ical sequence. Thus, the six microregions studied injuries, hospitalizations, and deaths, which are were Salvador, Ilhéus-Itabuna, Feira de Santana, shown to be on the rise in many developing coun- Porto Seguro, Vitória da Conquista, and Jequié. tries. Traffic accidents have come to represent The choice to work with geographical mi- 2.2% of mortalities worldwide and result in the croregions as territorial units was made for two deaths of over 1.2 million people each year, prin- reasons. In the first place, the group of municipali- cipally among young men 3. In Brazil, such events ties that constitute these microregions was stable constitute the second cause of death among all throughout the series. In other words, there was external causes and, despite reductions afforded no change in the composition of each location by the new Brazilian Traffic Code instituted in during the 12 years of the study. In the second 1998, considerable rate increases are observed place, this method provided the possibility of ad- Cad. Saúde Pública, Rio de Janeiro, 29(1):131-144, jan, 2013 EVOLUTION OF MORTALITY DUE TO TRAFFIC 133 dressing the phenomenon in a broader area that mation System (http://www2.datasus.gov.br/ includes not only municipalities, but also a con- DATASUS/index.php?area=040804, accessed on siderable road system. Bahia State, located in the 20/Apr/2010). For the selection of cause of death, Northeast region of Brazil, has 417 municipalities the codes employed were those between V01 and and 32 geographical microregions. Its population V89 (land transport accidents) specifically classi- in 2010 was estimated at 14,016,906 inhabitants fied as “traffic accident” in the 10th revision of the distributed in a territory of 564,830km2 (Brazil- International Statistical Classification of Diseases ian Institute of Geography and Statistics. http:// and Related Health Problems (ICD-10) 13. www.ibge.gov.br/estadosat/perfil.php?sigla=ba, The rates estimated for each microregion accessed on 13/Oct/2011). The road system has were: overall traffic accident mortality rate (V01- a total length of 124,545km divided between V89) per 100,000 inhabitants, pedestrian traffic federal (5,100km), state (19,800km), and munici-