Severity of injuries in different modes of transport, expressed with disability-adjusted life years (DALYs)

Background: Health impact assessment (HIA) studies are increasingly predicting the health effects of mode shifts in traffic. The challenge for such studies is to combine the health effects, caused by injuries, with the disease driven health effects, and to express the change in the health with a common health indicator. Disability-adjusted life year (DALY) combines years lived disabled or injured (YLD) and years of life lost (YLL) providing practical indicator to combine injuries with diseases. In this study, we estimate the average YLDs for one person injured in a transport crash to allow easy to use methods to predict health effects of transport injuries. Methods: We calculated YLDs and YLLs for transport fatalities and injuries based on the data from the Swedish Traffic Accident Data Acquisition (STRADA). In STRADA, all the fatalities and most of the injuries in Sweden for 2007-2011 were recorded. The type of injury was recorded with the Abbreviated Injury Scale (AIS) codes. In this study these AIS codes were aggregated to injury types, and YLDs were calculated for each victim by multiplying the type of injury with the disability weight and the average duration of that injury. YLLs were calculated by multiplying the age of the victim with life expectancy of that age and gender. YLDs and YLLs were estimated separately for different gender, mode of transport and location of the crash. Results: The average YLDs for injured person was 14.7 for lifelong injuries and 0.012 for temporal injuries. The average YLDs per injured person for lifelong injuries for pedestrians, cyclists and car occupants were 9.4, 12.8 and 18.4, YLDs, respectively. Lifelong injuries sustained in rural areas were on average 31% more serious than injuries in urban areas. Conclusions: The results show that shifting modes of transport will not only change the likelihood of injuries but also the severity of injuries sustained, if injured. The results of this study can be used to predict DALY changes in HIA studies that take into account mode shifts between different transport modes, and in other studies predicting the health effects of traffic injuries.