Incidence of road injuries in Kazakhstan


[Download detailed results tables: Kazakhstan-WebTables]
Last Updated: Sept 27 2009

Important: Please note that the results presented here are preliminary. Additional adjustments will be necessary as the results are made consistent with the ongoing Global Burden of Disease (GBD-2005) project, for which the results presented here are an input. Final estimates of the GBD-2005 study will be released in late 2010.  

About this report

Reliable statistics of road injuries are an essential input for describing the public health burden of injuries, evaluating the impact of safety policies, and benchmarking achievements. While injury surveillance systems are common in high income countries, most low and middle income countries are unlikely to have such capacity for several decades. In the interim, estimates should be derived by harmonizing injury statistics from the wide array of data sources that may be available in a country or region. 

This report summarizes our findings for the incidence of deaths and non-fatal injuries from road crashes in Kazakhstan. It is one of a series of national road injury assessments that we are producing during the course of this project. The intended audience of these reports includes the global donor community, the international research community, and national health and transport policy makers. We are committed to keeping this project open-source and collaborative in nature. All readers are encouraged to provide feedback to help improve methods, incorporate other sources of information, and suggest more effective methods for communicating these results.


Summary Results
In 2005, road crashes resulted in 3,783 deaths in Kazakhstan representing an annual injury rate of 24.5 deaths per 100,000 people. In addition, over 200,000 people were victims of non-fatal injuries due to road crashes. The road injury death rate in Kazakhstan was the highest of the six countries in the Europe and Central Asia analyzed in this project (Figure 1), and 4.2 times the death rate in countries with the best road safety performance (Sweden, UK, and Netherlands). 

Injuries as a whole, including from unintentional and intentional causes, resulted in 22,403 deaths in Kazakhstan in 2005. 

Road injuries are the second leading cause of injury deaths in Kazakhstan, second only to suicides (Table 1). In 2005, road injuries account for 17% of all injury deaths in Kazakhstan. 

How did we compute these estimates?

Our general methodology for estimating deaths and non-fatal injuries involves piecing together data from a wide array of sources that typically include death registers, hospital records, funeral records, health surveys, and police reports. This requires filling information gaps, mapping from varying case definitions, deriving population based incidence estimates from sources that may not track denominator populations, and appropriately reapportioning cases assigned to poorly specified causes. For a general description of the broad methodology, please visit the Methods-overview section of our website.

The following sections describe the specific data sources used, the estimation methods, and the key results for our estimates of road injuries Kazakhstan.  

Overview of data sources

We estimated the incidence and distribution of road injury deaths in Kazakhstan using national death registration data obtained from the WHO Mortality Database. We estimated the incidence and distribution of non-fatal injury deaths using the results of the 2002/2003 World Health Surveys.

Estimates of road injury deaths

Our review of data sources for estimating national road injury deaths in Kazakhstan revealed two potential data systems: national death registration data and official government statistics as reported to the International Road Federation and the 2009 WHO Global Status Report on Road Safety. We obtained death registration data from the publicly available WHO Mortality Database. These data are tabulations of deaths recorded by national civil registration systems. Typically these systems record age, sex, and causes of death coded using principles of the International Statistical Classification of Diseases (ICD). 

A total of 25 years of data were available, most recently for the year 2007. We only analyzed data for the most recent four years available (2004-2007), which had causes of death coded to a summary tabulation list of ICD-10. 

Reclassification to GBD-2005 definitions: We reclassified age into 38 age-sex groups. The age definitions match those used by the GBD-2005 project and are available on the GBD-Injury expert group website. Click here to go directly to the age definitions. 
We reclassified the ICD coded deaths to the definitions of road injuries (and other injuries) as recommended by the GBD-Injury expert group. Unfortunately, the data for Kazakhstan reported in the WHO Mortality Database is tabulated to a condensed tabulation of ICD10 that only permits classification to 8 sub-categories of injury deaths. One of these is transport deaths, which, in this reports is used as a measure of  road injury deaths. 

It should be noted that the use of the condensed ICD10 tabulation list for coding deaths implied that it was not possible to reclassify deaths coded to the various partially specified categories. This would lead to an underestimate of road injury deaths.

Comparison of our estimates with other sources

Our estimate of road injury deaths in Kazakhstan are 13% higher than those reported in the 2009 WHO  Global Status Report on Road Safety (Figure 3). 









Road deaths by age and sex

Most road deaths occur among adult males (Figure 3a). Almost 3/4th (73%) of all road injury deaths were men and most of these men (88%) were adults older than 20 years. Death rates (Figure 3b) among men are 2.7 times higher than those among women overall. Men have higher death rates for all age groups but the gender differential is smaller among the elderly.  Both death counts and death rates rise dramatically in the transition in age from childhood to young adults (see age groups 10-14 years and 15-19 years). 

Such age and sex patterns in deaths and death rates are consistent with those seen in other countries. For the most part, the gender differentials in death rate are a result of higher exposure to road traffic among men in combination with higher risk-taking behavior. Similarly, the age pattern of death rates partly reflects patterns of exposure and partly case-fatality rates. While exposure to road traffic declines with age among older populations, the bio-mechanical tolerance to injury (i.e. the likelihood of death in the event of a crash) also declines, resulting in increasing death rates with age. 



Estimates of non-fatal road injuries

The incidence of non-fatal road injuries can be estimated from various sources, including police reports, hospital administrative records, and population surveys. Among these, police reports are widely known to under report road injury cases in low income countries as well as in high income countries. Hospital records have the advantage of providing detailed medical descriptions of injuries making classification of injuries by severity possible. However, estimation of population rates is difficult without investing substantial efforts in identifying the hospital catchment population. Thus, population based health and injury surveys are the most reliable sources of information for incidence of road injuries, especially in information-poor settings.

We estimated the incidence of non-fatal road injuries in Kazakhstan using the 2002-2003 World Health Surveys (WHS), a nationally represented household survey that included questions on road injury involvement. These surveys, which were conducted by the World Health Organization, provide a unique opportunity for cross-country comparisons of non-fatal injuries because they asked the same set of questions in 53 countries, most of which are low- or middle- income countries. The surveys included the following set of road injury related questions in their household module:
  • In the past 12 months, have you been involved in a road traffic accident where you suffered from bodily injury? 
    • Yes/No
  • When (in the last 12 months) did the accident happen? 
    • Within the last 30 days/ 1-2 months ago/ 3-5 months ago/6-12 months ago/ Do not know
  • Did you receive any medical care or treatment for your injuries? 
    • Yes/No
  • Where did you first receive care? 
    • On-site, ambulance/Hospital/Outpatient facility/Private physician/ Traditional healer/ Other
  • Was it government operated or private? 
    • Government operated/ Private
  • How soon after the traffic accident occurred did you first receive care? 
    • In one hour or less/ In over one hour but within 24 hours/More than 24 hours later
In Kazakhstan, 4,495 interviews were conducted as part of the WHS, with a response rate of 100% and only 0.2% of the surveys had missing responses for the question on bodily injury in road accidents. In our analysis of the WHS, we replaced the missing values for this question with the predicted value from a logistic regression model fit to the cases with a non-missing response. The model used the response to this question as the dependent variable and the following independent variables: gender, age groups, place of residence, permanent income quintile, country, marital status, education, occupation, self-rated health, visual acuity (seeing and recognizing a person from across road), and alcohol consumption as predictor dummy variables. We used survey (svy) commands in Stata 10 for the analysis of the WHS.

Non-fatal injuries by age, sex, and residence

Our analysis of the 2002/2003 WHS suggests that over 200,000 people in Kazakhstan are involved in non-fatal road crashes annually. This corresponds to 1.3% [95% CI:0.6 -1.9%] of the population. 

Although road injury incidence is slightly higher among residents of rural areas than residents of urban areas, the difference is not statistically significantly (Figure 4). Similarly, while men have higher rates of non-fatal road injury incidence than women, the difference is not statistically significant (Figure 5).  Road injury incidence is higher among young adults (18-44 years) than among elderly, but the differences are not statistically significant. 
                    

Acknowledgements

These country reports were produced as part of a project funded by the World Bank Global Road Safety Facility. The results presented here are based on secondary analysis of data collected by various national and international agencies.

ċ
Kazakhstan_webtables1Oct2009
(424k)
Kavi Bhalla,
Oct 4, 2009, 9:31 PM