Iran Occupational Health Journal
سلامت كار ايران
ioh
Medical Sciences
http://ioh.iums.ac.ir
136
journal136
1735-5133
2228-7493
10.61186/ioh
fa
jalali
1398
4
1
gregorian
2019
7
1
16
2
online
1
fulltext
fa
بررسی ارتباط فاکتورهای اجتماعی- اقتصادی با پیامد مرگ و شدت آسیبدیدگی در مصدومان حوادث ترافیکی
The Investigation of Relationship between Socio Economic Status and the Outcomes of Deaths and severity Injury in Road Traffic Crashes Patients
بیماریهای شغلی
Occupational Diseases
پژوهشي
Research
<strong>زمینه و هدف</strong>: حوادث ترافیکی و مرگ و میر ناشی از آن، یک مشکل مهم بهداشت و سلامت در کشور ایران است. وضعیت اقتصادی اجتماعی از فاکتورهای مهم مرتبط با وضعیت سلامت محسوب می­شود. هدف این مطالعه بررسی ارتباط فاکتورهای اجتماعی- اقتصادی با پیامد مرگ و شدت مصدومیت ناشی از حوادث ترافیکی در بین بیماران ترومایی بیمارستان پورسینای شهر رشت سال 1394 است.<br>
<strong>روش بررسی</strong>: مطالعه حاضر یک مطالعه مقطعی-تحلیلی است. برای بدست آوردن فاکتورهای اصلی اجتماعی اقتصادی از روش تحلیل مولفه های اصلی استفاده شد. ارتباط این فاکتورها با پیامد مرگ و شدت تروما بیماران با استفاده از آنالیز رگرسیون لجستیک مورد بررسی قرار گرفت.<br>
<strong>یافته ها</strong>: در این مطالعه تعداد 300 نفر از مصدومان حوادث ترافیکی مورد بررسی قرار گرفتند. از لحاظ جنسی 234 نفر مرد (78%) و 66 نفر زن (22%) بود. میانگین سنی مصدومان 25/34 سال (07/19) بود. مقیاس <span dir="LTR">ISS</span> بالای 15 به عنوان آسیب دیدگی شدید در نظر گرفته شد که تعداد 245 نفر از بیماران (7/81%) دارای نمره <span dir="LTR">ISS</span> کمتر و مساوی 15 بودند. برخی از فاکتور های اقتصادی اجتماعی با پیامد مرگ و شدت مصدومیت دارای ارتباط بودند. مقادیر نسبت شانس برای این فاکتورها به ترتیب 45/0 (فاصله اطمینان 95%: 836/0- 242/0) و 65/0 (فاصله اطمینان 95% : 95/0- 45/0) بدست آمد.<br>
<strong><span dir="RTL">نتیجه گیری</span></strong><span dir="RTL">: </span> <span dir="RTL">نتایج این مطالعه نشان داد که عوامل اقتصادی اجتماعی با مرگ و میر و میزان مصدومیت های ناشی از حوادث ترافیکی ارتباط دارد. </span>
<strong>Background and aims:</strong><span id="214"> <span id="214-258">Road</span></span> <span id="264">traffic</span> crashes and its <span id="273-1193-1194">deaths</span> and <span id="1195-1196">injuries</span> are one of the main public health problems in all over the <span id="1197-1198">world</span> especially in Low and <span id="212">Middle Income</span> Countries <span id="p111">(<span id="211">LMICs</span></span>).<span id="p114"> <span id="259">Road</span> <span id="265">traffic</span> crashes resulting in <span id="274-1199-1200">deaths</span>, <span id="372">physical</span> and psychological <span id="215">problems, and</span></span> economic costs which <span id="1533-1534">have</span> damages on <span id="1201-1202">families</span> and <span id="1203-1204">communities</span>.<span id="p115"> The <span id="1205-1206">number</span> of <span id="260">road</span> <span id="266">traffic</span> <span id="275">deaths</span> was <span id="1535-1536-418">exceeded</span> from 1.3 <span id="1207-1208">million</span> in 2016.</span><span id="p116"> <span id="1209-1210">Most</span> of the <span id="261">road</span> <span id="267">traffic</span> injuries <span id="216-1537-1538">are</span><span id="216"> belong</span></span> to low and middle-income countries of the <span id="1211-1212">world</span>.<span id="p1703"> Road traffic injury is the eight leading causes of deaths for all ages, while it is largely neglected.</span> <br>
<span id="p119">There <span id="1541-1542">are</span> several effective factors <span id="416">in </span><span id="263-416">road</span> <span id="269">traffic</span> crashes.</span><span id="p120"> The <span id="312">socio-economic</span> <span id="322">status</span> is known as important factors related to <span id="287">health</span> <span id="323">status</span>, although its <span id="1217-1218">influence</span> is <span id="360-375">not</span> <span id="360-376">fully</span> <span id="360-377">understood</span> on <span id="374">different</span> aspects of <span id="288-1219-1220">health</span>.</span><span id="p121"> <span id="1221-1222">People</span> who <span id="1543-1544">live</span> in <span id="378">low</span> <span id="313">socioeconomic</span> <span id="324">status</span> <span id="1545-1546">suffer</span> from the <span id="1223-1224">disease</span> and <span id="1225-1226">injuries</span> two <span id="1227-1228">times</span> more than others.</span><span id="p122"> The <span id="1229-1230">results</span> of the studies show that <span id="333">fatal</span> and <span id="334">non-fatal</span> injuries <span id="1547-1548-379">have</span> an inverse relationship with <span id="314">socio-economic</span> <span id="325">status</span>.</span><span id="p123"> The <span id="315">socio-economic</span> <span id="326">status</span> is known as important factors related to health <span id="327">status</span>.</span><span id="p124"> <span id="1231-1232">People</span> who <span id="1549-1550">live</span> in <span id="380">low</span> <span id="316">socioeconomic</span> <span id="328">status</span> <span id="1551-1552">suffer</span> from the <span id="1233-1234">disease</span> and <span id="1235-1236">injuries</span> two <span id="1237-1238">times</span> more than others.</span><span id="p125"> The <span id="1239-1240">results</span> of the studies show that <span id="335">fatal</span> and <span id="336">non-fatal</span> injuries <span id="1553-1554-381">have</span> an inverse relationship with SES.</span><span id="p126"> However, there <span id="1555-1556">is</span> a <span id="1241-1242">lack</span> of enough <span id="1243-1244">information</span> about the <span id="1245-1246">effects</span> of socioeconomic status on road traffic crashes and its related outcomes.</span> <br>
<span id="p128">The <span id="337">incidence</span> rate of road traffic injuries and its <span id="382">related</span> deaths have a relationship with socio-economic status.</span><span id="p129"> In the international level, these <span id="338-1247-1248">incidences</span> <span id="1557-1558">vary</span> between the High-income <span id="289">countries</span> and Low and Middle-income <span id="290">countries</span>.</span><span id="p130"> <span id="419">Moreover</span>, the <span id="339-1249-1250">incidences</span> of road traffic injuries and <span id="1251-1252">deaths</span> <span id="1559-1560">vary</span> between the <span id="383">different</span> <span id="317">socio-economic</span> groups in each <span id="291-1253-1254">country</span>.</span><br>
<span id="p131">The <span id="318">socio-economic</span> <span id="329">status</span> is <span id="1561-1562-385">known</span> as the main <span id="420">predictor</span> factor in <span id="384">different</span> aspects of <span id="1255-1256">health</span>.</span><span id="p132"> The <span id="1257-1258">importance</span> of <span id="319">socio-economic</span> <span id="330">status</span> will <span id="1563-1564">increase</span> in <span id="1565-1566">regarding</span> this <span id="1259-1260">point</span> which the <span id="1261-1262">outcomes</span> of road traffic crashes are sometimes irreversible.</span><span id="p133"> However, the <span id="1263-1264">effect</span> of <span id="320">socioeconomic</span> <span id="331">status</span> on the <span id="386">many</span> aspects of <span id="1265-1266">health</span> is <span id="361-387">not</span> <span id="361-388">fully</span> <span id="361-389">understood</span>.</span><span id="p134"> <span id="1567-1568">Identifying</span> the <span id="321">socio-economic</span> <span id="332">status</span> factors related to the <span id="1267-1268">outcomes</span> of road traffic crashes can <span id="1569-1570">provide</span> a <span id="390">good</span> opportunity for <span id="1269">policy makers</span> and <span id="1270-1271">managers</span> to <span id="1571-1572-391">use</span> preventive interventions in high-risk groups.</span><br>
<strong><span id="1280-1281"><span id="p137">Methods</span></span></strong>:<span id="p138"> This <span id="1282-1283">study</span> <span id="1575-1576-392">used</span> an analytical cross-sectional design.</span><span id="p139"> The <span id="421">studied</span> sample <span id="1577-1578">was</span> <span id="1284-1285">people</span> who injured because of road traffic crashes and <span id="1579-1580">referred</span> to <span id="218-1286-1287">Pour-Sina</span></span> <span id="219-1286-1287">hospital</span> in the <span id="1288-1289">city</span> of <span id="220">Rasht</span>.<span id="p140"> <span id="221">Rasht</span></span> <span id="1581-1582-394">is</span> the <span id="393">central</span> city of <span id="222-1290-1291">Guilan</span> <span id="343-1290-1291">province</span>.<span id="p141"> <span id="223-1292-1293">Guilan</span></span> <span id="344-1292-1293">province</span> is <span id="1583">located</span> in the <span id="1294">north</span> of Iran and the <span id="1295-1296">rate</span> of road traffic crashes is high in this <span id="345">province</span>.<span id="p142"> The <span id="1297-1298">collection</span> of <span id="1299-1300">data</span> has been done by two <span id="1301-1302">researchers</span>.</span><span id="p143"> The data collection questioner trained <span id="362-363">in </span><span id="1303-1304-362-363">order</span><span id="362-363"> to</span> <span id="1584-1585">meet</span> the quality assurance and <span id="1305">prevention</span> the information bias.</span><span id="p144"> The using questionnaires <span id="1586-1587">consisted</span> of two <span id="1306-1307">parts</span>.</span><span id="p145"> The first <span id="1308-1309">part</span> <span id="1588-1589">was</span> a <span id="1310">checklist</span> to <span id="1590-1591">collecting</span> the demographic information including <span id="224">the</span></span>;<span id="p146"> <span id="1311-1312">age</span>, <span id="1313-1314">gender</span>, a marital status which <span id="1592-1593-422">obtained</span> from hospital records.</span><span id="p147"> <span id="423">Moreover</span>, <span id="1594-1595">collecting</span> the crash information such as;</span><span id="p148"> the <span id="1315-1316">location</span> of the <span id="282-1317-1318">injury</span>, the <span id="1319-1320">type</span> of <span id="283-1321-1322">injury</span>, the <span id="1323-1324">severity</span> of <span id="284-1325-1326">injury</span> <span id="p136">(<span id="1573-1574">based</span> on Injury Severity Score)</span><span id="225">,</span></span> the clinical outcome of the <span id="1327-1328">patient</span> which were <span id="1596-1597">extracted</span> from hospital records.<span id="p149"> The second <span id="1329-1330">part</span> of the <span id="1331-1332">instrument</span> was <span id="1598-1599">related</span> to socio-economic issues.</span><span id="p150"> For this <span id="1333-1334">purpose</span>, the standardized questionnaire was <span id="1600-1601">used</span> which the <span id="1335-1336">validity</span> and <span id="1337-1338">reliability</span> of that were <span id="1602-1603">confirmed</span> in the previous study.</span><span id="p151"> In the <span id="1339-1340">cases</span> that the injured people had <span id="1604-1605-397">died</span> or were <span id="396">unable</span> to <span id="349-398">interview</span> <span id="432">due to</span> the <span id="1341-1342">severity</span> of the <span id="1343-1344">injuries</span>, the <span id="350-1345-1346">interview</span> was <span id="1606-1607">conducted</span> with one of the <span id="395">close</span> relatives <span id="p135">(<span id="1272-1273">father</span>, <span id="1274-1275">mother</span>, <span id="1276-1277">brother</span> or <span id="1278-1279">sister</span>)</span> and after <span id="1608-1609-424">obtaining</span> informed consent.</span><br>
<span id="364-365"><span id="p153">In </span><span id="1351-1352-364-365">order</span><span id="364-365"> to</span> <span id="1612-1613-425">determine</span> the socio-economic status <span id="292">factors</span> <span id="p152">(that <span id="226-1610-1611">are</span></span> a <span id="1347-1348">combination</span> of <span id="1349-1350">variables</span>)</span><span id="227">,</span> the principal components analysis was <span id="1614-1615">used</span>.<span id="p154"> Principal component analysis <span id="1616">simplifies</span> the <span id="1353-1354">data</span> and reduces the number of <span id="1355-1356">variables</span>.</span><span id="p155"> To <span id="228">extracted</span></span> the <span id="293-1357-1358">factor</span>/<span id="294-1359-1360">factors</span> from the <span id="1361-1362">variables</span>, the Varimax <span id="351">rotation</span> method was <span id="1617-1618">used</span>.<span id="p156"> The <span id="1363-1364">Varimax </span><span id="352-1363-1364">rotation</span> is <span id="1619-1620-399">used</span> if <span id="295-1365-1366">factors</span> are <span id="1621-1622">assumed</span> to be uncorrelated which is known as orthogonal <span id="353">rotation</span>.</span><span id="p157"> In this <span id="1367-1368">study</span>, the Eigenvalue greater than <span id="229">1</span></span> was <span id="1623-1624">chosen</span>.<span id="p158"> After <span id="1625-1626-426">determining</span> the <span id="296-1369-1370">factor</span>, the <span id="1371-1372">variables</span> that were present in each <span id="297-1373-1374">factor</span> were <span id="1627-1628">identified</span>.</span><br>
<span id="p160">To <span id="1629-1630-427">obtain</span> the main socio-economic status <span id="233-298">factors</span><span id="233"> the</span></span> <span id="1375-1376">method</span> of principal component analysis was <span id="340-1631-1632-400">used</span>.<span id="p161"> To <span id="1633-1634">assess</span> the <span id="1377-1378">interest</span> of the <span id="1379-1380-428">implementation</span> of the principal component analysis on a <span id="1381-1382">data</span>, Bartlett’s sphericity test and the <span id="234-1383-1384">KMO</span></span><span id="1383-1384"> index</span> were <span id="341-1635-1636">used</span>.<span id="p162"> The <span id="401">main</span> SES <span id="299">factors</span> were <span id="1637-1638-429">determined</span> and <span id="366-367">in </span><span id="1385-1386-366-367">order</span><span id="366-367"> to</span> <span id="1639-1640">assess</span> the <span id="1387-1388">relationship</span> between these <span id="300-1389-1390">factors</span> and <span id="1391-1392">death</span> and <span id="1393-1394">severity</span> of <span id="1395-1396">injuries</span> related to road traffic crashes, the logistic regression with the Backward-LR method was <span id="342-1641-1642">used</span>.</span><span id="p163"> The <span id="1397-1398">analysis</span> was <span id="1643-1644">adjusted</span> on the <span id="1399-1400">variable</span> of <span id="1401-1402">age</span> and <span id="1403-1404">sex</span> of <span id="1405-1406">patients</span>.</span><span id="p164"> For the <span id="1407-1408">severity</span> of the <span id="1409-1410">injury</span>, the <span id="235">ISS</span></span> scale was <span id="1645">grouped</span> <span id="p159">(<span id="230">ISS></span></span> 15, <span id="231">ISS</span> = <span id="232"><15</span>) and it is <span id="354">considered</span> as the dependent variable in the Logistic Regression model.<span id="p165"> The <span id="237">ISS</span></span> scale above 15 is <span id="355-1646-1647">considered</span> to <span id="1648-1649-402">be</span> a severe injury All <span id="1650-1651">analyses</span> were <span id="1652-1653">performed</span> <span id="1654-1655">using</span> the <span id="238">SPSS</span> software version 20.<span id="p166"> The significance level of the <span id="1411-1412">tests</span> in this <span id="1413-1414">study</span> was <span id="356-1656-1657">considered</span> 0.05.</span><br>
<strong><span id="1415-1416"><span id="p172">Results</span></span></strong>:<span id="p173"> In this <span id="1417-1418">study</span>, 300 traumatic <span id="346">patients</span> were <span id="1658">recruited</span>.</span><span id="p174"> From all, 234 <span id="347-1419-1420">patients</span> <span id="p171">(78%)</span> were male.</span><span id="p175"> The <span id="403">mean</span> age of injured <span id="348">patients</span> <span id="1659-1660-404">was</span> 34.25 years old <span id="p170">(19.07)</span>.</span><span id="p176"> The <span id="243-1421-1422">ISS</span></span><span id="1421-1422"> scale</span> was <span id="1661">grouped</span> <span id="p169">(<span id="240">ISS></span></span> 15, <span id="241">ISS</span> = <span id="242"><15</span>).<span id="p177"> <span id="244">the</span></span> <span id="245">ISS</span> scale above 15 is <span id="1662-1663">considered</span> to <span id="1664-1665-405">be</span> a severe injury.<span id="p178"> The severe injury <span id="p168">(<span id="239">ISS</span></span> > 15)</span> was <span id="1666-1667">observed</span> among 245 <span id="p167">(81.7%)</span> <span id="1423-1424">patients</span>. <br>
<span id="p185">Bartlett’s sphericity test and the <span id="248-1429-1430">KMO</span></span><span id="1429-1430"> index</span> showed that there <span id="1668-1669">is</span> a <span id="407">good</span> correlation between the <span id="430">studied</span> variables and the <span id="1431-1432">using</span> of principal component analysis is feasible.<span id="p186"> The p-value for the <span id="1433-1434">Bartlett test</span> is significant and the <span id="249-1435-1436">KMO</span></span><span id="1435-1436"> index</span> is more than 0.5.<span id="p187"> Some socio-economic status <span id="301">factors</span> had a relationship with the <span id="1437-1438">outcomes</span> of <span id="1439-1440">death</span> and the <span id="1441-1442">severity</span> of the <span id="1443-1444">injury</span> of <span id="1445-1446">patients</span>.</span><span id="p188"> <span id="368-369">There </span><span id="1670-1671-368-369">were</span><span id="368-369"> three </span><span id="302-1447-1448-368-369">factors</span><span id="368-369"> which </span><span id="1672-1673-368-369">affect</span> the <span id="1449-1450">outcome</span> of road traffic crashes.</span><span id="p189"> The first <span id="303-1451-1452">factor</span> <span id="1674-1675">includes</span> the following variables;</span><span id="p190"> household cost, the <span id="256">education level</span> of an injured person, and the <span id="257">education level</span> of the <span id="1453-1454">mother</span>.</span><span id="p191"> The second <span id="1455-1456">factor</span> <span id="1676-1677">includes</span> the <span id="1457-1458">variables</span> of;</span><span id="p192"> <span id="1459-1460">job</span>, <span id="1678-1679">owning</span> the mobile and motorcyclist.</span><span id="p193"> The third <span id="1461-1462">factor</span> <span id="1680-1681">includes</span> the <span id="1463-1464">variables</span> of;</span><span id="p194"> <span id="1465-1466">income</span> and fathers job.</span><span id="p195"> The <span id="1467-1468">results</span> of logistic regression analysis <span id="1682-1683">showed</span> that factor 3 <span id="p184">(<span id="406">family</span> income and <span id="1425-1426">father</span>'s <span id="1427-1428">job</span>)</span> had a significant relationship with the <span id="1469-1470">outcome</span> of traumatic <span id="276">death</span>.</span><span id="252"><span id="p196"> For</span></span> this <span id="304-1471-1472">factor</span>, the odds ratios of 0.45 <span id="p182">(CI 95%;</span><span id="p183"> <span id="247">0.042-</span></span> 0.83) for <span id="277-1473-1474">deaths</span> and 0.65 <span id="p180">(CI 95%;</span><span id="p181"> <span id="246">0.45-</span></span> 0.90) for the <span id="1475-1476">severity</span> of <span id="1477-1478">injuries</span> was <span id="1684-1685-431">obtained</span>.<span id="p197"> The highest SES <span id="1686-1687">had</span> the <span id="408">lowest</span> <span id="278">deaths</span> and <span id="1479-1480">injuries</span>.</span> <br>
<span id="p202">There <span id="1688-1689">was</span> a <span id="1485-1486">relationship</span> between economic <span id="305">factors</span> and the <span id="1487-1488">severity</span> of the <span id="1489-1490">trauma</span>, the economic-social third <span id="306">factor</span> including variables;</span><span id="p203"> <span id="410">family</span> income and <span id="1491-1492">father</span>'s <span id="1493-1494">occupation</span> were <span id="1690-1691">identified</span> as an effective <span id="307">factor</span> in the <span id="1495-1496">severity</span> of <span id="1497-1498">trauma</span>.</span><span id="p1707"> The odds ratio for the third factor <span id="p1706">(household income and father's occupation)</span> was 0.68 <span id="p1704">(95% confidence interval:</span><span id="p1705"> 0.452-0.908)</span>.</span><br>
<strong><span id="1503-1504"><span id="p206">Conclusion</span></span></strong>:<span id="p207"> The <span id="1505-1506">results</span> of this <span id="1507-1508">study</span> <span id="1694-1695-370">showed</span><span id="370"> that social economic factors </span><span id="254-1696-1697-370">affect</span></span><span id="370"> both the </span><span id="1509-1510-370">deaths</span><span id="370"> and the </span><span id="1511-1512-370">severity</span><span id="370"> of </span><span id="1513-1514-370">injuries</span>.<span id="p1709"> The results of this study showed that the third factor <span id="p1708">(family income and father's job)</span> had a significant relationship with traumatic death.</span><span id="p209"> <span id="414">In other </span><span id="1519-1520-414">words</span>, the <span id="1521">mortality rate</span> of road <span id="270">traffic</span> crashes is high among <span id="1522-1523">families</span> with a <span id="413">low</span> level of socio-economic status.</span><span id="p210"> <span id="357-1702-1703">Considering</span> the <span id="415">high</span> rates of <span id="280-1524-1525">deaths</span> and severe <span id="285">injuries</span> caused by <span id="271-1526">traffic</span><span id="1526"> accidents</span> in Iran compared to other <span id="1527-1528">countries</span>, it is necessary economic and social <span id="310">factors</span> will be <span id="358">considered</span> as effective <span id="311">factors</span> on <span id="281-1529-1530">deaths</span> and <span id="286-1531-1532">injuries</span> in road <span id="272">traffic</span> policy-making and planning.</span><br>
حوادث ترافیک جاده ای, وضعیت اقتصادی اجتماعی, آسیب, مرگ و میر
Road Traffic Crashes, Socio Economic Status, Injury, Mortality
1
10
http://ioh.iums.ac.ir/browse.php?a_code=A-10-2300-1&slc_lang=fa&sid=1
Shahrokh
Yousefzadeh
شاهرخ
یوسف زاده
s.shahrokh@gubm.qc.ir
13600319475328460031134
13600319475328460031134
No
Gilan university of medical sciences
دانشگاه علوم پزشکی گیلان
Alireza
Razzaghi
علیرضا
رزاقی
alirezarazzaghi_21@yahoo.com
13600319475328460031135
13600319475328460031135
Yes
ShahidBehesthi University of Medical Sciences
دانشگاه علوم پزشکی شهید بهشتی