Safety Science 50 (2012) 10091018

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Trends in motor vehicle crash mortality in Europe, 19802007

Chiara Orsi a,, Paola Bertuccio b, Anna Morandi a, Fabio Levi c, Cristina Bosetti b, Carlo La Vecchia b,d
a
Centro Interdipartimentale di Studi e Ricerche sulla Sicurezza Stradale, Dipartimento di Scienze Sanitarie Applicate e Psicocomportamentali, Universit degli Studi di Pavia,
Via Bassi 21, 27100 Pavia, Italy
b
Dipartimento di Epidemiologia, Istituto di Ricerche Farmacologiche Mario Negri, Via La Masa 19, 20156 Milan, Italy
c
Unit depidmiologie du cancer et Registres Vaudois et Neuchtelois des Tumeurs, Institut de mdecine sociale et prventive (IUMSP),
Centre Hospitalier Universitaire Vaudois et Universit de Lausanne, CHUV-Falaises 1, 1011 Lausanne, Switzerland
d
Dipartimento di Medicina del Lavoro, Universit degli Studi di Milano, Via Commenda 10, 20122 Milan, Italy

a r t i c l e i n f o a b s t r a c t

Article history: Recent trends (19802007) in mortality from road trafc crashes in European countries, and, for compar-
Received 16 August 2011 ative purposes, in the USA and Japan were reviewed. Data came from the World Health Organisation
Received in revised form 29 November 2011 database. Age-standardised rates, at all ages and at 1524, 2564, P65 years, were computed. Joinpoint
Accepted 6 December 2011
regression analyses to evaluate signicant changes in trends were performed. In the European Union as a
Available online 29 December 2011
whole rates declined from 20.2 in 1987 to 13.5/100,000 in 2007 in men, and from 6.3 to 3.7/100,000 in
women; European Union rates remained lower than USA, but higher than Japanese ones. In 2007, the
Keywords:
highest male rates were in Lithuania (36.7/100,000), the Russian Federation (35.2), Ukraine (29.8), and
Road trafc crashes
Mortality
Latvia (28.5), and the lowest ones in the Netherlands (6.2) and Sweden (6.9); the highest female rates
International comparisons were in the Russian Federation (11.3), Lithuania (9.7), Belarus, Latvia, and Ukraine (around 8), and the
Trends lowest ones in Switzerland (1.7), the UK, and Nordic countries (around 2). Mortality from motor vehicle
Joinpoint regression crashes declined in northern and western European countries and though to a lesser extent in south-
ern European countries, too. Mortality trends were also favourable in the Czech Republic and Poland since
the mid 1990s, whereas they were still upwards in Romania and the Russian Federation. No trend was
observed in Hungary and Ukraine. Trends were consistent in various age groups considered. Thus, addi-
tional urgent and integrated intervention is required to prevent avoidable deaths from motor vehicle
crashes, particularly in selected central and eastern European countries.
2011 Elsevier Ltd. All rights reserved.

1. Introduction In several high-income countries, the fall in death rates from

Road trafc deaths, disabilities, and injuries are a major global
public health issue. Worldwide, the number of people killed in road
trafc crashes each year is estimated around 1.3 million (World
Health Organisation, 2009; Anonymous, 2011). In addition,
between 20 and 50 million people globally are estimated to be
injured or disabled each year.
In the European Union (EU) with about 500 million inhabit-
ants and 230 million motor vehicles a total of 1200,000 injuries
and 34,500 deaths occur every year from road crashes (European
Commission, 2011a). In the USA, there were 33,808 deaths in
2008, in a population of 309 million inhabitants with 256 million
registered motorised vehicles (National Highway Trafc Safety
Administration, 2010).
Corresponding author. Tel.: +39 0382987552; fax: +39 0382987570.
E-mail addresses: chiara.orsi@unipv.it (C. Orsi), paola.bertuccio@marionegri.it
(P. Bertuccio), amorandi@unipv.it (A. Morandi), Fabio.Levi@chuv.ch (F. Levi), cristina.
bosetti@marionegri.it (C. Bosetti), carlo.lavecchia@marionegri.it (C. La Vecchia).
motor vehicle crashes has been one of the most favourable changes
in mortality from any cause. These declines in mortality reect a
large number of advancements in road safety policy, distribution
and crashworthiness of the eet, road network characteristics, as
well as human behaviour and attitudes, including alcohol drinking
(Page, 2001).
This paper presents recent trends in mortality from motor vehi-
cle crashes in Europe, and, for comparative purposes, in the USA
and Japan.
2. Materials and methods
We abstracted ofcial death certication data from road trafc
crashes over the period 19802007 for 33 European countries, plus
the USA and Japan, from the World Health Organisation (WHO)
database as available on electronic support (World Health
Organisation, 2011). The WHO database included all deaths from
road crashes, independently from the time elapsed since the crash.
Estimates of the resident population, based on ofcial censuses,
were derived from the same WHO database. Besides the United

0925-7535/$ - see front matter 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.ssci.2011.12.008
1010 C. Orsi et al. / Safety Science 50 (2012) 10091018

Men 0-85 yrs Women 0-85 yrs

30 15

USA
25
Japan
Death rate/100 000

Death rate/100 000

EU
20 10

15

10 USA 5
Japan
5 EU

0 0
1980-84 1985-89 1990-94 1995-99 2000-04 2005-07 1980-84 1985-89 1990-94 1995-99 2000-04 2005-07
Calendar period Calendar period

Men 15-24 yrs Women 15-24 yrs

60 25
USA
50 Japan
20
EU
Death rate/100 000

Death rate/100 000

40
15
30
10
20 USA
Japan
5
10 EU

0 0
1980-84 1985-89 1990-94 1995-99 2000-04 2005-07 1980-84 1985-89 1990-94 1995-99 2000-04 2005-07
Calendar period Calendar period

Fig. 1. Trends in age-standardised (world population) mortality rates from motor vehicle crashes per 100,000 men and women in the European Union (EU), the USA and
Japan, at all ages and at age 1524 years, 19802007.

Kingdom as a whole, England and Wales, and Scotland were also
considered separately. For Portugal data were available up to
2003, for Belgium up to 2004, for Slovakia, Spain and the USA up
to 2005, for Denmark, Germany, Luxembourg, the Russian Federa-
tion and Ukraine up to 2006. The EU was dened as the 27 member
states as in 2007, excluding Cyprus, whose data were not available.
In a few countries, data were missing for one or more calendar
years; no extrapolation was made for missing years.
During the calendar period considered, three different Revisions
of the International Classication of Diseases (ICDs) were used
(8th ICD code = E810823, 9th ICD code = E810819, 10th ICD
code = V01V99). Since no major changes were introduced in the
procedure of coding of road trafc crashes, classication of deaths
was recoded for all calendar periods and countries according to
the 10th Revision of the ICD (World Health Organisation, 1992).
From the matrices of certied deaths and resident populations,
we computed age-standardised rates 1 at all ages and in three sep-
arate age groups (1524, 2564, P65 years), on the basis of the
world standard population (Doll and Smith, 1982).
To identify signicant changes in trends for 18 selected major
countries, we performed joinpoint regression analysis using the
Joinpoint software from the Surveillance Research Program of
the US National Cancer Institute (National Cancer Institute, 2011).
The analysis identies the best tting points (the joinpoints)
1
An age-standardised rate is a weighted average of the age-specic (crude) rates,
where the weights are the proportions of persons in the corresponding age groups of a
standard population. This allows to reduce the potential confounding effect of age and
to compare age-standardised rates computed using the same standard population
(Doll and Smith, 1982).
where a signicant change in the linear slope of the trend (in a
log-scale) is detected (Kim et al., 2000). The analysis starts with
the minimum number of joinpoints (e.g. 0 joinpoints, which is a
straight line on a log scale), and tests whether one or more join-
points (up to 3) are signicant and must be added to the model.
We then estimated the annual percent change (APC) for each of
the identied trends by tting a regression line to the natural loga-
rithm of the rates using calendar year as the regressor variable [i.e.,
given y = a + bx, where y = ln(rate) and x = calendar year, the APC is
estimated as 100  (eb 1)].
3. Results
In the EU (as in Japan) rates decreased, particularly since 1990
in both sexes, whereas in the USA rates declined up to the mid
1990s, to level off thereafter in men, but not in women (Fig. 1).
Similar trends were observed at all ages and in younger population
(age 1524 years).
Table 1 gives the overall age-standardised mortality rates from
motor vehicle crashes per 100,000 men and women in 33 European
countries, plus the EU, the USA and Japan around 1987 (1985
1999), 1997 (19951999) and in 2007, and the corresponding per-
cent changes in rates. In the EU overall, between 1987 and 2007
rates declined from 20.2 to 13.5/100,000 men, and from 6.3 to
3.7/100,000 women; corresponding declines were from 25.5 to
21.0/100,000 men, and from 10.4 to 8.5/100,000 women in the
USA, and from 14.9 to 6.5/100,000 men, and from 4.4 to 2.3/
100,000 women in Japan. In 1987, among European men the high-
est rates were in Portugal (40.2/100,000), Latvia (37.1), Lithuania
 C. Orsi et al. / Safety Science 50 (2012) 10091018 1011

Table 1
Overall age-adjusted (world population) mortality rates from motor vehicle accidents per 100,000 men and women in selected European countries, the European Union as a
whole, Japan and the USA, around 1987 (19851989), 1997 (19951999) and in 2007, and corresponding percent changes in rates.

Men Women
1987 1997 2007 No. of % Change % Change 1987 1997 2007 No. of % Change % Change
deathsa 1997/1987 2007/1997 deathsa 1997/1987 2007/1997
Austria 26.40 16.88 11.73 530 36.05 30.51 7.49 5.34 3.23 172 28.70 39.51
Belarus (1995, 19971999) 22.00 25.39 26.45 1427 15.40 4.17 5.42 7.15 8.05 493 31.77 12.64
Belgium (2004) 25.81 20.92 16.81 923 18.95 19.63 8.71 7.02 4.36 275 19.37 37.94
Bulgaria 16.46 14.08 18.67 803 14.46 32.60 5.57 4.45 5.41 267 20.08 21.49
Croatia 28.29 21.72 22.16 539 23.22 2.00 7.61 5.85 5.28 139 23.19 9.73
Czech Republic (19861989) 13.35 20.18 15.96 949 51.17 20.88 4.27 6.29 4.67 299 47.55 25.74
Denmark (2006) 17.33 14.49 7.97 231 16.40 45.02 6.75 4.58 3.05 93 32.18 33.49
Estonia 27.36 34.65 22.41 165 26.66 35.34 8.08 7.92 5.61 52 2.06 29.18
Finland 15.81 12.89 11.60 352 18.48 10.04 6.35 4.32 3.91 115 31.90 9.65
France 24.41 18.39 11.01 3519 24.63 40.15 8.45 6.36 2.95 1124 24.68 53.65
Germany (2006) 16.45 14.65 8.81 3946 10.92 39.83 5.73 4.99 2.77 1413 12.91 44.53
Greece 27.05 28.65 21.86 1395 5.90 23.71 8.20 8.53 5.60 381 4.04 34.28
Hungary 23.88 22.28 20.09 1163 6.67 9.82 7.38 6.27 5.47 366 15.02 12.82
Iceland 13.90 13.35 9.79 17 3.97 26.65 6.33 4.16 0.54 1 34.34 87.01
Ireland 18.41 15.82 9.54 231 14.08 39.70 5.84 5.38 3.04 74 7.86 43.44
Italy 21.05 18.32 14.33 4669 12.97 21.77 5.86 4.98 3.16 1162 15.10 36.51
Latvia 37.06 42.70 28.51 361 15.22 33.23 9.57 11.57 8.23 125 20.87 28.88
Lithuania 34.37 33.72 36.69 665 1.88 8.79 9.81 9.59 9.67 212 2.16 0.76
Luxembourg (2006) 32.84 20.81 11.71 30 36.63 43.71 8.38 6.75 3.70 10 19.46 45.20
Malta 7.06 7.94 5.18 13 12.47 34.77 1.68 1.25 1.20 3 25.90 3.81
Netherlands 12.09 10.19 6.21 575 15.70 39.08 4.79 3.63 2.29 224 24.19 36.90
Norway 13.06 11.83 7.81 203 9.44 33.96 4.75 3.89 2.34 68 18.04 39.99
Poland (19951996, 1999) 23.03 26.52 21.09 4644 15.16 20.48 5.39 6.85 5.83 1420 27.16 14.90
Portugal (2003) 40.23 28.29 25.72 1561 29.68 9.07 9.48 7.47 6.81 436 21.20 8.92
Romania (1989) 13.09 17.58 21.61 2724 34.27 22.93 4.34 5.99 6.67 920 38.10 11.44
Russian Federation (2006) 25.23 29.98 35.24 27,850 18.82 17.54 6.64 9.49 11.31 10,391 42.91 19.25
Slovakia (2005) 25.69 19.32 594 24.81 6.49 5.33 170 17.94
Slovenia 32.22 25.58 22.56 256 20.60 11.82 8.61 7.03 5.49 63 18.34 21.88
Spain (2005) 24.79 20.10 15.51 3876 18.95 22.84 7.35 5.84 3.82 1020 20.51 34.60
Sweden 12.45 7.67 6.86 367 38.35 10.54 4.93 2.96 2.27 132 39.92 23.54
Switzerland 20.19 12.30 7.55 325 39.09 38.60 5.96 4.00 1.69 90 32.91 57.82
Ukraine (2006) 24.08 18.61 29.82 7527 22.71 60.25 6.01 5.11 8.08 2358 15.06 58.11
United Kingdom (UK) 12.86 8.22 7.87 2559 36.08 4.25 4.49 2.76 2.20 832 38.50 20.49
UK, England and Wales 12.44 7.94 7.57 2195 36.22 4.55 4.36 2.63 2.09 712 39.56 20.52
UK, Scotland 15.32 10.14 8.71 233 33.81 14.10 5.31 3.64 2.48 79 31.38 31.86
European Union 20.23 17.15 13.51 37,101 15.21 21.24 6.32 5.32 3.72 11,360 15.79 30.22
USA (2005) 25.54 20.55 20.98 33,546 19.54 2.13 10.39 9.51 8.53 14,171 8.51 10.25
Japan 14.89 13.17 6.50 5559 11.56 50.66 4.40 4.33 2.25 2709 1.62 47.99
a
In the last available calendar year

(34.4), Luxemburg (32.8), and Slovenia (32.2), and the lowest ones
were in the Netherlands (12.1), Sweden (12.5), and the UK (12.9).
In European women the highest rates were in Lithuania (9.8),
Latvia (9.6), and Portugal (9.5), and the lowest ones in the Czech
Republic, Romania, UK, Sweden, the Netherlands and Norway (be-
tween 4 and 5). Declines in rates, particularly over the last decade,
were observed in most European countries, the major exception
being Romania, Russia, and a few other countries of Central and
Eastern Europe (CEE). In 2007, in men the highest rates were in
Lithuania (36.7/100,000), the Russian Federation (35.2), Ukraine
(29.8), and Latvia (28.5), and the lowest ones in the Netherlands
(6.2), and Sweden (6.9). In women, the highest rates were in the
Russian Federation (11.3), Lithuania (9.7), Belarus, Latvia, and
Ukraine (around 8), and the lowest ones in Switzerland (1.7), the
UK, and Nordic countries (around 2).
Table 2 gives the rates for the population aged 1524 years.
Corresponding gures at age 2564 years and age 65 years and
over are given in Table 3 and Table 4, respectively. Geographical
patterns and time trends in mortality from motor vehicle crashes
in various age groups were similar to those for the whole popula-
tions. Thus, in all age groups rates in 2007 were higher in the Baltic
countries, the Russian Federation and other CEE countries for both
sexes, while the lowest ones were in northern European countries.
Declines in rates were observed consistently in all age groups, but,
as for overall mortality, unfavourable patterns were observed in
Romania, Russia, and a few other CEE countries, particularly in
the young (age 1524 years).
Table 5 shows the joinpoint analysis for motor vehicle crash
mortality in men from selected European countries over the period
19802007, at all ages and at age 1524 years over recent calendar
years. Mortality declined in men from northern and western
European countries (Denmark, France, Germany, the Netherlands,
Sweden, Switzerland and the UK) and though to a lesser extent
in those from southern European ones (Italy, Greece, Portugal),
with somewhat more favourable declines in younger men. Mortal-
ity trends were also favourable in the Czech Republic and Poland
since the mid 1990s, whereas they were upwards in Romania
and the Russian Federation, and no consistent pattern was ob-
served in Hungary and Ukraine. In several countries, however,
trends were not linear. Thus, in France, Italy and Sweden they were
upwards in mid-late 1990s, particularly among young men, in
Spain they increased in the 1980s, in Germany rates were stable
between the mid 1980s and the mid 1990s, and declined only
thereafter, and in most CEE countries as well as in Russia there
were substantial rises around the late 1980s/early 1990s.
Corresponding analysis for women is given in Table 6. Although
rates were lower than those in men, trends were consistent with
male ones in most countries, with favourable patterns in western,
northern, but also southern Europe, and upward pattern in
Romania and Russia.
1012 C. Orsi et al. / Safety Science 50 (2012) 10091018

Table 2
Age-adjusted (world population) mortality rates from motor vehicle accidents per 100,000 men and women aged 1524 years in selected European countries, the European Union
as a whole, Japan and the USA, around 1987 (19851989), 1997 (19951999) and in 2007, and corresponding percent changes in rates.

Men Women
1987 1997 2007 No. of % Change % Change 1987 1997 2007 No. of % Change % Change
deathsa 1997/1987 2007/1997 deathsa 1997/1987 2007/1997
Austria 60.96 41.47 25.78 134 31.97 37.83 13.45 10.71 7.27 36 20.37 32.12
Belarus (1995, 19971999) 33.24 32.88 32.54 269 1.08 1.04 6.62 9.58 11.43 88 44.67 19.32
Belgium (2004) 54.05 41.15 34.90 228 23.88 15.19 13.23 11.91 6.88 43 10.02 42.21
Bulgaria 19.36 16.28 28.24 150 15.89 73.43 6.02 6.29 12.28 61 4.53 95.15
Croatia 34.99 33.17 41.16 123 5.22 24.09 8.97 9.02 10.08 28 0.56 11.82
Czech Republic (19861989) 19.81 31.13 28.46 202 57.16 8.56 4.89 9.05 6.13 40 85.29 32.29
Denmark (2006) 35.47 30.96 20.19 63 12.74 34.78 8.99 6.98 6.40 19 22.40 8.33
Estonia 37.02 48.74 44.78 48 31.66 8.12 10.16 9.97 7.79 8 1.84 21.86
Finland 28.87 18.54 19.51 66 35.80 5.26 8.56 6.29 9.07 29 26.54 44.25
France 49.09 37.45 22.37 901 23.72 40.28 13.91 10.90 4.96 194 21.62 54.52
Germany (2006) 38.11 35.96 18.72 927 5.64 47.95 10.67 11.43 5.60 262 7.18 50.99
Greece 47.35 49.34 43.29 296 4.20 12.27 11.80 11.68 9.13 57 1.00 21.80
Hungary 35.02 24.38 22.78 152 30.38 6.57 9.09 8.36 7.41 47 7.93 11.40
Iceland 28.50 22.47 12.55 3 21.18 44.16 13.87 8.63 0.00 0 37.76 100.00
Ireland 36.73 31.22 19.09 60 14.99 38.85 8.65 8.02 4.92 15 7.30 38.67
Italy 37.77 35.78 27.36 859 5.26 23.53 8.52 8.54 6.86 200 0.19 19.67
Latvia 56.91 62.27 33.28 61 9.40 46.55 12.19 18.62 10.46 18 52.73 43.83
Lithuania 47.72 48.30 53.91 148 1.21 11.63 11.00 14.49 11.34 29 31.74 21.77
Luxembourg (2006) 84.88 37.33 20.10 6 56.02 46.16 20.75 18.84 10.78 3 9.20 42.78
Malta 19.69 14.59 9.81 3 25.90 32.78 2.46 2.23 3.33 1 9.47 49.52
Netherlands 23.23 20.66 13.27 134 11.07 35.77 7.56 6.09 3.94 38 19.43 35.38
Norway 34.04 23.48 12.86 39 31.01 45.26 8.93 6.60 2.42 7 26.08 63.36
Poland (19951996, 1999) 28.24 34.66 29.47 930 22.72 14.96 4.79 8.78 9.36 270 83.18 6.54
Portugal (2003) 61.84 46.78 39.56 289 24.35 15.44 9.54 10.58 9.28 62 10.80 12.22
Romania (1989) 7.40 14.19 24.11 401 91.79 69.86 2.66 5.58 8.31 128 109.40 48.94
Russian Federation (2006) 34.82 39.06 44.84 5620 12.15 14.80 8.02 13.81 16.29 1929 72.28 17.97
Slovakia (2005) 31.17 23.05 104 26.06 8.08 6.34 26 21.55
Slovenia 51.09 42.21 46.47 64 17.39 10.10 14.32 11.64 8.08 10 18.71 30.64
Spain (2005) 42.23 32.95 27.74 754 21.97 15.81 11.79 8.89 6.72 171 24.59 24.37
Sweden 28.03 12.32 14.58 88 56.06 18.34 8.68 4.43 4.19 24 48.98 5.41
Switzerland 43.95 22.79 14.42 67 48.14 36.74 10.76 6.88 2.45 11 36.05 64.45
Ukraine (2006) 37.40 23.45 38.70 1496 37.29 65.04 7.65 6.95 11.66 419 9.23 67.79
United Kingdom (UK) 28.36 17.63 16.57 696 37.83 6.04 7.04 5.08 4.35 170 27.83 14.39
UK, England and Wales 27.98 16.97 15.79 588 39.36 6.95 6.99 4.89 4.15 144 30.01 15.20
UK, Scotland 28.76 21.62 20.43 70 24.83 5.51 7.19 6.05 5.07 16 15.95 16.23
European Union 37.57 31.33 24.12 7764 16.60 23.01 9.57 8.86 6.50 1961 7.39 26.65
USA (2005) 53.64 38.59 37.36 8169 28.06 3.19 19.52 16.78 15.11 3069 14.05 9.95
Japan 31.78 22.89 9.75 660 27.98 57.41 5.54 5.69 2.79 179 2.60 50.87
a
In the last available calendar year.

Table 3
Age-adjusted (world population) mortality rates from motor vehicle accidents per 100,000 men and women aged 2564 years in selected European countries, the European Union
as a whole, Japan and the USA, around 1987 (19851989), 1997 (19951999) and in 2007, and corresponding percent changes in rates.

Men Women
1987 1997 2007 No. of % Change % Change 1987 1997 2007 No. of % Change % Change
deathsa 1997/1987 2007/1997 deathsa 1997/1987 2007/1997
Austria 26.12 16.59 12.59 283 36.49 24.09 6.33 4.77 2.99 70 24.64 37.29
Belarus (1995, 19971999) 27.94 36.69 38.56 983 31.34 5.08 5.70 8.73 9.27 255 53.28 6.20
Belgium (2004) 26.86 23.79 19.93 527 11.43 16.22 8.51 7.00 5.08 135 17.72 27.45
Bulgaria 21.39 19.38 24.06 504 9.40 24.18 5.84 4.39 4.79 109 24.85 9.07
Croatia 37.26 26.10 26.50 312 29.94 1.50 7.53 5.32 4.23 49 29.29 20.49
Czech Republic (19861989) 14.95 25.66 20.28 601 71.64 20.96 4.02 6.52 5.12 154 62.34 21.56
Denmark (2006) 15.76 13.94 7.79 116 11.49 44.13 6.21 4.52 2.17 33 27.13 51.97
Estonia 33.39 48.22 26.56 88 44.45 44.93 8.87 9.34 5.57 21 5.32 40.35
Finland 14.88 14.66 13.36 191 1.43 8.91 6.27 4.01 3.52 49 36.09 12.24
France 26.86 20.76 13.08 1994 22.72 36.98 8.65 6.64 3.00 489 23.30 54.73
Germany (2006) 15.25 14.56 9.81 2161 4.49 32.65 4.60 4.25 2.55 571 7.48 40.00
Greece 31.55 35.02 25.30 772 11.01 27.75 8.10 9.25 5.67 168 14.18 38.65
Hungary 28.59 31.64 28.87 797 10.65 8.74 7.52 6.99 6.32 185 6.97 9.58
Iceland 10.33 15.09 12.42 10 46.12 17.68 5.19 3.29 1.20 1 36.64 63.60
Ireland 17.78 16.96 10.05 121 4.60 40.76 5.12 5.43 2.55 29 6.11 53.16
Italy 22.63 19.91 17.18 2678 11.99 13.74 5.99 5.18 2.90 471 13.52 43.97
Latvia 44.69 59.34 41.71 241 32.79 29.72 10.01 12.76 10.01 64 27.44 21.49
Lithuania 43.26 45.54 50.32 422 5.26 10.52 9.79 10.01 10.89 102 2.19 8.80
Luxembourg (2006) 30.17 26.16 17.39 22 13.27 33.54 6.84 6.17 3.73 5 9.77 39.62
 C. Orsi et al. / Safety Science 50 (2012) 10091018 1013

Table 3 (continued)

Men Women
1987 1997 2007 No. of % Change % Change 1987 1997 2007 No. of % Change % Change
deathsa 1997/1987 2007/1997 deathsa 1997/1987 2007/1997
Malta 5.85 9.27 5.55 6 58.52 40.11 0.87 1.16 1.08 1 33.79 7.19
Netherlands 11.14 10.10 5.99 264 9.32 40.70 4.12 3.15 1.93 85 23.68 38.62
Norway 10.11 12.38 8.98 112 22.46 27.42 3.80 3.52 3.14 38 7.33 10.96
Poland (19951996, 1999) 30.29 35.91 28.18 2936 18.57 21.54 5.17 6.63 5.79 613 28.23 12.74
Portugal (2003) 48.04 33.21 31.63 879 30.86 4.77 9.32 6.98 6.83 196 25.08 2.19
Romania (1989) 18.02 24.60 28.96 1697 36.53 17.74 4.47 6.25 7.08 426 39.67 13.30
Russian Federation (2006) 33.17 42.27 50.62 18,573 27.43 19.75 6.88 10.54 13.20 5337 53.09 25.27
Slovakia (2005) 35.15 28.18 411 19.85 6.58 5.95 92 9.50
Slovenia 38.41 31.23 26.29 153 18.69 15.82 7.56 6.27 3.66 21 17.13 41.59
Spain (2005) 29.65 25.06 18.79 2316 15.48 25.02 7.13 6.09 3.88 467 14.48 36.36
Sweden 11.60 8.91 7.84 194 23.21 11.95 4.38 2.87 2.46 61 34.54 14.14
Switzerland 18.25 12.81 7.88 163 29.85 38.46 5.12 3.54 1.71 34 30.85 51.67
Ukraine (2006) 30.86 26.41 42.77 5022 14.42 61.96 6.09 5.82 9.37 1243 4.49 61.20
United Kingdom (UK) 11.45 8.46 8.93 1388 26.13 5.67 3.72 2.40 1.89 308 35.52 21.17
UK, England and Wales 10.95 8.23 8.66 1193 24.84 5.26 3.55 2.27 1.81 262 35.97 20.34
UK, Scotland 15.08 10.44 9.53 126 30.75 8.72 4.76 3.41 2.08 29 28.37 38.92
European Union 22.01 19.92 16.57 21,762 9.52 16.79 5.96 5.25 3.67 4925 12.00 30.13
USA (2005) 26.86 22.96 25.17 19,362 14.53 9.62 9.97 9.63 8.95 7034 3.35 7.08
Japan 13.35 13.29 7.04 2464 0.45 47.06 3.96 3.90 1.93 722 1.67 50.49
a
In the last available calendar year.

Table 4
Age-adjusted (world population) mortality rates from motor vehicle accidents per 100,000 men and women aged 65 or more years in selected European countries, the European
Union as a whole, Japan and the USA, around 1987 (19851989), 1997 (19951999) and in 2007, and corresponding percent changes in rates.

Men Women
1987 1997 2007 No. of % Change % Change 1987 1997 2007 No. of % Change % Change
deathsa 1997/1987 2007/1997 deathsa 1997/1987 2007/1997
Austria 38.73 21.73 16.25 101 43.89 25.24 17.72 9.39 6.94 63 47.03 26.11
Belarus (1995, 19971999) 26.59 25.94 28.93 136 2.41 11.52 10.48 10.85 12.19 123 3.46 12.43
Belgium (2004) 36.57 26.76 18.40 151 26.84 31.24 16.36 11.75 8.13 88 28.17 30.86
Bulgaria 26.98 22.09 22.91 125 18.15 3.75 11.32 8.86 9.84 89 21.73 10.99
Croatia 43.83 40.44 29.27 89 7.74 27.61 14.95 13.88 10.15 53 7.13 26.91
Czech Republic (19861989) 30.41 30.14 21.80 134 0.90 27.66 12.28 12.63 8.46 88 2.85 33.02
Denmark (2006) 32.77 23.73 12.26 49 27.58 48.33 14.90 10.90 5.75 32 26.84 47.26
Estonia 42.06 30.26 32.36 26 28.04 6.93 19.79 9.42 13.35 20 52.40 41.70
Finland 37.51 30.54 21.91 83 18.58 28.25 15.32 10.15 5.28 31 33.73 47.97
France 32.10 22.70 11.84 536 29.27 47.86 14.34 10.38 5.21 369 27.61 49.83
Germany (2006) 23.84 15.19 11.27 778 36.31 25.78 11.88 6.89 4.84 518 42.05 29.73
Greece 41.12 46.06 29.42 298 12.00 36.12 17.88 19.54 10.50 137 9.27 46.25
Hungary 50.98 37.89 29.91 185 25.68 21.06 19.60 12.93 11.15 120 34.07 13.73
Iceland 30.72 14.34 14.82 3 53.32 3.30 13.44 6.61 0.00 0 50.82 100.00
Ireland 32.58 22.93 17.56 42 29.61 23.42 13.34 11.67 6.52 22 12.47 44.11
Italy 45.70 33.55 18.42 1039 26.59 45.09 13.43 9.88 5.74 453 26.43 41.91
Latvia 52.01 43.73 39.41 52 15.93 9.88 20.57 17.78 13.40 38 13.58 24.63
Lithuania 56.66 42.42 42.07 76 25.14 0.84 25.98 17.05 18.23 67 34.39 6.91
Luxembourg (2006) 26.39 17.69 8.58 2 32.97 51.50 11.25 6.61 3.23 2 41.24 51.15
Malta 9.85 11.36 14.97 4 15.41 31.79 10.47 3.29 2.06 1 68.59 37.41
Netherlands 26.51 19.07 13.64 161 28.05 28.49 11.33 8.56 5.50 82 24.41 35.83
Norway 19.01 19.74 14.80 44 3.83 25.04 9.82 8.50 5.22 21 13.46 38.61
Poland (19951996, 1999) 40.92 40.20 33.57 671 1.75 16.50 16.83 17.09 13.17 467 1.55 22.95
Portugal (2003) 68.53 45.50 47.16 353 33.60 3.65 23.24 15.46 12.48 144 33.49 19.27
Romania (1989) 25.87 30.22 39.16 529 16.80 29.58 11.40 12.55 15.35 311 10.08 22.28
Russian Federation (2006) 29.11 29.97 38.19 2450 2.94 27.42 13.54 14.45 17.54 2480 6.69 21.39
Slovakia (2005) 41.91 29.08 67 30.60 14.16 9.97 41 29.58
Slovenia 54.80 43.53 29.33 36 20.56 32.63 20.47 17.36 12.85 25 15.19 25.95
Spain (2005) 36.91 29.44 22.80 724 20.25 22.54 14.00 10.88 7.40 340 22.27 32.02
Sweden 20.28 13.13 10.48 81 35.27 20.18 9.66 5.87 3.67 42 39.29 37.42
Switzerland 36.82 20.79 14.14 83 43.54 32.00 12.79 7.70 3.70 41 39.81 51.99
Ukraine (2006) 26.79 20.16 32.53 817 24.74 61.38 10.28 7.33 11.66 586 28.68 59.07
United Kingdom (UK) 18.55 10.51 8.00 388 43.36 23.88 10.46 5.82 4.43 303 44.42 23.90
UK, England and Wales 18.11 10.20 7.79 341 43.70 23.58 10.29 5.74 4.37 265 44.20 23.92
UK, Scotland 22.00 11.81 8.45 32 46.33 28.41 11.90 6.55 4.62 29 44.93 29.47
European Union 32.83 24.80 18.17 6691 24.48 26.72 13.62 9.88 7.12 3893 27.44 27.95
USA (2005) 29.38 28.74 28.08 4658 2.16 2.30 15.22 15.42 13.02 3082 1.28 15.53
Japan 33.44 34.28 18.16 2310 2.50 47.02 15.53 15.92 9.60 1740 2.49 39.68
a
In the last available calendar year.
1014 C. Orsi et al. / Safety Science 50 (2012) 10091018

Table 5
Joinpoint analysis for mortality from motor vehicle accidents in men from selected European countries, at all ages and at 1524 years, 19802007.

Country Trend 1 Trend 2 Trend 3 Trend 4

Years APC Years APC Years APC Years APC
All ages
Bulgaria 19802007 0.12*
Czech Republic 19861994 1.32* 19942007 0.51*
Denmark 19801999 0.21* 19992006 0.75*
France 19801996 0.68* 19962000 0.11 20002007 1.21*
Germany 19801987 1.42* 19871991 0.78 19912006 0.62*
Greece 19801995 0.26* 19952007 0.73*
Hungary 19801987 0.10 19871990 4.03* 19901994 2.77* 19942007 0.16
Italy 19801987 0.88* 19871991 0.25 19912007 0.42*
Netherlands 19801988 0.74* 19882000 0.12 2002007 0.59*
Poland 19831987 1.16 19871990 4.89* 19901993 2.10 19932007 0.52*
Portugal 19801986 1.98* 19861991 0.46 19912000 2.34* 20002003 2.65
Romania 19892007 0.19
Russian Federation 19801987 1.33* 19871990 7.12 19901996 2.02 19962006 1.09*
Spain 19801982 3.25 19821990 1.45* 19901993 2.68 19932005 0.31*
Sweden 19801989 0.12 19891995 0.96* 19952000 0.63* 200,02,007 0.38*
Switzerland 19801994 0.94* 19942007 0.47*
UK 19801990 0.18 19901994 1.07* 19942007 0.01
Ukraine 19811986 1.41* 19861989 5.39* 19891999 2.02* 19992006 2.20*
1524 years
Bulgaria 19802003 0.04
Czech Republic 19861992 2.78* 19922007 0.34*
Denmark 19802006 0.67*
France 19801996 1.47* 19961999 1.43 19992007 2.32*
Germany 19801986 3.77* 19861995 0.30 19952006 1.95*
Greece 19801983 5.80 19832007 0.41*
Hungary 19801987 0.01 19871990 5.10 19901996 4.07* 19962007 0.11
Italy 19801988 1.09* 19881991 3.92 19911994 2.90 19942007 0.77*
Netherlands 19801987 1.65* 19872000 0.16 20002007 1.22*
Poland 19831987 1.58 19871990 6.09 19902007 0.99*
Portugal 19801986 3.36 19861991 3.14 19911999 4.70* 19992003 1.91
Romania 19892007 0.51*
Russian Federation 19801986 1.97* 19861989 8.34 19891996 1.66 19962006 1.10*
Spain 19801982 5.43 19821990 3.75* 19901994 5.41* 19942005 0.11
Sweden 19801988 0.26 19881995 2.63* 19952001 1.17* 20012007 0.66
Switzerland 19801990 1.37* 19901994 3.95 19942007 0.70*
UK 19801998 1.04* 19982007 0.20
Ukraine 19811986 0.73 19861989 7.78 19891997 3.98* 19972006 1.88*
*
Signicantly different from 0 (p < 0.05). APC, annual percent change.

Fig. A1, reported in Appendix A, shows joinpoint regression
analysis graphs, corresponding to Tables 5 and 6.
4. Discussion
The major nding of the present report is the decline in mortal-
ity rates from motor vehicle crashes between 1980 and 2007 across
Europe both in men and women at all ages. Between 1987 and
2007 the overall fall in the EU was 35% in men and 41% in women.
Mortality has long been decreasing in most northern and western
European countries, whereas trends were somewhat variable in
countries of southern Europe and particularly of CEE. Rates were
higher among young people and among men as compared to
women.
In most high income countries of North America and Europe,
declining trends in mortality have started in the 1970s, but favour-
able trends were larger over most recent years. Further, recent
trends became favourable in middle-income countries of central
and eastern Europe, as well as in Spain, Portugal and Greece,
although mortality has showed upward trends in the 1990s (La
Vecchia et al., 1994).
The inconsistent trends in CEE countries around the 1990s are
due to the dissolution of the Soviet Union, and the consequent
socio-economic changes. The political and social changes have as
a consequence, on one hand, the increasing number of motor
vehicles, and on the other hand, the decrease of the political weight
of road safety and the decrease in police enforcement. In Hungary,
for instance, from 1987 to 1990 there was a deteriorating trend,
mainly due to the change of the political and social systems; from
1991 to 2000 there was an important reduction in fatalities (more
than 50%), probably due to the introduction of safety measures,
such as the First National Road Safety Programme (European
Commission, 2011b); from 2001 to 2006 there was a deteriorating
trend again mainly due to the increase in speed limits outside
built-up areas; from 2007 until now there was a great decrease
in fatalities, mainly due to consistent road safety measures and
to the economic recession (Holl et al., 2010).
Similarly, in Germany the upward trends between the mid
1980s and mid 1990s are largely due to the re-unication with
the former German Democratic Republic (Winston et al., 1999).
The fall in mortality rates in the EU overall and in many coun-
tries can be explained by multisectoral strategic plans that have
been implemented. In fact, the inclusion of road safety in the polit-
ical agenda and the subsequent implementation of several road
safety interventions have reduced the number of deaths in road
trafc collisions (Koornstra et al., 2002; Novoa et al., 2011). The dif-
ferences in trends across European countries are at least in part
attributable to different adoption of road safety policies and their
effectiveness. In fact, building capacity for systematic safety man-
agement is a long-term process that in western and northern coun-
tries has developed over an extended period of motorisation: some
 C. Orsi et al. / Safety Science 50 (2012) 10091018 1015

Table 6
Joinpoint analysis for mortality from motor vehicle accidents in women from selected European countries, at all ages and at 1524 years, 19802007.

Country Trend 1 Trend 2 Trend 3 Trend 4

Years APC Years APC Years APC Years APC
All ages
Bulgaria 19802003 0.08* 20032007 0.41
Czech Republic 19861995 0.37* 19951998 0.45 19982002 0.19 20022007 0.45*
Denmark 19802006 0.17*
France 19802001 0.21* 20012007 0.48*
Germany 19801987 0.45* 19871990 0.23 19902002 0.16* 20022006 0.37*
Greece 19801996 0.06 19962007 0.34*
Hungary 19801987 0.10 19871990 4.03* 19901994 2.77* 19942007 0.16
Italy 19802007 0.12*
Netherlands 19802007 0.14*
Poland 19831987 0.28 19871990 0.96 19902007 0.11
Portugal 19801995 0.07 19952000 0.87* 20002003 0.93
Romania 19892007 0.05
Russian Federation 19801987 0.20 19871991 1.12* 19911996 0.20 19962006 0.34*
Spain 19801982 1.10 19821989 0.44* 19891993 0.50 19932005 0.14*
Sweden 19801990 0.02 19901994 0.41 19942007 0.07*
Switzerland 19801982 0.40 19821985 0.76 19852007 0.21*
UK 19802000 0.14* 20002007 0.02
Ukraine 19811985 0.28 19851990 0.71 19901999 0.43 19992006 0.58
1524 years
Bulgaria 19802003 0.07
Czech Republic 19862001 0.38* 20012007 0.73*
Denmark 19802006 0.21*
France 19801996 0.42* 19961999 0.52 19992007 0.86*
Germany 19801983 0.15 19831986 1.24 19861998 0.11* 19982006 0.76*
Greece 19801984 1.26* 19842007 0.14*
Hungary 19801987 0.01 19871990 5.10 19901996 4.07* 19962007 0.11
Italy 19802007 0.06*
Netherlands 19802007 0.22*
Poland 19831987 0.31 19871991 0.70* 19912007 0.11*
Portugal 19801995 0.16 19952003 0.47
Romania 19892007 0.22*
Russian Federation 19801987 0.15 19871990 1.78 19902006 0.33*
Spain 19801983 0.46 19831989 1.23* 19891994 1.12* 19942005 0.07
Sweden 19801990 0.12 19901994 1.08 19942007 0.00
Switzerland 19802007 0.45*
UK 19802007 0.15*
Ukraine 19811985 0.24 19851990 0.98* 19901999 0.50* 19992006 0.73*
*
Signicantly different from 0 (p < 0.05). APC, annual percent change.

of the countries with lower mortality rates, such as Sweden, the
Netherlands and the UK, have put into legislation models in which
effective partnerships are the key method of delivering road safety
plans, setting targets and introducing other safety performance
indicators (Belin et al., 1997; Koornstra et al., 2002; Wegman and
Elsenaar, 1997). In most CEE countries, in contrast, systematic
safety management is generally weaker and needs to be strength-
ened (Laamme and Diderichsen, 2000). Such strategies addressed
different elements of the trafc system: vehicles, road infrastruc-
tures, rescue, medical treatments, and road users and human
factors.
There is evidence that vehicle-centred safety during the period
considered has appreciably contributed to the observed declining
trends, though quantication of each single measure remains elu-
sive (Anonymous, 2011; Evans, 2003; Koornstra et al., 2002).
As regards road infrastructures and road design, stakeholders
responsible for (or interested in) improving road environment
and reducing crash mortality have developed solutions which
reduced the number of view obstructions, improved the line-
of-sight and the conditions of roadways for vulnerable road users
(Akerman et al., 2000; Federal Highway Administration, 2010;
Fischer et al., 2010; Jacobsen, 2003).
Another important aspect is the efcacy and reduction of criti-
cal assistance times in attending road emergencies and the
improvement in functional communication mechanisms that can
put all the actors of the rescue chain (police force, road operators,
medical and mechanical assistance, re brigades) in the best con-
ditions to effectively shorten the communication chain between
the crash and the rescue, thus minimising the post crash collateral
losses. Various studies worldwide have shown that death was
potentially preventable in a large proportion of those who died
as a result of road crashes before they reached hospital (Mock
et al., 1997; Hussain and Redmond, 1994). In most European coun-
tries an eCall in-vehicle emergency service has been improved. It is
aimed at reducing the effects of crashes by allowing the communi-
cation between an In Vehicle System and a corresponding infra-
structure of Public Safety Answering Points (2010/40/EC)
(European Commission, 2011c).
Improvements in medical treatments have also contributed to
the declines in mortality from road trafc crashes (Anonymous,
2011; CRASH-2 Collaborators and Intracranial Bleeding Study,
2011). The importance of early rehabilitation has also been proved,
though best practise in treatment programmes has yet to be iden-
tied (European Transport Safety Council, 1999), and several coun-
tries need to increase the capacity of their health care systems to
provide adequate rehabilitation to survivors of road trafc crashes.
It is more difcult to determine whether the observed decrease
is also due to changed road users drive attitudes: the human fac-
tors (age, sex, experience, tness, emotion, health, alcohol/drugs,
capacity of reaction, . . .) still remain the most common cause of
road crashes (European Union and IRU 2007; European Association
of Motorcycle Manufacturers, 2009; Magazz et al., 2006;
1016 C. Orsi et al. / Safety Science 50 (2012) 10091018

Bulgaria Czech Republic Denmark

40 40 50

Deaths per 100 000

Deaths per 100 000

Deaths per 100 000
40
30 30
30
20 20
20
10 10 10

0 0 0
1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005
Calendar year Calendar year Calendar year

France Germany Greece

70 70 60

Deaths per 100 000

Deaths per 100 000

Deaths per 100 000

60 60 50
50 50 40
40 40
30
30 30
20
20 20
10 10 10
0 0 0
1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005
Calendar year Calendar year Calendar year

Hungary Italy The Netherlands

60 60 40
Deaths per 100 000

Deaths per 100 000

Deaths per100 000

50 50
30
40 40
30 30 20
20 20
10
10 10
0 0 0
1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005
Calendar years Calendar year Calendar year

Poland Portugal Romania

50 100 30
Deaths per 100 000
Deaths per 100 000

Deaths per 100 000

90
40 80
70 20
30 60
50
20 40
30 10
10 20
10
0 0 0
1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005
Calendar year Calendar year Calendar yeasr

Russian Federation Spain Sweden

60 60 40
Deaths per 100 000
Deaths per 100 000
Deaths per 100 000

50 50
30
40 40
30 30 20
20 20
10
10 10
0 0 0
1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005
Calendar years Calendar years Calendar years

Switzerland UK Ukraine
60 50
Deaths per 100 000

Deaths per 100 000

60
Deaths per 100 000

50 40 50
40 40
30
30 30
20
20 20
10 10 10
0 0 0
1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005 1980 1985 1990 1995 2000 2005
Calendar years Calendar years Calendar years
Men 15-24 years Men 0-85 years Women 15-24 years Women 0-85 years

Fig. A1. Joinpoint analysis for mortality from motor vehicle crashes in selected European countries, at all ages and at age 1524 years, 19802007.
 C. Orsi et al. / Safety Science 50 (2012) 10091018
Marchetti et al., 2009; Orsi et al., 2009; Petridou and Moustaki,
2000; Robb et al., 2008).
High rates in men and in the young are consistent with previous
investigations (Alvarez and Fierro, 2008; Kim et al., 2006; Valent
et al., 2002). In fact, young age, inexperience and risk taking behav-
iour contribute to the high risk of young drivers. Men, especially in
their younger age, have higher rates of crash involvement than
women, even when corrected for exposure factors (Cerrelli, 1998).
Alcohol is an important cause of road crash mortality, though
quantication of its role remains open to discussion (Laapotti
and Keskinen, 2008; Ricci et al., 2008). Over the last decades, alco-
hol drinking has substantially declined in France, Italy and other
southern European countries, but not in northern, western, and
eastern Europe (La Vecchia, 2001; Bosetti et al., 2007). This may ex-
plain at least part of the excess mortality in the CEE countries,
while reecting the stricter embracement of policies against
alcohol in drivers in northern Europe (Marks and Williams, 2007;
Britton et al., 2003).
Another important aspect that could also explain, at least in
part, the differences in trends across European countries is the
different level of motorisation across countries, conrming the
Smeeds law (Smeed, 1949). Countries with lower mortality rates
(for example the Netherlands, Sweden and the UK) have among
the highest level of motorisation while the worst performing
ones have the lowest ones.
Use of international data requires homogenous denitions to
derive meaningful comparisons, but several countries still do not
comply with the international denitions of injuries, crashes, and
casualties recommended by the 1968 Vienna Convention (United
Nations Economic Commission for Europe, 2011). Only the number
of fatalities is comparable across countries. Therefore, reliable
comparisons can essentially be based on mortality indicators and
not on morbidity.
Still, trends in mortality from motor vehicles crashes can be
somewhat inuenced by changes in criteria and death certication
accuracy, and problems of reliability and validity of death certica-
tions which may vary both within and between countries,
calendar periods and age groups should be considered in the
interpretation of the observed trends. However, it is unlikely that
any such potential bias can explain more than a small proportion
of the substantial changes observed, since deaths from motor
vehicle crashes are relatively easy to identify and certify, and are
sufciently reliable in most of the countries considered (Bhalla et
al., 2010). The consistency of trends at all ages and at younger
and middle age (including age 1524) is an additional indicator
of the validity of death certication. Moreover, no major changes
in mortality rates were observed across subsequent Revisions of
the ICD.
Additional determinants of the trends observed are changes in
the number and composition of motor vehicles (including motor-
cycles) over time, the average number of kilometres per year, as
well as changes in road design and legislation in various coun-
tries, calendar years and generations of drivers (Evans, 1993; La
Vecchia et al., 1994). Any such inference, however, goes beyond
the scope of this work, which is essentially descriptive, in terms
of providing access to comparative data on road vehicle crashes
in Europe.
5. Conclusions
Despite the favourable trends in mortality in many European
countries, road crashes remain an important cause of death. Road
trafc deaths are to a great extent preventable and further progress
is possible, and has indeed been observed in areas where trends
1017
have long been favourable. This conrms that effective counter-
measures exist and that there is scope for future improvements.
As the human factors are a major cause of road crashes, preven-
tive measures have to focus on road users. Strict restrictions of
alcohol drinking should be endorsed. Lifelong training interven-
tions, not only in the driving schools, are needed. Opportunities
for road education in order to understand how each road user
operates and functions in trafc should be created.
It is also important to carry out real world crash analyses with a
common standard for in-depth crash analysis in order to give the
responsible stakeholders a tool for better assessment and improve-
ment of the situation and harmonise global legislation. A common
understanding and approach of crash analysis could support a vi-
sion of zero deaths.
Specic focus is required for urgent intervention to prevent
avoidable deaths from motor vehicle crashes in selected CEE coun-
tries, where deaths rates remain excessively high.
Acknowledgements
This work was conducted with the contribution of the Italian
Association for Cancer Research, the Swiss League Against Cancer
and the Swiss Foundation for Research Against Cancer.
Appendix A
See Fig. A1.
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