Prevalence of drink driving and speeding in China: a time series analysis from two cities

Evaluating the effectiveness of implementing a more severe law on prevention of road traffic injury mortality in mainland China: an interrupted time series study based on national mortality surveillance

BACKGROUND

In China, road traffic injury (RTI) is the seventh-leading cause of death More than 1.5 million adults in China live with permanent disabilities due to road traffic accidents. In 2011, the Chinese government implemented a more severe law that increased the penalty points and fines for persons charged with drink-driving as a criminal offence.

OBJECTIVES

This study evaluated the short-term and long-term effects of the drink-driving law. It also aimed to establish whether punishments of increased severity resulted in greater reductions in RTI mortality.

METHODS

RTI mortality data was obtained from the Disease Surveillance Points System. A two-level interrupted time series model was used to analyse daily and monthly road traffic mortality rates, accounting for the varying trends among counties.

RESULTS

The overall RTI mortality rate showed a decreasing trend from 2007 to 2015 in mainland China, especially after 2011, and similarly decreasing trends were noted among males and females and in urban and rural areas. After the Criminal Law and Road Traffic Law amendment was implemented in 2011, charging drink-driving as a criminal offence, the immediate daily RTI mortality rate reduced by 1.57% (RR=0.9843, 95% CI: 0.9444 to 1.0259), while the slope change significantly decreased by 0.04% (RR=0.9996, 95% CI: 0.9994 to 0.9997) compared with the period before the Law was revised. Stratified analysis showed that the effect size of the law was higher for males in urban and high socioeconomic circumstances (SEC) than females in rural and low and moderate SEC. Meanwhile, the increase in penalty points for dangerous driving behaviours showed no significant effects.

CONCLUSION

Evidence was found that charging criminal responsibility for drink-driving is associated with reducing RTI deaths in China.

Assessing alcohol consumption in a Chinese urban population and a university town using high temporal resolution wastewater-based epidemiology

BACKGROUND

Alcohol consumption is a leading preventable risk factor for morbidity and mortality in China. Understanding drinking patterns provides important data to inform public health policies in alcohol control, especially in specific groups like university students. This study aims to assess the alcohol consumption patterns and level of use in an urban population and a university town in a Chinese city using wastewater-based epidemiology (WBE).

METHODS

Daily wastewater sample was collected from an urban catchment (n = 270) and every Wednesday's sample from a university town of 10 university campus (n = 43) in 2017-2018. Concentration of alcohol consumption biomarker in wastewater, ethyl sulfate, was measured by direct injection LC-MS/MS analysis. Per capita daily alcohol consumption was then back calculated for assessment purposes.

RESULTS

Per capita daily alcohol consumption was 1.4 ± 0.6 mL/ person aged 15 + /day (EPD) (range: 0.2-4.9) in the urban catchment and 1.3 ± 0.6 EPD (range: 0.3-2.6) in the university town. Trends of alcohol consumption were stable in both catchments in 2017-2018. Alcohol consumption on weekends (1.5 EPD) and weekdays (1.4 EPD) were at a similar level. Additionally, no difference was observed between holidays (1.5 EPD) and non-holidays (1.4 EPD).

CONCLUSION

There is a stable weekly drinking level in the studied urban population, which is different compared to studies conducted in Western countries. Our study suggested a similar consumption level between the urban population and university students. Drinking during weekdays could negatively affect China's economic productivity and future public health policies could be adapted to reflect this pattern of drinking.

Did "Conduce Sin Alcohol" a Program that Monitors Breath Alcohol Concentration Limits for Driving in Mexico City Have an Effect on Traffic-Related Deaths?

In September 2003, Mexico City introduced "Conduce sin Alcohol" (CSA)-drive without alcohol-a program that monitors breath alcohol concentration limits among drivers to reduce road traffic crashes. To our knowledge, no study has evaluated the impact of this program on mortality. We estimated the effect of CSA on the monthly rate of traffic-related deaths (deaths per one million people) in Mexico City. We applied interrupted time series analyses (ITSA) using monthly data from 1998 to 2016, adjusting for number of people covered by a public health insurance, monthly number of public health care facilities in the city, monthly average rain precipitation in milliliters, and number of vehicles registered. Our results show a statistically significant average reduction in the monthly trend of traffic-related deaths of 0.08 per 1 million people/per month after the program was implemented relative to the pre-intervention trend. The relative difference comparing pre- and post-intervention predicted values from the ITSA model shows that there was a 23.2% reduction in the fatality rate. Findings from this study can be used to scale up programs to monitor alcohol concentration limits among drivers in cities with high alcohol-related crashes and deaths where the program has not been implemented.

Speeding in the city of Xalapa, Mexico: Prevalence and associated factors

OBJECTIVE

To estimate the prevalence of speeding in the city of Xalapa, Veracruz, in Mexico and to identify factors potentially associated to this risk behavior.

METHODS

A cross-sectional study was conducted on December 2019 in Xalapa, Veracruz. Speed measurement was conducted in a random sample of 10% of all the main roads in the urban area (n = 12). Observations were conducted over the course of one week at different times spending no more than 1.5 h in each site at a time. All vehicles circulating in each observation site during the data collection were included in the sample. Characteristics of drivers, vehicles and the environment were also collected and analyzed, using logistic regression analysis and a multiple ordinal regression model to identify factors associated to speeding and more serious violations of speed limits.

RESULTS

Average speed of the 3,390 vehicles observed was 50.97 km/h. Prevalence of speeding was 65.66% (95%-CI: 64.04-67.26%); 26.96% (95%-CI: 25.47-28.49) exceeded the speed limit by 50%. Speeding and more serious violations of speed limits were more frequent in light vehicles, residential zones and during weekends. More serious violations of speed limits were also more frequent on smaller roads, where speed limit were lower and during morning hours.

CONCLUSIONS

The great majority of vehicles transgress speed limits in Xalapa, Veracruz. Our results support the urgent need to implement speed control measures in the city. Changes in road infrastructure design, as well as promoting a comprehensive speeding legislation (with adequate speed limits and correctly enforced) aimed at reducing exposure to this key risk factor are recommended. As evaluation of road safety interventions is key, our data could be used as a baseline to evaluate the effects and impact of future interventions implemented in this Mexican city.

Drink driving and speeding in Sao Paulo, Brazil: empirical cross-sectional study (2015-2018)

OBJECTIVES

To evaluate the prevalence of drink driving and speeding during 2015-2018 in Sao Paulo, Brazil.

DESIGN

Cross-sectional observational study.

SETTING

Roads representing the five main regions of the city of Sao Paulo in Brazil, one of the world's largest urban areas.

PARTICIPANTS

Drivers (N=10 294) stopped at routine roadside breath testing checkpoints and those driving in selected roads for speeding measurement (N=414 664).

PRIMARY AND SECONDARY OUTCOME MEASURES

Microwave radar guns were used to measure the speed of vehicles, while the prevalence of drivers under the influence of alcohol was observed in police checkpoints. Data were collected during three consecutive years (2016-2018) following a baseline study established in 2015 using a city-level representative sample of observational data representing all days of the week.

RESULTS

Alcohol-related fatalities kept at a constantly high percentage, with 39% of road traffic deaths involving alcohol in 2016. Drivers testing above the legal breath alcohol concentration limit showed a decreasing trend, from 4.1% (95% CI 2.9% to 5.5%) at baseline to 0.6% (95% CI 0.2% to 1.2%) in the end of 2018 (p<0.001); however, more than half of drivers refused breath tests at checkpoints despite steep legal penalties. The prevalence of speeding among all vehicles decreased from 8.1% (95% CI 7.9% to 8.2%) to 4.9% (95% CI 4.7% to 5.1%) by the end of 2016 (p<0.001), but then increased again to 13.5% (95% CI 13.2% to 13.9%) at the end of the study period (p<0.001).

CONCLUSIONS

Drink driving rates have reduced, likely due to an increase in drivers refusing breath alcohol tests, while speeding rates have increased significantly by the end of the study period, particularly among motorcycles. Future strategies aiming at reducing road traffic injuries in the major Brazilian city should tailor drink driving and speeding enforcement based on the new evidence provided here.

Evaluating the impact of criminalizing drunk driving on years of life lost due to road traffic deaths in one megacity, China

Objective: Road safety is an important public health issue worldwide. However, few studies have analyzed the association between criminalizing drunk driving and years of life lost (YLL) due to road traffic deaths (RTDs). Our study can provide useful information about this policy. Methods: We used interrupted time-series analysis to find the changes in monthly YLL and RTD before and after law enforcement began using RTD data from 2008 to 2014 in Tianjin. Results: After adjustment for seasonality, months, holidays, and the number of people in each district, criminalizing drunk driving was followed by a 11.1% (95% confidence interval [CI], 1.1-21.1%) reduction in risk of RTDs and a corresponding 778.1-year (95% CI, 200-1,355.1) reduction in monthly YLL. The reduction in YLL was especially significant among males, those aged 16-64 years old, and suburban residents. Conclusions: This study highlights that the law can lead to a reduction in YLL due to RTDs in Tianjin, China. Large immediate public health benefits resulted from the new road traffic law in China. YLL provides a complementary measure for examining the effect of criminalization on drunk driving RTDs.