National level economic factors predict traffic-related deaths, an ecological analysis

Background/Purpose: There is significant global variation in vehicular related fatality rates. Variation can also be seen on an intra-country level, and has previously been associated with economic factors such as gross domestic product (GDP). The interpretation of these findings has been that wealthier countries allocate substantial financial resources to safety infrastructure and law enforcement of policy measures such as seat belt and drunk driving laws. Factors that might contribute to traffic safety have not been reported on a global scale. We therefore set out to determine if economic and safety enforcement factors might in part explain traffic safety. Methods: Per-capita GDP, national consumer gas prices, hospital beds per 10,000 population, vehicle-related fatalities per 100,000 population, and enforcement of drunk driving, speeding, and seat belt usage laws were obtained from World Health Organization and World Bank databases. Multivariate analysis was conducted on 182 countries with fatalities per 100,000 population used as the outcome measure. Results: Variation in vehicle-related fatalities on a global scale were best explained by GDP (P<0.001), gasoline prices (P=0.002) and hospital beds (P=0.005), but not by law enforcement. Conclusions: Global variation of vehicular related fatalities is predicted by economic factors but not law-enforcement practices. Per-capita GDP, consumer gas prices, and hospital beds were negatively correlated with fatalities. These observational findings provide rationale to explore a strategy of reducing vehicle-related fatalities by increasing gasoline taxes and redistributing funds to augment hospital infrastructure.