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Note: Numbers are percentages of trauma victims in each of the respective categories. RTA, road traffic accidents.

Note: Numbers are percentages of trauma victims in each of the respective categories. RTA, road traffic accidents.

Fig. 1. Road traffic fatality trends in three high-income countries (Australia, United Kingdom, United States of America). Sources: Transport Safety Bureau, Australia; Department of Transport, United Kingdom; Fatality Analysis Reporting System, United States of America (World Health Organisation, 2004).

Fig. 1. Road traffic fatality trends in three high-income countries (Australia, United Kingdom, United States of America). Sources: Transport Safety Bureau, Australia; Department of Transport, United Kingdom; Fatality Analysis Reporting System, United States of America (World Health Organisation, 2004).

(World Health Organisation, 2004). Furthermore TBI from road traffic accidents has been falling in high-income countries for some years. In Australia there has been an average yearly decline in TBI of 5%, most due to an 8% decline in vehicle occupancy injuries (O'Connor and Cripps, 1999). Between 1968 and 1983 road traffic accident mortality declined by more than 20% in Europe (Fig. 1) In contrast it increased by more than 150% in Asian countries and more than 200% in African countries (Soderlund, 1995) (Fig. 2).

Traffic type has important influences on injury patterns. In Beijing one third of traffic deaths occur among bicyclists. In India pedestrians account for 15-35% of injuries, 2-wheeler occupants 20-40% and bicyclists 5-15% (Gururaj, 2002). Taiwan had a high rate of TBI from road traffic accidents reported in 1991 to be 89 per 100,000

(Chiu et al., 1995). This was considered to be related to the rapidly increasing use of motor cycles, the most dangerous form of road transport in current use anywhere in the world, and an increasing component of traffic in developing countries (World Health Organisation, 2004).

Other causes of neurotrauma also show marked regional variation and changing trends. In the USA firearm injuries exceeded road traffic accidents for the first time in 1990 and this trend contrasted with a fall in road traffic accident deaths (Sosin et al., 1995). Other trends in injury causation have been documented in several countries. A review of head injury mortality from 1987 to 2000 in Sweden showed a constant rate of injury over this period, however a fall in transport-related injury was balanced by an increase in falls below the age of 25 and over the age of 65 (Kleiven et al., 2003). In the UK

Fig. 2. Global and regional road fatality trends, 1987-1995. Data are displayed according to regional classification of TRL Ltd., United Kingdom. The World Health Organisation, 2004 document from which this comes states that reproduced with permission of the authors namely, Jacobs G, Aeron-Thomas A, Astrop A. Estimating Global Road Fatalities. Crowthorne, Transport Research Laboratory, 2000 (TRL Report 445).

Fig. 2. Global and regional road fatality trends, 1987-1995. Data are displayed according to regional classification of TRL Ltd., United Kingdom. The World Health Organisation, 2004 document from which this comes states that reproduced with permission of the authors namely, Jacobs G, Aeron-Thomas A, Astrop A. Estimating Global Road Fatalities. Crowthorne, Transport Research Laboratory, 2000 (TRL Report 445).

there were regional differences between the incidence of road traffic accident versus falls and of alcohol-related accidents (Kay and Teasdale, 2001).

Surveys from different countries also indicate variation in the causation of spinal cord injury between countries and over time. In most countries vehicular accidents are the leading cause of spinal cord injury in the younger age group but, as with head injury, this figure is falling while the incidence of injury due to falls in the older age group is increasing (Cripps, 2006). Falls and violence are more prevalent in developing countries and in the lower economic strata of developed countries (Ackery et al., 2004).

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