Burden of Road Traffic Injuries in Turkey

Figures & data

Figure 1 Literature review flowchart for road traffic injuries in Turkey.

Table I Overview of the strengths and weaknesses of select data sources for road traffic injury in Turkey, 2010

Data source	Strengths	Weaknesses	Opportunities	Threats
Death statistics	A well-established annual report that assembles and disaggregates data regarding deaths and causes of death ^a The definition of road traffic death does include 30-day follow-up	Raw data for this report are procured from hospitals, clinics, death certificates, and prosecutors Only includes information regarding provincial and district centers ^a	Extend beyond the district and provincial areas to encompass wider population	Risk of RTIs being encompassed into injuries category
Police data	Well-established system of reporting as police are mandated by Highway Traffic Law No. 2918 to complete road traffic accident reports after every crash and to compile these information monthly for the Turkish Statistical Institute ^d	The definition of road traffic death does not include 30-day follow-up ^b ^,c Misreporting or underreporting Only enforcement information are available	Standardize data collection with other ministries to allow for 30-day follow-up Tighten reporting of crashes Collect more systematic risk factor data	Collection of too much data will detract from police work Reporting may have wider implications to the general population in terms of insurance costs
Pre-hospital and hospital data	Advanced 24-h reporting system that covers all 81 provinces and follows emergency vehicles using GPS	The definition of road traffic death does not include 30-day follow-up Risk factor information is not collected	Modify surveillance to include 30-day follow-up Collect more disaggregated data on RTIs and risk factors	Must ensure that surveillance system does not become too time-consuming Will require training of data collectors
Traffic accident statistics report	Well-established annual report that assembles and disaggregates data related to road traffic crashes ^d	Raw data for this report are procured from GDS, gendarmerie, and insurance. Therefore, limitations from these data sources apply (see above for GDS)	Hold organizations responsible for data collection; e.g., GDS, Ministry of Health accountable for quality of data Impose quality indicators and time constraints to ensure validity and timeliness of data	Risk of not being given the data with political changeovers
^a TurkStat (2008).
^b Bilgic and Karacasu.
^c SweRoad (2001).
^d TurkStat (2008b).

Figure 2 Primary and secondary data sources in Turkey.

Figure 3a Annual road traffic crash rate per 100,000 population (1999–2008) in Turkey. Source: TurkStat (2008b).

Figure 3b Annual road traffic injury rate per 100,000 (1999–2008) in Turkey. Source: TurkStat (2008b).

Figure 3c Annual road traffic fatality rate per 100,000 population (1999– 2008) in Turkey. Source: TurkStat (2008a).

Figure 4a Road traffic crash rate of drivers in 2008 by age and gender (traffic police jurisdiction only). Source: TurkStat (2008b).

Figure 4b Road traffic injury rate per 100,000 population in 2008 by age (traffic police jurisdiction only). Source: TurkStat (2008b).

Figure 4c Percentage of road traffic deaths in 2008 by road user type (traffic police jurisdiction only). Source: TurkStat (2008b).

Table II Summary of selected studies on road traffic injuries in Turkey literature review

Author (date)	Type of study	Location	Study population	RTI-related results
Cost studies
Gurses et al. (2003)	Prospective	Denizli	91 Patients under 16 years of age	45% of the injuries were the result of motor vehicle crashes Costs due to motor vehicle crash-induced pediatric trauma was estimated to be US$500
Naci et al. (2008)	Secondary	Turkey	N/A	360,571 years of potential life were lost as a result of road traffic fatalities 142,696 potentially productive years of life were lost as a result of road traffic fatalities
Sut et al. (2010)	Retrospective	Edirne	126 Patients	The daily cost of road traffic crash victims is estimated to be US$582 The cost per life saved was US$8,578 and the cost per life-year saved was US$272.5
Hospital-based studies
Aksoy et al. (2002)	Retrospective	Ankara	553 Patients	Most common cause of maxillofacial fracture was traffic crashes (90.15% or n = 498)
Alicioglu et al. (2008)	Retrospective	Edirne	212 Patients	Most patients were male (n = 204 or 96.2%) with mean patient age of 36 years
Aras et al (2004)	Cross-sectional	Ankara	40 Patients	Most common cause was traffic crashes (62.5%)
Atilgan et al. (2010)	Retrospective	Diyarbakir	532 Patients	Most common causes were falls (n = 248 or 46%) and road traffic crashes (n = 153 or 28%)
Aygencel et al. (2008)	Cross-sectional	Ankara	262 Patients	3% of all patients who visited the emergency department during the study period were road traffic crash victims 19 Patients had alcohol levels above the legal limit and 244 (93.1%) did not use seat belts
Demirhan (2009)	Retrospective	Istanbul	4205 Patients	Most common cause of blunt injury was road traffic crashes (n = 1998 or 47.5%)
Durak et al. (2008)	Retrospective	Bursa	1307 Patients	Most of the victims were male (n = 889 or 68%) and motor vehicle occupants (n = 941 or 72.2%) The mean age was 34.8 years and the majority of the victims were between 15 and 59 (n = 1035 or 81.5%)
Erhan et al. (2005)	Retrospective	Istanbul	106 Pediatric patients	Most common cause was motor vehicle crashes (41%) The majority of the motor vehicle crash victims were in the 12 to 17 age group
Erol et al. (2004)	Retrospective	Diyarbakir	2901 Patients	Most common cause was road traffic crashes (n = 1104 or 38%)
Erturer et al. (2005)	Retrospective	Istanbul	372 Patients	Most common causes were falls (n = 211 or 56.7%) and motor vehicle crashes (n = 145 or 39%)
Gur et al. (2005)	Retrospective	Anatolia	539 Patients	Most common cause was road traffic crashes (n = 200 or 37.1%)
Guven (1988)	Retrospective	Central and eastern Anatolia	302 Patients	Most common causes were road traffic crashes (n = 91 or 47.89% in East Anatolia; n = 94 or 44.34% in central Anatolia)
Karacan (2000)	Retrospective	Turkey	581 Patients	Most common cause was road traffic crashes (48.8%) Victims of road traffic crashes were generally in their middle ages
Karamehmetoglu et al. (1997)	Retrospective	Southeast Turkey	75 Patients	Most common causes of spinal cord injury were falls (37.3%), gunshot wounds (29.3%), and road traffic crashes (25.3%)
Ozkaya et al. (2009)	Retrospective	Istanbul	216 Patients	Most common cause of maxillofacial trauma was road traffic crashes (67.1%)
Simsek et al. (2007)	Retrospective	Turkey and United States	210 Patients	Road traffic crashes was the most common cause of mandibular fractures in Turkey (36.2%) and the second leading cause (28.1%) in the United States
Soylu et al. (1998)	Retrospective	Adana	242 Children	Traffic crashes accounted for 9.1% of injuries and were the leading cause of perforations with glass
Squyer et al. (2008)	Retrospective	Turkey and United States	506 Cases from Turkey	Most common cause of injury was road traffic crashes in Turkey (40.32%) and the United States (45.23%)
Uzun et al. (2006)	Retrospective	Istanbul	802 Patients	Road traffic crashes were the third most common cause of nerve injury in children (n = 27 or 15.7%) and adults (n = 150 or 23.77%)
Yagmur et al. (1999)	Retrospective	Diyarbakir	329 Cases	Males accounted for more road traffic-related deaths than females Children 10 and under were at the highest risk for traumatic deaths related to road traffic crashes
Yetiser et al. (2008)	Retrospective	Ankara	35 Patients	Most common cause for temporal bone fractures was road traffic crashes (n = 19 or 54%)
Medicolegal studies
Birgen et al. (1999)	Retrospective	Turkey	112 Cases	Most common causes of dental injuries were assaults (n = 61 or 54.5%) and road traffic crashes (n = 43 or 38.4%)
Asirdizer et al. (2004)	Retrospective	Turkey	372 Cases	Most common causes included cutting and stabbing objects (n = 160 or 43%), gunshots (n = 136 or 36.6%), and traffic crashes (n = 52 or 14%)
Cekin et al. (2005)	Retrospective	Adana	1110 Cases	Road traffic crash victims constituted 441 of the cases Most of victims of road traffic crashes were pedestrians (n = 207 or 47%), male (n = 296 or 67.1%), and in the 0 and 6 age group (n = 207 or 46.9%)
Demircan et al. (2008)	Retrospective	Ankara	13,823 Cases	A total of 165 motor vehicle trauma cases died in the emergency department and 15 died outside of the emergency department
Esiyok et al. (2005)	Retrospective	Ankara	563 Cases	Most of the cases were male (n = 364 or 64.7%) Most of the injuries took place in the lower extremities (n = 347)
Fedakar et al. (2007)	Retrospective	Bursa	160 Cases	Most common cause of blunt heart wound was traffic crashes (n = 9 or 5.6%) All victims of blunt heart wounds caused by traffic crashes were male
Hilal et al. (2010)	Retrospective	Adana	726 Cases 65 years or older	Most common cause for unnatural death was road traffic crashes (n = 119 or 16.4%) Males were at higher risk compared to females (n = 86 and n = 33, respectively)
Secondary data analysis
Akgungor (2007)	Secondary data analysis	Turkey	N/A	Although the number of motor vehicles has increased significantly, highway networks only expanded by 8700 km between 1955 and 2005 The number of road traffic crashes and injuries both rose between 1990 and 2004 Males accounted for more deaths and injuries (76.99% and 71.69%, respectively) in 2004 Passengers were at the highest risks accounting for 48.79% of injuries and 40.18% of deaths in 2004
Caglayan et al. (2010)	Secondary data analysis	D-100 that passes through Izmir City	N/A	The risk of road traffic death is 2 times higher on D-100 than on other roads within Izmir City The total number of road traffic crashes between 2000 and 2004 decreased from 2119 to 1336. Likewise, injuries decreased from 448 to 339 and deaths from 16 to 5
Ergor et al. (2003)	Secondary data analysis	Aegean region	N/A	Motor vehicle crashes constituted 10.8% or n = 183 of the accidents in the Aegean region Of all fatal accidents, 26.3% were due to motor vehicle crashes
Tansel (1989)	Secondary data analysis	Turkey	N/A	The relationships between vehicle kilometers as well as young drivers on traffic crash rate were positive
Tansel (1988)	Secondary data analysis	Ankara, Istanbul, and Izmir	N/A	Road traffic crashes were found to be more prevalent in built-up areas (90%) Istanbul had the highest number of road traffic crashes and deaths but Ankara had the most severe crashes 80% of the crashes were due to driver error such as speeding
Tansel (1988)	Secondary data analysis	Turkey	N/A	Most of the road traffic crashes involving pedestrians were found to be in built-up areas Pedestrians under the age of 18 and 65 years and above were at the highest risk
Social behavioral studies
Oksuz and Malhan (2005)	Cross-sectional	Ankara	650 Students	More men than women drove under the influence of alcohol Parental education and living away from family were associated with not wearing seat belts
Ozkan et al. (2006)	Cross-sectional	Ankara	217 Students	High perceptual-motor skills were associated with being male and having high masculinity scores, whereas high safety skills were associated with having high femininity scores
Ozkan et al. (2005)	Cross-sectional	Ankara	306 Turkish drivers	Positive drivers committed fewer errors and violations. Moreover, they tended to be older in age and had more driving experience
Ozkan et al. (2005)	Cross-sectional	Ankara	354 Students	The relationship between high masculinity scores and risky driving (i.e., aggression, violations, and offenses) was positively associated
Rasanen et al. (2007)	Cross-sectional	Ankara	408 Pedestrians	Pedestrian bridge usage varied from 6% to 63% Pedestrian bridges with escalators had the highest percentage of usage and pedestrian bridges with traffic signals below had the lowest percentage of usage
Sevketoglu et al.(2009)	Cross-sectional	Istanbul	532 Mothers	28% of mothers did not know what a car seat was; 52% knew but never used it; 20% knew and used it
Simsekoglu (2008)	Cross-sectional	Ankara	277 Students	Seat belt use was associated with attitude and subjective norms
Simsekoglu et al. (2008)	Cross-sectional	Turkey	221 People	Mean response showed that seat belts were used more often outside the city and during bad weather. Seat belts were least likely to be used within the city Reasons for using seat belts included travel conditions, safety, habit, and to avoid fines
Simsekoglu (2005)	Multi-methods	Ankara	N/A	The proportion of seat belt use by drivers was 49% on city roads, 45% on inter-city roads, and 46% on both The proportion of seat belt use by front seat passengers was 51.3% for city roads, 55.5% for inter-city roads, and 54.2% for all roads
Sumer et al. (2006)	Cross-sectional	Turkey	785 Drivers	Low safety skills and heavy dependence on driving skills may lead drivers to underestimate risks
Turkum (2006)	Cross-sectional	Eskisehir	398 People	Self-protecting behavior was affected by personal and social network's experiences with road crashes
Warner et al. (2009)	Cross-sectional	Sweden and Turkey	252 Turkish drivers and 219 Swedish drivers	Positive attitude, positive subjective norm, and perceived behavioral control in terms of obeying speed limit were found to be more prevalent among Swedish drivers compared to Turkish drivers after adjusting for age and gender
Yasak et al. (2009)	Cross-sectional	Turkey	200 Drivers	Some factors such as driving experience and academic level were found to be associated with driving anger
Yildirim and Lajunen	Cross-sectional	Ankara	N/A	Average speed was found to be above the speed limit of 50 km/h at all times throughout the study. The percentage of vehicles exceeding the speed limit was 97.1% Speed was higher during the evenings as well as during Ramadan 20.2% of the observed participants wore seat belts
Yilmaz et al. (2004)	Cross-sectional	Eskisehir	600 Drivers	Most participants did not pay adequate attention to roads and believed that road traffic crashes were the result of fate

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