ABSTRACT

Objective:

To assess the trend in motorcyclist mortality rate from traffic accidents in the state of São Paulo, Brazil, from 2015 to 2020.

Methods:

This is an ecological time series study with secondary data from the Traffic Accident Management Information System of the State of São Paulo (INFOSIGA), referring to motorcyclists’ deaths due to road traffic injuries in the state of São Paulo, Brazil, from 2015 to 2020. The Annual Percent Change was calculated according to the Prais-Winsten regression model, using the Stata 14.0 software.

Results:

A total of 11,343 deaths of motorcyclists due to road traffic injuries were reported. The highest proportion of deaths occurred among men (88.1%), aged between 18 and 24 years (27.9%), in the two most populous and urbanized regions of the state. The distribution of mortality showed minimal variation in the analyzed period, from 4.22 to 4.42 deaths/100 thousand inhabitants. Among the analyzed sociodemographic variables, the mortality trend of motorcyclists was mostly stationary.

Conclusion:

The analysis of the mortality of motorcyclists due to road traffic injuries in the state of São Paulo showed a stationary trend.

Keywords:
Accidents, traffic; Mortality; Motorcycles; Epidemiology

INTRODUCTION

Worldwide, road traffic injuries (RTI) are responsible for 1.35 million deaths and over 50 million injured individuals annually¹1 World Health Organization. Road traffic injuries [Internet]. 2022 [cited on Aug. 8, 2022]. Available at: https://www.who.int/health-topics/road-safety#tab=tab_1.
https://www.who.int/health-topics/road-s... . Of these victims, 93% are from developing countries and the vast majority (73%) are young men under 25 years of age¹1 World Health Organization. Road traffic injuries [Internet]. 2022 [cited on Aug. 8, 2022]. Available at: https://www.who.int/health-topics/road-safety#tab=tab_1.
https://www.who.int/health-topics/road-s... . Brazil ranks among the ten countries with the highest mortality from RTI²2 Aquino EC, Antunes JLF, Morais Neto OL. Mortality by road traffic injuries in Brazil (2000–2016): capital cities versus non-capital cities. Rev Saúde Pública 2020; 54: 122. https://doi.org/10.11606/s1518-8787.2020054001703
https://doi.org/10.11606/s1518-8787.2020... , totaling 208,687 deaths in the period from 2015 to 2020³3 Brasil. Ministério da Saúde. DATASUS tecnologia da Informação a Serviço do SUS. Óbitos por causas externas – Brasil. [Internet]. 2020 [cited on May 17, 2021] Available at: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/ext10uf.def
http://tabnet.datasus.gov.br/cgi/tabcgi.... .

Deaths and injuries due to traffic accidents are a major socioeconomic concern with a significant impact on the gross domestic product (GDP) of around 5% in low- to middle-income countries⁴4 World Health Organization. Global status report on road safety 2015. Geneva: World Health Organization; 2015.. The Institute for Applied Economic Research (Instituto de Pesquisa Econômica Aplicada – IPEA) estimated annual national costs in 2014 of BRL 40 billion with RTI on highways and BRL 10 billion in urban areas, with a single fatal accident surpassing the value of BRL 600 thousand of damages to society.⁵5 Rissanen R, Berg HY, Hasselberg M. Quality of life following road traffic injury: a systematic literature review. Accid Anal Prev 2017; 108: 308-20. https://doi.org/10.1016/j.aap.2017.09.013
https://doi.org/10.1016/j.aap.2017.09.01... . Physical, psychological, and family consequences resulting from RTI are also remarkable, as most victims do not resume normal population levels of quality of life⁶6 Brasil. Instituto de Pesquisa Econômica Aplicada. Acidentes de trânsito nas rodovias federais brasileiras: caracterização, tendências e custos para sociedade. Relatório de Pesquisa. Brasília: IPEA; 2015.. The severity of RTI is closely related to physical dependence, mental disorders, and financial issues⁶6 Brasil. Instituto de Pesquisa Econômica Aplicada. Acidentes de trânsito nas rodovias federais brasileiras: caracterização, tendências e custos para sociedade. Relatório de Pesquisa. Brasília: IPEA; 2015..

Despite the significant reduction in total RTI mortality observed in Brazil between 1990 and 2015, deaths involving motorcyclists did not show the same behavior⁷7 Ladeira RM, Malta DC, Morais Neto OL, Montenegro MMS, Soares Filho AM, Vasconcelos CH, et al. Acidentes de transporte terrestre: estudo Carga Global de Doenças, Brasil e unidades federadas, 1990 e 2015. Rev Bras Epidemiol 2017; 20(suppl 1): 157-70. https://doi.org/10.1590/1980-5497201700050013
https://doi.org/10.1590/1980-54972017000... . The increase in the mortality rate in traffic accidents involving motorcyclists is mainly explained by the considerable growth of the national motorcycle fleet⁷7 Ladeira RM, Malta DC, Morais Neto OL, Montenegro MMS, Soares Filho AM, Vasconcelos CH, et al. Acidentes de transporte terrestre: estudo Carga Global de Doenças, Brasil e unidades federadas, 1990 e 2015. Rev Bras Epidemiol 2017; 20(suppl 1): 157-70. https://doi.org/10.1590/1980-5497201700050013
https://doi.org/10.1590/1980-54972017000... . Motorcycles are a low-cost mode of transport and are often used as a work tool, especially for workers who provide freight and delivery services⁸8 Corgozinho MM, Montagner MA, Rodrigues MAC. Vulnerabilidade sobre duas rodas: tendência e perfil demográfico da mortalidade decorrente da violência no trânsito motociclístico no Brasil, 2004-2014. Cad Saúde Colet 2018; 26(1): 92-9. https://doi.org/10.1590/1414-462X201800010163
https://doi.org/10.1590/1414-462X2018000... . The presence of commercial motorcyclists is evident in urban centers of the country, considering that they meet the needs of speed and agility of the consumer society⁹9 Soares DFPP, Mathias TAF, Silva DW, Andrade SM. Motociclistas de entrega: algumas características dos acidentes de trânsito na Região Sul do Brasil. Rev Bras Epidemiol 2011; 14(3): 435-44. https://doi.org/10.1590/S1415-790X2011000300008
https://doi.org/10.1590/S1415-790X201100... ,¹⁰10 Silva DW, Andrade SM, Soraes DA, Soares DFPP, Mathias TAF. Perfil do trabalho e acidentes de trânsito entre motociclistas de entregas em dois municípios de médio porte do Estado do Paraná, Brasil. Cad Saúde Pública 2008; 24(11): 2643-52. https://doi.org/10.1590/S0102-311X2008001100019
https://doi.org/10.1590/S0102-311X200800... .

The vehicle's own characteristics place the driver at an increased risk of serious injuries and deaths when compared with other types of vehicles⁵5 Rissanen R, Berg HY, Hasselberg M. Quality of life following road traffic injury: a systematic literature review. Accid Anal Prev 2017; 108: 308-20. https://doi.org/10.1016/j.aap.2017.09.013
https://doi.org/10.1016/j.aap.2017.09.01... . The instability of the vehicle, the conditions of conservation of the motorcycle, and the fact that motorcyclists frequently use the spaces between the roadways are also decisive in the occurrence of accidents¹¹11 Oliveira NLB, Souza RMC. Fatores associados ao óbito de motociclistas nas ocorrências de trânsito. Rev Esc Enferm USP 2012; 46(6): 1379-86. https://doi.org/10.1590/S0080-62342012000600014
https://doi.org/10.1590/S0080-6234201200... ,¹²12 Botelho LJ, Gonzaga HN. Mortalidade por acidentes motociclísticos: estudo comparativo entre Santa Catarina e Brasil. Bol Curso Med UFSC 2017; 8(3): 8-14. https://doi.org/10.32963/bcmufsc.v3i8.2427
https://doi.org/10.32963/bcmufsc.v3i8.24... .

In this context, there is an inevitable greater probability, enhanced by the frequency of inappropriate behavior among drivers (excessive speed, inexperience, negligence regarding the use of helmets, consumption of alcohol and illicit drugs), of the occurrence of RTI with the involvement of this group specifically¹³13 Malta DC, Andrade SSCA, Gomes N, Silva MMA, Morais Neto OL, Reis AAC, et al. Lesões no trânsito e uso de equipamento de proteção na população brasileira, segundo estudo de base populacional. Ciên Saúde Colet 2016; 21(2): 399-409. https://doi.org/10.1590/1413-81232015212.23742015
https://doi.org/10.1590/1413-81232015212... . When compared with car drivers and passengers, motorcyclists are subject to an up to 20 times greater risk of traffic accidents with fatal outcomes⁸8 Corgozinho MM, Montagner MA, Rodrigues MAC. Vulnerabilidade sobre duas rodas: tendência e perfil demográfico da mortalidade decorrente da violência no trânsito motociclístico no Brasil, 2004-2014. Cad Saúde Colet 2018; 26(1): 92-9. https://doi.org/10.1590/1414-462X201800010163
https://doi.org/10.1590/1414-462X2018000... ,¹⁴14 Beck LF, Dellinger AM, O'Neil ME. Motor vehicle crash injury rates by mode of travel, United States: using exposure-based methods to quantify differences. Am J Epidemiol 2007; 166(2): 212-8. https://doi.org/10.1093/aje/kwm064
https://doi.org/10.1093/aje/kwm064... .

There are several efforts and public policies to reduce RTI throughout the world. The United Nations (UN) Global Plan for the Decade of Action for Road Safety 2021–2030 includes a goal of reducing deaths by at least 50%, focusing on low- and middle-income countries. The UN recommends, among some actions, multimodal transport, the reduction of maximum speeds, in addition to prioritizing pedestrians, cyclists and public transport users, discouraging the use of private vehicles in high-density urban areas¹⁵15 United Nations General Assembly. Improving the global road safety: resolution [Internet] 2020. [cited on Sept. 26, 2022]. Available at: https://digitallibrary.un.org/record/3879711
https://digitallibrary.un.org/record/387... .

In this study we aimed to evaluate the trend in the mortality rate due to RTI of motorcyclists in the state of São Paulo, Brazil, from 2015 to 2020. Detailed analysis of motorcyclists’ mortality is essential so that conditions and related characteristics can be identified to develop and improve public policies both to support RTI and to prevent it. The obtained information contributes to actions specially aimed at the most vulnerable groups as well as to support traffic control strategies.

METHODS

This is an ecological time series study, for which data from the Traffic Accident Management Information System of the State of São Paulo (Sistema de Informações Gerenciais de Acidentes de Trânsito do Estado de São Paulo – INFOSIGA) were used, in the period between January 1^st, 2015 and December 31, 2020. INFOSIGA is a monthly updated database that integrates information from the 645 municipalities of the state, constituting a great advance, as it provides fundamental support for the effectiveness of public policies aimed at preventing traffic accidents, considering that other databases are only updated once a year¹⁶16 Carneiro LP, Battistella LR. Two innovative Brazilian programs relating to road safety prevention. A case study. Sao Paulo Med J 2019; 137(suppl): 2-7. https://doi.org/10.1590/1516-3180.2019.13715019lpc
https://doi.org/10.1590/1516-3180.2019.1... . In INFOSIGA, unlike the Department of Informatics of the Brazilian Unified Health System (DATASUS) and the Mortality Information System (Sistema de Informação sobre Mortalidade – SIM), the 10^th Revision of the International Classification of Diseases (ICD 10) is not used; it is fed with data from incident reports from the Civil Police, the Military Police, and the Federal Highway Police.

By the online platform Painel de Resultados (available from http://www.infosiga.sp.gov.br), it is possible to access the INFOSIGA database, perform tabulations, obtain sociodemographic data on involved individuals and other characteristics of the accident, such as: day and time, accident mechanism, occurrence of deaths, vehicle and road specifications. Data collection was performed by two trained researchers designated by the authors, and a third investigator was responsible for correcting possible discrepancies.

The state of São Paulo, where the study was carried out, is a federative unit of Brazil with 46,649,132 inhabitants in an area of 248,219.485 km² and a human development index of 0.783. It is the Brazilian state with the highest concentration of motor vehicles, totaling 30,778,960 vehicles, of which 4,951,261 are motorcycles¹⁷17 Brasil. Instituto Brasileiro de Geografia e Estatística. Cidades. São Paulo [Internet]. 2020 [cited on May 20, 2021]. Available at: https://cidades.ibge.gov.br/brasil/sp/pesquisa/22/28120?ano=2020
https://cidades.ibge.gov.br/brasil/sp/pe... .

Deaths were estimated considering deaths from RTI involving motorcyclists reported in INFOSIGA. For the construction of mortality rates, data were collected from the population residing in the state of São Paulo, from the 2010 Census by the Brazilian Institute of Geography and Statistics (IBGE), and from intercensal projections for the years of the analyzed period (2015, 2016, 2017, 2018, 2019, and 2020), according to information provided by DATASUS³3 Brasil. Ministério da Saúde. DATASUS tecnologia da Informação a Serviço do SUS. Óbitos por causas externas – Brasil. [Internet]. 2020 [cited on May 17, 2021] Available at: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?sim/cnv/ext10uf.def
http://tabnet.datasus.gov.br/cgi/tabcgi.... .

All traffic accidents that occurred between 2015 and 2020, in the state of São Paulo, whose outcome was the death of a motorcyclist (driver and/or passenger) were included. Traffic accidents involving motorcyclists without deaths, as well as other accidents involving other vehicles and modes of transport, were excluded.

The variables of interest in the study were:

1. Year of death: 2015, 2016, 2017, 2018, 2019, and 2020;

2. Sex: man and woman;

3. Age group: 0–17, 18–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59, 60–64, 65–69, 70–74, 75–79, and 80 years or older;

4. Day of the week: Monday, Tuesday, Wednesday, Thursday, Friday, Saturday, and Sunday;

5. Shift: early morning, morning, afternoon, and night;

6. Place of death: health facilities, road, and others;

7. Involvement of another vehicle: automobile, bicycle, truck, motorcycle, bus, pedestrian, others, and none;

8. Jurisdiction of the road: municipal, state, and federal;

9. Administrative region of the state of São Paulo: Araçatuba, Baixada Santista, Barretos, Bauru, Campinas, Central, Franca, Itapeva, Marília, Metropolitan Region of São Paulo, Presidente Prudente, Registro, Ribeirão Preto, São José do Rio Preto, São José dos Campos, and Sorocaba (Figure 1).

The analysis of trends in mortality rates was performed using the Prais-Winsten linear regression test, as proposed by Antunes and Cardoso¹⁸18 Antunes JLF, Cardoso MRA. Uso da análise de séries temporais em estudos epidemiológicos. Epidemiol Serv Saúde 2015; 24(3): 565-76. https://doi.org/10.5123/S1679-49742015000300024
https://doi.org/10.5123/S1679-4974201500... , which provides for the correction of the first-order autocorrelation. This process considered the mortality rate as the dependent variable and the years of the historical series as the independent variable. The Annual Percentage Change (APC) was calculated considering the significance level of 95%, according to Equations 1, 2, and 3.

Where:

β: slope of linear regression;

ul: upper limit;

ll: lower limit of the confidence interval.

Mortality trends of motorcyclists from RTI and their variables were classified according to the APC value. Positive APC values were considered as upward trend; negative values, downward trend; and APC results with p>0.05, as stationary trend. All analyses were performed using the statistical program STATA 14.0 (College Station, TX, United States of America).

Finally, for the purpose of comparison between databases, another similar epidemiological survey was carried out with information available from the SIM. All deaths from external causes of morbidity and mortality that occurred in the same period, between 2015 and 2020, in the state of São Paulo were estimated. The considered categories of transport accidents, according to ICD 10, were:

V20–V29: Motorcycle rider injured in transport accident;

V30–V39: Occupant of three-wheeled motor vehicle injured in transport accident.

The present study involved only the description and analysis of secondary data. All these sources of information are in the public domain. Additional information that is not freely accessible was not collected. In particular, no personally identifiable information was obtained for this study.

According to Resolution No. 510/2016, of April 7, 2016, of the National Health Council of the Brazilian Ministry of Health, research using information of public access, pursuant to Law No. 12.527, of November 18, 2011, will neither be registered nor assessed by the Research Ethics Committees (CEP)/National Commission of Ethics in Research (CONEP) system.

RESULTS

A total of 11,343 deaths of motorcyclists due to traffic accidents in the state of São Paulo were notified in INFOSIGA during the period from 2015 to 2020. This result was 25.6% higher than the 9,032 motorcycle deaths reported in SIM (Supplementary Table 2). Among the deaths reported in INFOSIGA, the highest proportion occurred among men (88.1%), aged between 18–24 years, and 67.52% of the cases were concentrated in the group of young adults aged 18–39 years. We observed that the largest share of deaths occurred from Friday to Sunday (56% of cases), with emphasis on the afternoon and night shifts, which totaled 54.6%. The lowest incidences of deaths were concentrated on Tuesdays and in the morning shift (Table 1).

Deaths that occurred on the road, that is, at the scene of the accident, were less frequent than those in health facilities, 39.6 and 55%, respectively. Occurrences in other locations totaled 5.4% of deaths. The municipal roads of the large population conglomerates of the state of São Paulo, administrative regions of Campinas and Metropolitan Region of São Paulo, were the main places of deaths from motorcycle accidents, concentrating 53.5% of the occurrences. The administrative regions of Barretos and Registro had the lowest occurrences of motorcyclist deaths, accounting for 2.4% of cases (Table 1) (Figure 1).

Accidents involving other vehicles, mainly automobiles (23.5%) and trucks (9.2%), surpassed those without the involvement of other modes of transport (18%) or pedestrians (0.2%). In addition to these findings, a high percentage (40.1%) of missing data stands out specifically in this variable, described as “unavailable.” Missing data added up to 7.1% in the “shift” variable; however, in the others, these data either remained below 5% or did not occur.

The distribution of deaths between 2015 and 2020 is homogeneous. The frequency of deaths per year did not show significant variations. This is confirmed by the minimal variation in the mortality rate in the analyzed period, from 4.22 to 4.42 deaths of motorcyclists per 100 thousand inhabitants (Figure 2) (Supplementary Table 3).

In Table 1 we present the results of the Prais-Winsten regression estimates on the mortality rate of motorcycle accidents in the state of São Paulo from 2015 to 2020. Among the analyzed variables, the trend in motorcycle mortality due to RTI was mostly stationary (Supplementary Table 4).

We observed an upward trend, that is, APC with positive values, in mortalities of the following variables: deaths that occurred during the night shift in the age groups of 45–49 and 55–59 years; in the administrative region of Sorocaba; accidents involving trucks; and those without the participation of another mode of transport or pedestrian. Conversely, we observed a downward trend, that is, APC with negative values, in the mortalities of the following variables: Thursday as the day of the week; early morning shift; administrative region of Presidente Prudente; and the age groups 0–17 and 30–34 years (Table 1).

DISCUSSION

Our findings point to the temporal stability of the mortality rate of motorcyclists due to RTI in the state of São Paulo from 2015 to 2020. It is worth highlighting this stationary trend because, as it is an external cause of death that can be prevented (public policies, traffic education, improvement in road and working conditions), this indicator is expected to annually decrease. Despite this result, according to Aquino et al.²2 Aquino EC, Antunes JLF, Morais Neto OL. Mortality by road traffic injuries in Brazil (2000–2016): capital cities versus non-capital cities. Rev Saúde Pública 2020; 54: 122. https://doi.org/10.11606/s1518-8787.2020054001703
https://doi.org/10.11606/s1518-8787.2020... , in the period between 2010 and 2016, the trend of motorcyclists’ deaths in the state of São Paulo was upward.

Mortality of motorcyclists in the state of São Paulo was below the national rates and in the Midwest, North, and Northeast regions, Brazilian macro-regions that have the highest incidence of motorcycle deaths, with the city of Boa Vista, capital of the state of Roraima, as the Brazilian capital with the highest rate (16.1 deaths/100 thousand inhabitants)²2 Aquino EC, Antunes JLF, Morais Neto OL. Mortality by road traffic injuries in Brazil (2000–2016): capital cities versus non-capital cities. Rev Saúde Pública 2020; 54: 122. https://doi.org/10.11606/s1518-8787.2020054001703
https://doi.org/10.11606/s1518-8787.2020... ,⁸8 Corgozinho MM, Montagner MA, Rodrigues MAC. Vulnerabilidade sobre duas rodas: tendência e perfil demográfico da mortalidade decorrente da violência no trânsito motociclístico no Brasil, 2004-2014. Cad Saúde Colet 2018; 26(1): 92-9. https://doi.org/10.1590/1414-462X201800010163
https://doi.org/10.1590/1414-462X2018000... . However, RTI mortality is higher than in countries such as the United States of America and Canada, which have averages below 1.5 deaths/100 thousand inhabitants¹⁹19 Rodrigues EMS, Villaveces A, Sanhueza A, Escamilla-Cejudo JA. Trends in fatal motorcycle injuries in the Americas, 1998-2010. Int J Inj Contr Saf Promot 2014; 21(2): 170-80. http://doi.org/10.1080/17457300.2013.792289
http://doi.org/10.1080/17457300.2013.792... .

These results can be considered consequences of multiple factors mainly present in urban centers, as over half of deaths occurred on municipal roads, in the two most populous and urbanized administrative regions of the state of São Paulo: Campinas and Metropolitan Region of São Paulo.

The increased traffic of motor vehicles, the use of motorcycles as a work tool, and constant demands inherent in professional practice also combine to maintain high mortality, reaching proportions close to 30% of all deaths related to traffic accidents⁸8 Corgozinho MM, Montagner MA, Rodrigues MAC. Vulnerabilidade sobre duas rodas: tendência e perfil demográfico da mortalidade decorrente da violência no trânsito motociclístico no Brasil, 2004-2014. Cad Saúde Colet 2018; 26(1): 92-9. https://doi.org/10.1590/1414-462X201800010163
https://doi.org/10.1590/1414-462X2018000... . The exposure of this group is further potentiated by long working hours, inexperience of the driver, and high speeds on the roads (above 80 km/h)¹⁰10 Silva DW, Andrade SM, Soraes DA, Soares DFPP, Mathias TAF. Perfil do trabalho e acidentes de trânsito entre motociclistas de entregas em dois municípios de médio porte do Estado do Paraná, Brasil. Cad Saúde Pública 2008; 24(11): 2643-52. https://doi.org/10.1590/S0102-311X2008001100019
https://doi.org/10.1590/S0102-311X200800... ,²⁰20 Mascarenhas MDM, Souto RMCV, Malta DC, Silva MMA, Lima CM, Montenegro MMS. Characteristics of motorcyclists involved in road traffic accidents attended at public urgent and emergency services. Ciên Saúde Colet 2016; 21(12): 3661-71. https://doi.org/10.1590/1413-812320152112.24332016
https://doi.org/10.1590/1413-81232015211... .

Considering public actions in the city of São Paulo from 2010 to 2016, the reduction in maximum speed on public roads contributed to a sharp decline in RTI mortality. Among men, the mortality rate was from 18.46 to 10.99 deaths/100 thousand inhabitants. Conversely, among women, the reduction was from 3.66 to 2.80 deaths/100 thousand inhabitants²¹21 Leitão PA, Bezerra IMP, Santos EFS, Ribeirto SL, Takasu JM, Carlesso JS, et al. Mortalidade por acidentes de trânsito, antes e após redução da velocidade média de veículos automotores na cidade de São Paulo, Brasil, no período de 2010 a 2016. J Hum Growth Dev 2019; 29(1): 83-92. https://dx.doi.org/10.7322/jhgd.157755
https://dx.doi.org/10.7322/jhgd.157755... .

Traffic accidents that result in the death of motorcyclists often involve another vehicle. Such information corroborates the reality of urban centers, characterized by greater concentrations of vehicles and traffic, faced with the need for agility in displacements for the most diverse activities⁹9 Soares DFPP, Mathias TAF, Silva DW, Andrade SM. Motociclistas de entrega: algumas características dos acidentes de trânsito na Região Sul do Brasil. Rev Bras Epidemiol 2011; 14(3): 435-44. https://doi.org/10.1590/S1415-790X2011000300008
https://doi.org/10.1590/S1415-790X201100... ,²²22 Rios PAA, Mota ELA, Ferreira LN, Cardoso JP, Santos GJ, Rodrigues TB. Traffic accidents among drivers: incidence and differences between motorcyclists and car drivers in population-based study. Rev Bras Epidemiol 2019; 22: E190054. https://doi.org/10.1590/1980-549720190054
https://doi.org/10.1590/1980-54972019005... . A study carried out by the analysis of 378 traffic accidents involving motorcyclists in an urban center in India, with 3.8 million inhabitants, found involvement of other vehicles in 59% of the occurrences²³23 Fitzharris M, Dandona R, Kumar GA, Dandona L. Crash characteristics and patterns of injury among hospitalized motorised two-wheeled vehicle users in urban India. BMC Public Health 2009; 9: 11. https://doi.org/10.1186/1471-2458-9-11
https://doi.org/10.1186/1471-2458-9-11... .

Another study, carried out in Iran between 2011 and 2017, which included deaths of motorcyclists, identified that, of the 122,682 deaths from RTI, 28,356 (23.1%) were motorcyclists, and in 80.2% there was involvement of another vehicle. Of these cases, 95.3% were men, with approximately 30% in the age group between 18 and 24 years²⁴24 Barzegar A, Ghadipasha M, Forouzesh M, Valiyari S, Khademi A. Epidemiologic study of traffic crash mortality among motorcycle users in Iran (2011–2017). Chin J Traumatol 2020; 23(4): 219-23. https://doi.org/10.1016/j.cjtee.2020.05.008
https://doi.org/10.1016/j.cjtee.2020.05.... . Over half of the deaths had traumatic brain injury as the main cause, a fact closely related to the high mortality before the arrival at health services²³23 Fitzharris M, Dandona R, Kumar GA, Dandona L. Crash characteristics and patterns of injury among hospitalized motorised two-wheeled vehicle users in urban India. BMC Public Health 2009; 9: 11. https://doi.org/10.1186/1471-2458-9-11
https://doi.org/10.1186/1471-2458-9-11... ,²⁴24 Barzegar A, Ghadipasha M, Forouzesh M, Valiyari S, Khademi A. Epidemiologic study of traffic crash mortality among motorcycle users in Iran (2011–2017). Chin J Traumatol 2020; 23(4): 219-23. https://doi.org/10.1016/j.cjtee.2020.05.008
https://doi.org/10.1016/j.cjtee.2020.05.... . We identified that in the state of São Paulo, 39% of deaths occurred on the road, enabling us to infer the high rate of serious injuries among motorcyclists.

Most deaths result from cranioencephalic or visceral trauma and occur at the accident scene or within 24 hours after its occurrence²⁵25 Koizumi MS. Padrão das lesões nas vítimas de acidentes de motocicleta. Rev Saúde Pública 1992; 26(5): 306-15. https://doi.org/10.1590/S0034-89101992000500002
https://doi.org/10.1590/S0034-8910199200... ,²⁶26 Oliveira NLB, Souza RMC. Risco de lesões em motociclistas nas ocorrências de trânsito. Rev Esc Enferm USP 2012; 46(5): 1133-40. https://doi.org/10.1590/s0080-62342012000500014
https://doi.org/10.1590/s0080-6234201200... . A study conducted between 2011 and 2015 in a trauma center in Malaysia, the country with the highest mortality from RTI in Southeast Asia, identified, after analyzing 1,653 patients undergoing treatment for injuries from motorcycle traffic accidents, traumatic brain injury as the main predictor of mortality, increasing the risk of death by about four times²⁷27 Tan-Chor-Lip H, Tan JH, Mohamad Y, Ariffin AC, Imran R, Azmah-Tuan-Mat, TN. Clinical characteristics of 1653 injured motorcyclists and factors that predict mortality from motorcycle crashes in Malaysia. Chinese Journal of Traumatology 2019; 22(2): 69-74. https://doi.org/10.1016/j.cjtee.2018.11.001
https://doi.org/10.1016/j.cjtee.2018.11.... . A cohort study with 7,813 motorcycle riders in urgent and emergency services indicated the use of helmets as being responsible for a 76% reduction in the occurrence of traumatic brain injuries and a 28% reduction in referrals to other services, hospitalizations, or deaths²⁸28 Souto RMCV, Corassa RB, Lima CM, Malta DC. Helmet use and injury severity among crashed motorcyclists in Brazilian state capitals: an analysis of the violence an accidents survey 2017. Rev Bras Epidemiol 2020; 23 Suppl 1: e200011.supl.1. https://doi.org/10.1590/1980-549720200011.supl.1
https://doi.org/10.1590/1980-54972020001... .

In the analyzed period, practically a third of the deaths occurred during the night shift. This distribution can be explained by fatigue at the end of the day, increased vehicle flow, variation in visibility, unmarked vehicles, reduced police inspection, excessive speeding, and the use of alcohol or drugs. The combination of use of narcotic substances and reckless driving of automobiles is more frequent on weekends²⁰20 Mascarenhas MDM, Souto RMCV, Malta DC, Silva MMA, Lima CM, Montenegro MMS. Characteristics of motorcyclists involved in road traffic accidents attended at public urgent and emergency services. Ciên Saúde Colet 2016; 21(12): 3661-71. https://doi.org/10.1590/1413-812320152112.24332016
https://doi.org/10.1590/1413-81232015211... ,²⁸28 Souto RMCV, Corassa RB, Lima CM, Malta DC. Helmet use and injury severity among crashed motorcyclists in Brazilian state capitals: an analysis of the violence an accidents survey 2017. Rev Bras Epidemiol 2020; 23 Suppl 1: e200011.supl.1. https://doi.org/10.1590/1980-549720200011.supl.1
https://doi.org/10.1590/1980-54972020001... , a fact that contributes to the higher concentration of deaths observed on these days. According to research carried out at the Legal Medical Institute of the state of São Paulo, in 2005, 42.3% of motor vehicle drivers who died from RTI had serum alcohol levels above 0.6 g/L. Among motorcyclists, levels above 0.1 g/L were identified in 27.6% of deaths. The authors also point out the early morning shift on Saturdays and Sundays as the most frequent period for fatal RTIs, with and without alcohol consumption²⁹29 Ponce JC, Muñoz DR, Andreuccetti G, Carvalho DG, Leyton V. Alcohol-related traffic accidents with fatal outcomes in the city of Sao Paulo. Accid Anal Prev 2011; 43(3): 782-7. https//doi.org/10.1016/j.aap.2010.10.025
https//doi.org/10.1016/j.aap.2010.10.025... .

Analysis of time series on the impact of Law No. 11.705 (Prohibition), of 2008, which punishes drivers caught under the influence of alcohol or any psychoactive substance, on mortality from RTI in the Brazilian federative units, indicated a considerable decrease only in the state of Santa Catarina and the Federal District, with stability in the state of São Paulo³⁰30 Nunes HRC, Murta-Nascimento C, Lima MCP. Impact of the dry law on road traffic mortality in Brazilian states: an interrupted time series analysis. Rev Bras Epidemiol 2021; 24: e210045. https://doi.org/10.1590/1980-549720210045
https://doi.org/10.1590/1980-54972021004... . Another study on the impact of the implementation of the Brazilian Traffic Code (Código de Trânsito Brasileiro – CTB) and Law No. 11.705 on RTI mortality in the state of Paraná, Brazil, between 1980 and 2014 showed that after the implementation of the CTB there was a reduction of 9.69 deaths/100 thousand inhabitants per year for all categories of traffic accidents. The greatest impact was observed in the age group from 20 to 29 years. Nevertheless, after implementing Law No. 11.705, trends remained stationary for motorcycle riders³¹31 Abreu DROM, Souza EM, Mathias TAF. Impact of the brazilian traffic code and the law against drinking and driving on mortality from motor vehicle accidents. Cad Saude Publica 2018; 34(8): e00122117. https://doi.org/10.1590/0102-311X0012117
https://doi.org/10.1590/0102-311X0012117... .

Regarding the age of the victims, there was an upward trend in older age groups, from 45 to 49 and 55 to 59 years. Despite the lower incidence of traffic accidents, older age groups show higher concentrations of severe cases and, consequently, increased lethality, with a twice higher risk of death as an outcome in ages over 35 years²⁷27 Tan-Chor-Lip H, Tan JH, Mohamad Y, Ariffin AC, Imran R, Azmah-Tuan-Mat, TN. Clinical characteristics of 1653 injured motorcyclists and factors that predict mortality from motorcycle crashes in Malaysia. Chinese Journal of Traumatology 2019; 22(2): 69-74. https://doi.org/10.1016/j.cjtee.2018.11.001
https://doi.org/10.1016/j.cjtee.2018.11.... ,³²32 Mandacarú PMP, Rabelo IVM, Silva MAA, Tobias GC, Morais Neto OL. Óbitos e feridos graves por acidentes de trânsito em Goiânia, Brasil-2013: magnitude e fatores associados. Epidemiol Serv Saúde 2018; 27(2): e2017295. https://doi.org/10.5123/s1679-49742018000200001
https://doi.org/10.5123/s1679-4974201800... .

Furthermore, there is a downward trend in two groups: young people aged 0 to 17 and 30 to 34 years. Similar to many deaths from violent causes, those resulting from motorcycle accidents mostly victimize young men, who exceed 70% of the occurrences in our study and in several others²⁰20 Mascarenhas MDM, Souto RMCV, Malta DC, Silva MMA, Lima CM, Montenegro MMS. Characteristics of motorcyclists involved in road traffic accidents attended at public urgent and emergency services. Ciên Saúde Colet 2016; 21(12): 3661-71. https://doi.org/10.1590/1413-812320152112.24332016
https://doi.org/10.1590/1413-81232015211... ,²⁹29 Ponce JC, Muñoz DR, Andreuccetti G, Carvalho DG, Leyton V. Alcohol-related traffic accidents with fatal outcomes in the city of Sao Paulo. Accid Anal Prev 2011; 43(3): 782-7. https//doi.org/10.1016/j.aap.2010.10.025
https//doi.org/10.1016/j.aap.2010.10.025... ,³²32 Mandacarú PMP, Rabelo IVM, Silva MAA, Tobias GC, Morais Neto OL. Óbitos e feridos graves por acidentes de trânsito em Goiânia, Brasil-2013: magnitude e fatores associados. Epidemiol Serv Saúde 2018; 27(2): e2017295. https://doi.org/10.5123/s1679-49742018000200001
https://doi.org/10.5123/s1679-4974201800... –³⁵35 Souza CDF, Paiva JPS, Leal TC, Silva LF, Machado MF, Araújo MDP. Mortality in motorcycle accidents in Alagoas (2001-2015): temporal and spatial modeling before and after the “lei seca”. Rev Assoc Med Bras (1992) 2019; 65(12): 1482-8. https://doi.org/10.1590/1806-9282.65.12.1482
https://doi.org/10.1590/1806-9282.65.12.... .

The higher prevalence of accidents in this age group has negative socioeconomic consequences for society, as these individuals are in full working age. Therefore, the various injuries, temporary or permanent, as well as deaths, interrupt work activities, failing to generate income and production for the economic system, in addition to causing high costs to the health system, with hospital admissions and rehabilitation³³33 Barbosa MQ, Abrantes KSM, Silva Júnior WR, Casimiro GS, Cavalcanti AL. Acidente motociclístico: caracterização das vítimas socorridas pelo Serviço de Atendimento Móvel de Urgência (SAMU). R Bras C Saúde 2014; 18(1): 3-10. https://doi.org/10.4034/RBCS.2014.18.01.01
https://doi.org/10.4034/RBCS.2014.18.01.... .

Detailing the characteristics of the involved individuals, as well as the different conditions of the occurrences, is crucial for understanding the processes and planning of public actions. The use of time series, in this case, contributes to verify the results of preventive measures, that is, it points out the future projection resulting from measures currently or past adopted. Therefore, it becomes another important tool to assist in the adjustment, adequacy, investments, and innovation of public policies that result in the reduction of deaths from RTI.

We performed this study by analyzing a public domain database. The completion of data referring to the analyzed variables is not subject to our control, contributing to the presence of missing data. Furthermore, the information made available does not include the condition of motorcycle use (leisure, transport, commercial), use of alcohol or other drugs, nor the skin color and education of the victims, and it is not possible to measure such associations with RTI mortality in the state of São Paulo.

The analysis of motorcycle mortality from RTI in the state of São Paulo showed a stationary trend. This result reinforces the need for effective strategies and policies focusing on the younger and male population, as well as improving inspections to prevent RTI (reducing average speed, combating the use of alcohol and drugs), especially in urban areas of the state.

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