Traffic Injury Prevention
ISSN: 1538-9588 (Print) 1538-957X (Online) Journal homepage: http://www.tandfonline.com/loi/gcpi20
Road Traffic Deaths in Brazil: Rising Trends in
Pedestrian and Motorcycle Occupant Deaths
Aruna Chandran , Tanara Rosângela Vieira Sousa , Yayi Guo , David Bishai ,
Flavio Pechansky & The Vida No Transito Evaluation Team
To cite this article: Aruna Chandran , Tanara Rosângela Vieira Sousa , Yayi Guo , David Bishai ,
Flavio Pechansky & The Vida No Transito Evaluation Team (2012) Road Traffic Deaths in
Brazil: Rising Trends in Pedestrian and Motorcycle Occupant Deaths, Traffic Injury Prevention,
13:sup1, 11-16, DOI: 10.1080/15389588.2011.633289
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Traffic Injury Prevention, 13(S1):11–16, 2012
C 2012 Taylor & Francis Group, LLC
Copyright ISSN: 1538-9588 print / 1538-957X online
DOI: 10.1080/15389588.2011.633289
Road Traffic Deaths in Brazil: Rising Trends in
Pedestrian and Motorcycle Occupant Deaths
ARUNA CHANDRAN,1 TANARA ROSÂNGELA VIEIRA SOUSA,2 YAYI GUO,1
DAVID BISHAI,1 FLAVIO PECHANSKY,2 and THE VIDA NO TRANSITO
EVALUATION TEAM∗
1
Johns Hopkins International Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
Center for Drug and Alcohol Research, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil
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2
Objective: According to the World Health Organization, the global burden of road traffic mortality exceeds 1.27 million
people annually; over 90 percent occur in low- and middle-income countries. Brazil’s road traffic mortality rate of ∼20 per
100,000 is significantly higher than nearby Chile or Argentina. To date, there has been very little information published on
road traffic fatalities among vulnerable road users (VRUs) in Brazil.
Methods: Road traffic fatality data from 2000 to 2008 were extracted from Brazil’s Mortality Information System (SIM).
Road traffic deaths were extracted using the International Classification of Diseases (ICD-10) V-codes (V01–V89) and then
subcategorized by VRU categories. Information was then disaggregated by gender, age, and region.
Results: In 2008, 39,211 deaths due to road traffic injuries were recorded in Brazil, resulting in a crude mortality rate of
20.7 per 100,000 inhabitants. Pedestrian mortality averaged 5.46 deaths per 100,000 between 2000 and 2008. The mortality
rate for elderly pedestrians (80+ years) is 20.1 per 100,000, over 10 times that of 0- to 9-year-olds. In the past decade,
motorcycle occupant mortality has dramatically increased by over 300 percent from 1.5 per 100,000 in 2000 to 4.7 per
100,000 in 2008. The 20- to 29-year age group remains most affected by motorcycle deaths, with a peak fatality rate of 10.76
per 100,000 in 2008. The north and northeast regions, with the lower per capita gross domestic product (GDP), have higher
proportions of VRU deaths compared with other regions.
Conclusions: Vulnerable road users are contributing an increasing proportion of the road traffic fatalities in Brazil.
Nationally, elderly pedestrians are at particularly high risk and motorcycle fatalities are increasing at a rapid rate. Less
prosperous regions have higher proportions of VRU deaths. Understanding the epidemiology of road traffic mortality in
vulnerable road user categories will better allow for targeted interventions to reduce these preventable deaths.
Keywords Road traffic crashes; Mortality; Unintentional injuries; Brazil; Vulnerable road users; Pedestrians; Motorcyclists;
Bicyclists
INTRODUCTION
(DALYs) occur in low- and middle-income countries (LMICs)
despite these countries having only 48 percent of the world’s
registered vehicles (WHO 2008). The WHO-defined region of
the Americas had an estimated 152,000 road traffic deaths and
4.58 million DALYs in 2004; traffic deaths comprised over 44
percent of all unintentional injury deaths that year. In a report
summarizing published cost estimate studies, the annual direct
(injury and vehicle) economic costs of road crashes in Latin
America and the Caribbean were estimated to be US$19 billion
(Jacobs et al. 2000).
Vulnerable road users (VRUs) are traditionally defined as
slow-moving exposed/unprotected road users that are at higher
risk of injury when involved in a crash; normally these include
pedestrians, nonmotorized cyclists, and motorcyclists. When
breaking down road traffic injuries by user group, 60 percent
of traffic fatalities occur in motorized 4-wheeled cars in highincome countries (HICs) compared to 34 percent in LMICs.
According to the World Health Organization (WHO), the
global burden of road traffic mortality exceeds 1.27 million
people annually and is ranked as the ninth leading cause of
death, responsible for 2.2 percent of all deaths regardless of socioeconomic status (WHO 2008). Over 90 percent (nearly 1.16
million) of road traffic deaths and 92 percent (over 38 million)
of road traffic crash–associated disability-adjusted life years
Received 13 July 2011; accepted 16 October 2011.
∗ Vida no Transito Evaluation Team: Federal University of Minas Gerais,
Waleska Teixeira Caiaffa, Celeste de Souza Rodrigues, Amélia Augusta de
Lima Friche, Federal University of Rio Grande do Sul, Veralice Maria Gonçalves
Fernandes, Pontificial Catholic University of Parana, Samuel Jorge Moysés, and
Sandra Lúcia V. Ulinski Aguilera.
Address correspondence to Aruna Chandran, Johns Hopkins International
Injury Research Unit, Johns Hopkins Bloomberg School of Public Health, 615
N. Wolfe St., Baltimore, MD 21205. E-mail: [email protected]
11
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12
CHANDRAN ET AL.
In contrast, pedestrians account for an average of 45 percent
of road traffic fatalities in LMICs compared to 18 percent in
HICs (Naci et al. 2009). The increasing burden of pedestrian,
bicycle, and motorcycle injuries has been shown in some Latin
American countries in recent studies. In Argentina in 2007,
VRUs accounted for 29.5 percent of road traffic deaths (Ubeda
et al. 2011). Hijar et al. (2003) showed a pedestrian mortality
rate of over 7 per 100,000 in Mexico City, with a markedly high
rate of 35 per 100,000 in certain districts in the mid-1990s.
Brazil is a middle-income country that is the largest in South
America. It covers an area of 8.5 million km2 with an estimated
population of 190,732,694. The WHO estimates an annual road
traffic mortality rate of 21.9 per 100,000, and when Reichenheim et al. adjusted for underreporting, they found a slightly
higher rate of 23.1 per 100,000 (Reichenheim, 2011; WHO
2008). Brazil’s road traffic mortality rates have been increasing
since the 1960s, which correlates to increases in the registered
motor vehicle fleet size; the registered fleet size has increased
from approximately 32 million in 2001 to 54.5 million in 2008
(Vasconcellos 1999). In 2003, road traffic crashes in Brazil were
responsible for over 26 percent of fatal injuries (rate of 17 per
100,000 population; Gawryszewski and Rodrigues 2006). The
most commonly affected population in road traffic fatalities was
found to be males in the “20 to 29 year old” age group (Franca
et al. 2008). Reichenheim et al. (2011) showed using Brazil’s
Ministry of Health’s mortality database that pedestrians account
for nearly 35 percent of traffic deaths, with a mortality rate of
just over 6 per 100,000 in 2007. They also showed an alarming increase in motorcycle deaths by over 800 percent between
1996 and 2007. A 1996 study in Sao Paulo, which is the largest
city in Brazil, found that whereas one in ∼200 vehicle crashes
resulted in a fatality, one in 10 pedestrian crashes resulted in a
fatality (Companhia de Engenharia de Trafego 1996).
To date, there has been very little information published on
road traffic fatalities among vulnerable road users in Brazil. At a
time when multiple road safety intervention projects have been
launched throughout the country and at the outset of the Decade
of Action for Road Safety, it is important to understand the epidemiology of road traffic deaths in all road user categories in
order for more specific targeting of intervention programs (Maffei de Andrade et al. 2008; Salvarani et al. 2009). This article
utilizes the Brazilian Ministry of Health’s mortality database
to explore in detail the epidemiology of road traffic deaths in
Brazil disaggregated by vulnerable road user categories.
METHODS
Road traffic fatality data from 2000 to 2008 were extracted from Brazil’s Mortality Information System (Sistema
de Informações sobre Mortalidade; SIM) via the DATASUS
Database (Ministerio de Saude 2011). SIM was created by the
Ministry of Health in 1975, and the government provides training to the teams responsible for collecting mortality information.
Information is collected primarily from hospitals; additional in-
formation is sometimes collected from medical examiner’s offices at the municipal level (Fajardo et al. 2009).
The SIM data set is publicly available and contains information on over 40 different mortality variables. Mortality
information for SIM is collected from death certificates, which
since 1996 have been coded with V-codes according to the
codes in the 10th revision of the International Classification of
Diseases (ICD-10). Deaths through 2008 are currently available
in this database. Deaths due to road traffic crashes are recorded
as codes V01–V89 regardless of the length of time that elapses
between the crash and the time of death. All road traffic deaths
classified with one of these 3 codes were extracted. Specific
ranges of V-codes were used to designate road user categories.
Vulnerable road users are designated in the database using
one of the following: V01–V09 for pedestrians, V10–V19 for
bicyclists, V20–V39 for motorcyclists, and V40–49 for vehicle
occupants. Information once subcategorized by the major
vulnerable road user groups was then disaggregated by gender,
age, and region. Regional analyses were performed using
location of occurrence (as opposed to location of residence) in
order to target high-traffic risk areas.
Crude mortality rates and standard mortality ratios (SMRs;
ratio of regional to national road traffic mortality rate) were
calculated using population data obtained from the Brazilian
Unified Health System (Sistema Único de Saúde; SUS) database
(DATASUS). Nationwide Brazilian censuses are done once in
10 years, and the last was conducted in 2010. Population data
were interpolated for inter-census years for rate calculations,
and region-specific populations were utilized in regional analyses. The national population was used for standardization of
regional mortalities, and relevant adjustments were performed
for age and/or gender. National and regional gross domestic
product (GDP) information was obtained from the 2004–2008
Municipal Gross Domestic Product report (IBGE 2011) of
the Brazilian Institute of Geography and Statistics (Instituto
Brasileiro de Geografia e Estatistica; IBGE).
RESULTS
Road traffic mortality rates from transport crashes have increased steadily since the year 2000. In 2008, 39,211 deaths
due to road traffic injuries were recorded in Brazil, resulting in
a crude mortality rate of 20.7 per 100,000 inhabitants. When
disaggregating the data by age and gender, the highest rates occur in the 70+ age group (30.9 per 100,000 for both genders).
Males have a higher rate in all age groups, peaking at over 50
per 100,000 in the 20- to 29-year age group.
Disaggregating all road traffic deaths into vulnerable road
user categories (pedestrians, motorcycle occupants, and bicyclists) shows that in Brazil in 2008, vulnerable road user mortalities account for more than half (51%) of all road traffic deaths
and that the majority of the deaths are nearly equally distributed
between pedestrian and motorcycle occupant fatalities.
Pedestrian mortality has consistently been highest, averaging 5.46 deaths per 100,000 between 2000 and 2008 (Figure
1). In the past decade, mortality rates for motorcycle occupants
13
ROAD TRAFFIC DEATHS IN BRAZIL
1.40
Total Vulnerable Road Users
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12.00
1.20
All Motorcycle Occupants
1.00
Bicyclists
10.00
Ratio
Mortality Rate per 100,000 population
Pedestrians
8.00
0.80
6.00
0.40
4.00
0.20
2.00
0.00
0.00
Figure 1
to 2008.
2000 2001 2002 2003 2004 2005 2006 2007 2008
Year
Road traffic mortality rate for vulnerable road users in Brazil, 2000
have dramatically increased by over 300 percent, from 1.5 per
100,000 in 2000 to 4.7 per 100,000 in 2008. In 2000, the relative
proportion of fatalities by pedestrians were more than 3 times
that of motorcyclists; however, due to recent trends in rising
motorcycle mortality, the relative proportion of fatalities comparing pedestrians to motorcyclists are now almost equal (ratio
1.06 in 2008).
Regional Analysis
Disaggregating the mortality data by region, the highest crude
road traffic mortality rate has consistently been the central-west
region, with an average since 2000 of 28.7 per 100,000 population (Table I). The Federal District of Brazil (Brasilia, capital
city) is located in this region, which may explain the increased
mortality rate. Interestingly, Brazil’s largest cities of Sao Paulo
and Rio de Janeiro are in the southeast region, which has a relatively lower mortality rate. The northeast region has the lowest
road traffic mortality rate, averaging 17.8 per 100,000 population from 2000 to 2008. Notably, this region also has the lowest
per capita GDP of any region in Brazil, which may correspond
to a lower motorization rate and therefore limit exposure to
road traffic crashes. This region has 4.37 road traffic deaths per
$1,000 per capita GDP; in contrast, the southeast region has
1.69 crashes per $1000 per capita GDP.
Table I
Total
North
Northeast
Southeast
South
Central-West
0.60
Year
Figure 2 Ratio of vulnerable road user to nonvulnerable road user death rates
by region and year (color figure available online).
Utilizing national-level data as the reference, the SMR was
calculated for each region. The central-west and south regions
have SMRs of over 1.4 and 1.2, respectively, indicating that both
of these regions have significantly higher road traffic mortality
rates than the national average.
Due to the steady increase in mortality rates in vulnerable
road users, the ratio of number of road traffic deaths in vulnerable road users vs. nonvulnerable road users has been increasing
since 2006. Figure 2 shows the ratio of vulnerable to nonvulnerable road user death rates over time by region. The south,
central-west, and southeast regions mirror the national-level increase, such that in contrast to 2000 when there were two thirds
as many VRU deaths as non-VRU deaths, by 2008 there were
approximately equal numbers of VRU and non-VRU deaths.
In contrast, the north and northeast regions had a consistently
higher number of VRU than non-VRU deaths over the past
decade. Interestingly, these are the regions with the lowest per
capita GDPs, which may indicate lower levels of 4-wheeled
motorization.
Pedestrians
In 2008, a total of 9474 pedestrian mortalities occurred in Brazil,
resulting in a mortality rate of 5.0 per 100,000 population. This
rate was dramatically higher at over 10 per 100,000 in 1996
but then declined steadily until the year 2000; it has since been
Road traffic mortality in Brazil by region, 2000 to 2008 average
Region
North
Northeast
Central-west
Southeast
South
National
Population size
(2010)
Crude mortality rate (per
100,000 population)
Standardized crude
mortality ratio
VRU mortality rate
(per 100,000)
Per capita GDP (2008,
US$)
15,864, 454
53,081, 950
14,058, 094
80,364, 410
27,386, 891
190,755, 799
19.5
17.8
29.7
19.4
26.0
20.7
0.94
0.86
1.43
0.94
1.26
Reference
10.0
9.2
15.1
10.1
12.8
10.6
5552
4069
11,072
11,512
9922
8690
14
CHANDRAN ET AL.
12.00
Brazil
10.00
30.00
North
25.00
Northeast
Southeast
20.00
South
15.00
Central-West
10.00
Mortality rate per 100,000
Mortality rate per 100,000 population
35.00
8.00
6.00
4.00
2.00
5.00
0.00
<10
10-19
20-29
0.00
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2008
2003
2007
2002
30-39
40-49 50-59
Age Group
2006
2001
60-69
2005
2000
70-79
80+
2004
Age group
Figure 3 Pedestrian mortality rate in Brazil by region and age group, 2008
(color figure available online).
stable at around 5 per 100,000. The reason for this prior decline
is unclear. The majority of 2008 pedestrian fatalities occurred in
the southeast region (4288 deaths), and the fewest cases occurred
in the northern region (736 deaths).
Stratifying pedestrian deaths by age group shows a dramatic
increase in mortality rate with age in each region in Brazil
(Figure 3). The mortality rate for the elderly age group (80+
years old) is 20.1 per 100,000, over 10 times that of the youngest
age group (0–9 years old).
Stratifying pedestrian mortality by gender shows a rate of
7.63 per 100,000 for males and 2.44 per 100,000 for females
in 2008; the male to female mortality ratio for 2008 was 3.02.
Adjusting by age and gender, pedestrian mortality rates peak
for both genders in the 80+ age group, at 33.0 and 10.96 per
100,000 population for males and females, respectively.
The national trend of increased pedestrian mortality rates
with increases in age is mirrored in each of the 5 regions within
Brazil, with a peak mortality rate of 31.8 per 100,000 in the 80+
age group in the central-west region. Unlike with overall road
traffic mortality rates, the central-west and north regions have
the highest rates of pedestrian mortality.
Motorcyclists
In 2008, motorcycle fatalities resulted in nearly 9000 deaths in
Brazil, accounting for nearly a quarter (22.5%) of all transport
related deaths, and motorcycles accounted for 20.3 percent of
the total registered vehicle fleet. Motorcycle fatalities have been
an escalating problem in recent years, with the mortality rate
per 100,000 increasing sharply from 1.47 in 2000 to 4.71 in
2008. This has coincided with a dramatic rise in the number of
registered motorcycles in Brazil; the number of registered motorcycles more than doubled between 2003 and 2008 (5,332,056
to 11,045,686; increase by a factor of 2.07) and the total fleet
increased by a factor of 1.46 in that same period of time.
Figure 4 Motorcycle occupant mortality rate per 100,000 population by age
group over time.
The age group most affected by motorcycle fatalities has
consistently been the 20- to 29-year-old group in the past decade
(Figure 4). The 20- to 29-year age group remains most affected
by motorcycle deaths, with a peak fatality rate of 10.76 per
100,000 in 2008, compared to 3.63 per 100,000 in 2000.
The majority of motorcycle deaths occur in males (89.6%
in 2008), and gender-specific mortality rates peaked at 19.29
per 100,000 for males and 2.18 per 100,000 for females in the
20- to 29-year-old group. Most motorcycle fatalities occurred
in the southeast region of Brazil (3186 deaths), and the fewest
in the north region (653 cases) in 2008. Interestingly, before
2006, the northeast region had the most motorcycle fatalities
of the regions in Brazil. The highest motorcycle mortality rate
occurred in the midwest region (7.70/100,000) in 2008. When
stratifying by region and age group, motorcycle deaths in males
impacted elderly populations more heavily in both the north and
northeast regions (compared to youth populations). Comparing
motorcycle fatalities in Brazil by gender in 2008 showed that
8.6 times as many male motorcycle drivers died as female. The
southeast region had the highest male-to-female ratio (9.40)
and the northern region had the lowest (6.93). Unfortunately,
the SIM database does not allow differentiation of motorcycle
drivers versus passengers.
Bicyclists
In 2008, bicycle fatalities totaled over 1600 deaths. Nationally,
the highest number of these deaths occurred in the 40- to 49-year
age group (310 fatalities) and the lowest number was in the 80+
age group (26 deaths). The average mortality rate for bicyclists
in Brazil from 2000 to 2008 was significantly lower than that
for both pedestrians and motorcycle riders; the national average
is 0.75 per 100,000, and the regional average for the centralwest is significantly higher at 1.45 per 100,000 (Table II). Over
the years, the mortality rate for bicyclists has been increasing
ROAD TRAFFIC DEATHS IN BRAZIL
Table II
Average bicyclist mortality in Brazil (2000 to 2008)
Region
Mortality rate (per 100,000)
Proportionate mortality (%)
0.68
0.51
0.59
1.36
1.45
0.75
3.90
3.17
3.12
5.39
5.03
3.81
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North
Northeast
Southeast
South
Central-west
National
slightly, from 0.47 per 100,000 in 2000 and peaking in 2007 at
0.90 per 100,000.
Gender patterns for bicyclist mortalities are similar to that
for motorcyclists, with the 2000 to 2008 average male-to-female
ratio of 8.39. Age group–specific mortality rates most heavily impact elderly populations, with the 60- to 69-year-old age
group having a national mortality rate of 1.67 per 100,000 in
2008. On average, bicyclists in Brazil account for 3.8 percent
of road traffic deaths (2000–2008). The region-specific proportional mortality was highest for the central-west region (5.7) and
lowest for the northeast region (3.1) in 2008, though the overall
average from 2000 to 2008 shows the south region as having the
greatest regional proportionate mortality (5.4%).
DISCUSSION
Road traffic deaths are a significant problem in Brazil, resulting in a mortality rate averaging to 19.44 per 100,000 from
2000 to 2008. This is dramatically higher than the rates of nearby
countries such as Argentina (9.9 per 100,000) and Chile (10.7
per 100,000; Maffei de Andrade et al. 2008). Pedestrian and
motorcycle riders are particularly vulnerable road users, with
average mortality rates of 5.46 and 2.98 per 100,000 between
2000 and 2008.
Our analysis shows that elderly pedestrians are at particularly high risk. Brazil’s aging index comparing elderly (≥60
years old) to youth (<15 years old) populations has been steadily
growing since 2000. Elderly populations are more susceptible
to increased mortality due to factors of comorbidity, including
decreased physiologic reserve and elevated incidence of preexisting medical conditions (Gawryszewski and Rodrigues 2006).
Travel behavior in elderly populations also suggests increases in
nonmotorized transport (Ubeda et al. 2011). With a growing elderly population that is more susceptible to specific age-related
risks, targeted interventions addressing these risks are needed.
Demographic, economic, and urbanization differences may
explain some of the variations in road traffic mortality data
between regions. The southeast region of Brazil is the most
populous, because Brazil’s 2 largest cities Rio de Janeiro and
Sao Paulo are in this area. Interestingly, this is not the region
with the highest overall road traffic mortality rate. It is unclear
whether this is due to improved traffic safety or enforcement in
those areas or whether there is a difference in quality of data
collection. Highest VRU death rates occur in the central-west
and south regions; however, the least prosperous regions (north
and northeast) have a higher proportion of VRU (vs. non-VRU)
15
deaths. This is likely a result of there being fewer 4-wheeled
motorized traffic in the more rural north and northeast.
This analysis is limited by the quality of data collection and
reporting to the SIM national database. The accuracy of death
certificate and hospital-coded death data has long been recognized as limited (Glasser 1981; Lu et al. 2001), in particular with
road traffic deaths (Harris 1990; Hijar et al. 2012; Lapidus et al.
1994). Previous studies from Brazil have shown that cause-ofdeath coding in the SIM database can be limited; when reviewing
coded deaths from the southern city of Porto Alegre, Fajardo
et al. (2009) found that nearly 13 percent needed to be recoded
by researchers. In addition, information in SIM is not available
in real time; as of Spring 2011, only mortality data through
2008 were available. In addition, we only utilized Ministry of
Health mortality data for this study; numbers reported by the
police are markedly different. We also did not include crash or
injury data in this analysis because this information is collected
by different systems using different data gathering techniques.
Further study adjusting for differences in data collection would
allow for calculation of crash, injury, and case fatality data.
In summary, this analysis highlights the significant burden of
road traffic mortality in Brazil and, in particular, for vulnerable
road users. Pedestrian safety has not improved since the year
2000. Motorcycle occupant deaths are increasing at an alarming
rate coincident with a sharp increase in the size of the motorcycle
fleet. Although bicycle mortality rates are the lowest of the VRU
groups, they still require targeted intervention to prevent further
increase. Road traffic safety interventions should target these
obviously high-risk vulnerable road user populations.
ACKNOWLEDGMENTS
The authors thank Dr. Adnan A. Hyder for his support and
guidance. This work was conducted as part of the Road Safety in
10 Countries project funded by the Bloomberg Philanthropies.
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