Abstract

OBJECTIVE:

to describe the profile of work-related road traffic accident (RTA) victims, reported by Road Traffic Accident Information Sentinel Units in the state of Pernambuco, Brazil, from 2012-2014.

METHODS:

descriptive study of fatal and non-fatal work-related road traffic accident victims, reported by 21 RTA Information Sentinel Units in Pernambuco.

RESULTS:

87.8% of the 10,691 cases reported occurred among males; 69.0% of all records were related to the 20-39 age group; the sectors with most injured workers were Transport (24.4%) and Trade (21.3%); most of the victims were drivers (82.0%) and motorcycles were the most frequent vehicle at the time of the accident (77.0%).

CONCLUSION:

victims were predominantly young male motorcyclists; findings may serve to inform intersectoral actions to prevent work-related RTAs, appropriate to the profile of the victims.

Key words:
Transport Accidents; Epidemiological Surveillance; Work Accidents; Descriptive Epidemiology.

Introduction

Road traffic accidents are an important Public Health issue, because of their great impact on the population's profile of morbidity and mortality. There is an estimative of 1.24 million deaths and 50 million injuries every year due to accidents in public roads all over the world.¹1. World Health Organization. Global status report on road safety 2013: supporting a decade of action [Internet]. Geneva: World Health Organization; 2013 [cited 2016 Mar 11]. Available from: http://www.who.int/violence_injury_prevention/road_safety_status/2013/en/

From 2004 to 2013, Brazil registered a progressive growth in mortality due to road traffic accidents; most of the victims were men, in the 20-39 age group, and motorcyclists.²2. Ministério da Saúde (BR). Datasus. Óbitos por causas externas: Brasil, 2013 [Internet]. Brasília: Ministério da Saude; 2015 [citado 2015 maio 4] Disponível em: http://tabnet.datasus.gov.br/

In 2012, the state of Pernambuco registered 1,997 deaths due to road traffic accidents.³3. Secretaria Estadual de Saúde (PE). Sistema de Informação sobre Mortalidade [Internet]. Pernambuco: Secretaria de Saúde do Estado de Pernambuco; 2015 [citado 2015 maio 4]. Disponível em: http://tabnet.saude.pe.gov.br/cgi-bin/dh?tab/tabsim/obito.def Some studies point out that the Transport sector registers most of the work-related accidents, such as those involving delivery-service motorcyclists, and bus and truck drivers, and these facts prove the risks that are present in the cities' traffic, transforming those workers into victims.⁴4. Wünsch Filho V. Perfil epidemiológico dos trabalhadores. Rev Bras Med Trab. 2004 abr-jun;2(2):103-17. In survey carried out to estimate the annual occurrence of work-related accidents with motorcycle-taxi drivers registered in the Municipal Office of Transport and Traffic of Feira de Santana-BA, Amorim et al.⁵5. Amorim CR, Araújo EM, Araújo TM, Oliveira NF. Acidentes de trabalho com mototaxistas. Rev Bras Epidemiol. 2012 jan-mar;15(1):25-37. identified that 10.5% of the 267 surveyed individuals had already suffered a work-related accident.

In Brazil, a work-related accident (WA) is defined as accidents that occur during the work shift for the company or during the work shift of an insured person, according to the article 11 of Law No. 8,213, dated 24/07/91, and which cause physical injury or functional disorder that results in death or loss or reduction, permanent or temporary, of the work capacity.⁶6. Brasil. Lei nº 8.213, de 24 de julho de 1991. Dispõe sobre os planos de benefícios da previdência social e dá outras providências. Diário oficial da República Federativa do Brasil, Brasília (DF), 1991 ago 14; Seção 1:14809. A work-related accident is classified as (i) occupational - related to the characteristic of the activity performed by the injured professional; and (ii) commuting - when it occurred in the way between the worker's house and the work place and vice versa.⁶6. Brasil. Lei nº 8.213, de 24 de julho de 1991. Dispõe sobre os planos de benefícios da previdência social e dá outras providências. Diário oficial da República Federativa do Brasil, Brasília (DF), 1991 ago 14; Seção 1:14809. In Brazil, in 2013, 3,867 workers died due to external causes.²2. Ministério da Saúde (BR). Datasus. Óbitos por causas externas: Brasil, 2013 [Internet]. Brasília: Ministério da Saude; 2015 [citado 2015 maio 4] Disponível em: http://tabnet.datasus.gov.br/ In 2001, the Ministry of Health published the National Policy for Reduction of Morbidity and Mortality from Accidents and Violence.⁷7. Brasil. Ministério da Saúde. Portaria MS/GM nº 737 de 18 de junho de 2001. Aprova, na forma do anexo desta portaria, a política nacional de redução da morbimortalidade por acidentes e violências. Diário oficial da República Federativa do Brasil, Brasília (DF), 2001 jun 18; Seção 1:3 Then, in 2002, the Ministry proposed the 'Project for Reduction of Morbidity and Mortality from Road Traffic Accidents - mobilizing the society and promoting health',⁸8. Brasil. Ministério da Saúde. Portaria nº 344, de 19 de fevereiro de 2002. Aprova na forma do anexo desta portaria, o "projeto de redução de morbimortalidade por acidentes de trânsito-mobilizando a sociedade e promovendo a saúde" no âmbito do Sistema Único de Saúde (SUS). Diário Oficial da República Federativa do Brasil, Brasília (DF), 2002 fev 20; Seção 1:29. aiming at promoting surveillance and monitoring the risk and protection factors related to injuries and deaths in traffic. This intervention initiative was initially developed in five cities - São Paulo, Goiânia, Belo Horizonte, Recife and Curitiba -, then it expanded to other municipalities with the Ministry of Health's technical and financial support, and got stronger with the implementation of the National Network of Units for the Prevention of Violence and Promotion of Health, in 2004, and the National Policy of Health Promotion, in 2006.

In 2010, in order to increase knowledge on the profile of non-fatal victims of road traffic accidents in Pernambuco, the State Department of Health established the reporting of cases treated in 10 urgency and emergency traumatology and/or orthopedics services, naming it 'Road Traffic Accident Information Sentinel Units'. These notifications were regulated by the Ordinance SES No. 219, dated 11/04/2011,⁹9. Secretaria de Planejamento e Gestão (Pernambuco). Portaria nº 219, de 11 de abril de 2011. Acrescenta doenças e agravos estaduais à Lista Nacional de Doenças de Notificação Compulsória e dá outras providências. Diário Oficial do Estado de Pernambuco, Recife (PE), 2011 abr 12; Seção 1:15. which added road traffic accidents to other diseases and conditions on the List of Compulsory Notification in Sentinel Units, Annex III of the Ordinance MS/GM No. 104, dated 21/01/2011, valid at that moment. Still in 2011, the strategy was expanded to more than ten sentinel units and in 2012 one more unit was included, totalizing the current number of 21 Sentinel Units of Pernambuco.¹⁰10. Secretaria de Estado de Saúde (Pernambuco). Secretaria Executiva de Vigilância em Saúde. Diretoria Geral de Promoção, Monitoramento e Avaliação da Vigilância em Saúde. Nota Técnica D-GPMAVS nº 07/2014. Histórico e fluxo de dados da Vigilância Sentinela de Acidentes de Transporte Terrestre. Recife: Secretaria de Saúde; 2014.

Because it is a new health information system, which includes non-explored information, such as the risk and protection factors for the occurrence of road traffic accidents, the analysis proposed in this study will contribute to a bigger visibility of occupational and commuting work-related accidents that, according to literature, are underreported.¹¹11. Galdino A, Santana VS, Ferrite S. Os Centros de Referência em Saúde do Trabalhador e a notificação de acidentes de trabalho no Brasil. Cad Saude Publica. 2012 jan;28(1):145-59. By considering the real situation of road traffic accidents in Brazil and in the world and their relation with working, besides their impact on productivity and economy, also striking the victim's relatives, this study aims to describe the profile of work-related road traffic accident victims, reported by Road Traffic Accident Information Sentinel Units in the state of Pernambuco, Brazil, from 2012 to 2014.

Methods

This is a descriptive study on reported cases of (fatal and non-fatal) work-related road traffic accidents in 21 Road Traffic Accident Information Sentinel Units in Pernambuco State, Brazil.

Pernambuco has a territorial area of 98,149,119km²2. Ministério da Saúde (BR). Datasus. Óbitos por causas externas: Brasil, 2013 [Internet]. Brasília: Ministério da Saude; 2015 [citado 2015 maio 4] Disponível em: http://tabnet.datasus.gov.br/ and a population of 9,277,727 inhabitants, and is composed by 184 municipalities and the Island of Fernando de Noronha.¹²12. Instituto Brasileiro de Geografia e Estatística. Estimativas populacionais para os municípios brasileiros em 01.07.2013 [Internet]. Rio de Janeiro: Instituto Brasileiro de Estatística; 2013 [citado 2016 mar 11]. Disponível em: http://www.ibge.gov.br/home/estatistica/populacao/estimativa2013/estimativa_dou.shtm It is administratively divided in 12 Health Regions, where the reported sentinel units are distributed. Each municipality's central office of the Regional Administration of Health (RAH) - from the II to the XI Region - has sentinel units; in Health Region I, situated in the state's capital, Recife, there are ten sentinel units.

This study analyzed all the records of road traffic accident victims, including fatal and non-fatal victims, reported by 21 Road Traffic Accident Information Sentinel Units, which were identified as work-related accidents from January 1, 2012 to December 31, 2014.

The Information System for Road Traffic Accidents adopts the definitions of the International Statistics Classification of Diseases and Problems Related to Health - Tenth Revision (CID-10-Chapter XX). The selected variables were related to the victim's and accident's characteristics, and factors on the victim's risk and protection:

After selecting the work-related accident cases, the database was classified (cleansing), by excluding multiplicity, through probabilistic method, using the RecLink III. In the duplicity stage, the options PBloc, Ubloc and sex were used for blocking, and the variables name and date of birth were the comparison fields. After that, we used the Excel to identify, manually, the pairs signaled in RecLink during the duplicity stage, by comparing variables such as the date of the accident, date of the medical care, type of victim, mode of transport, other party involved in the accident, occupation, etc. The pairs in which these variables were identical were considered true, allowing multiple occurrences of an individual to remain in the analysis.

The existence of more than one report on the same victim for the same event/accident was considered as multiplicity. The occurrence of different accidents with the same victim was not considered multiplicity. In order to avoid distortions in the distribution of the frequency of occupations, the occurrences for which the occupation had not been informed or the described activities did not fit as an occupation were excluded.

The victims' occupations were grouped according to the sector of economic activity, regarding the National Classification of Economic Activities (CNAE) - Subclasses, version 2.2. CNAE is an instrument that standardizes the economic activities' codes nationwide, and is broadly used by many Tax Management departments.¹³13. Motta PT, Carvalho RLR, Duarte MEL, Rocha ADM. Análise dos acidentes de trabalho do setor de atividade econômica comércio no município de Belo Horizonte. REME Rev Min Enferm. 2011 jul-set;15(3):427-33.

The resources of the dynamic table from Microsoft Excel 2010 and the tool for analysis of the Statistical Package for Social Sciences (SPSS), version 13.0, were also used.

This study was submitted to the Committee of Ethics in Research of the Medicine Institute Professor Fernando Figueira (IMIP), and was approved as presented in the Certificate of Ethical Analysis (CAAE) No. 43031715.8.0000.5201.

Results

From January 2012 to December 2014, 131,607 cases of victims from road traffic accidents were reported in 21 Road Traffic Accident Information Sentinel Units of Pernambuco; 19,570 of these cases were identified as work-related road traffic accidents, i.e., 14.9% of the records (Figure 1). During the process of database cleansing 308 records were excluded for being multiplicities, and 8,879 reports of work-related accidents were also excluded: either because the nature of the occupation was not informed (8,292), or because the described activities did not fit as an occupation (587). Thus, the sample of the study was formed by 10,691 valid cases (Figure 1).

Out of the 10,691 reports, 87.8% of the victims were males and more than half of the cases involved individuals in the 20-39 age group (69.0%) (Table 1).

The sectors that individually presented the highest notification proportions were: Transport, Storage and Courier (23.4%) and Trade and Repairing of Vehicles (21.3%) (Table 2). In these sectors, the occupations that registered more victims were: delivery-service motorcyclists (motoboys and motorcycle-taxi drivers: 55.4% of the cases) and salespeople (26.4%). The Agriculture, Cattle Farming, Forestry, Fishing and Aquaculture sectors were the third most frequent sectors reported (18.2%): in almost all those cases, the victims were temporary agriculture workers (98.4%) (Table 2).

According to the characteristics of the event, most of the reported cases occurred in the urban area (72.4%) and on Mondays (17.1%). The main victims were drivers (82.0%); the motorcycle was identified as the most frequent vehicle at the time of the accident (77.0%); collisions were identified in 52.0% of the reports; and the car was most frequently reported as being the other party involved in the accident (31.0%) (Table 3).

Regarding the type of work-related accident, the analysis of the accidents was restricted to 5,054 cases, because this specification was only included in the system analyzed in August 2013, and 69.8% of the cases were related to commuting (Table 3).

Concerning the risk factors that led to the occurrence of the accidents, in 9.4% of the cases the driver was reported to be in high speed; consumption of alcoholic beverages, use of cellphone while driving or tiredness represented, respectively, 3.7%, 0.8% and 1.8% of the cases.

Regarding the victim's use of protection equipment, 88.0% of the motorcyclists reported to be wearing a helmet at the time of the accident and 44.0% of the victims were passengers of the car or bus/similar or heavy vehicle and reported to be using seat belt at the moment of the accident (Table 4).

Discussion

Among the workers that suffered a work-related road traffic accident and were notified in sentinel units in Pernambuco, young (20-29 age group) male adults were the most frequent victims. Motorcyclists were also among the main victims. Bastos et al.¹⁴14. Bastos YGL, Andrade SM, Soares DA. Características dos acidentes de trânsito e das vítimas atendidas em serviço pré-hospitalar em cidade do Sul do Brasil,1997/2000. Cad Saude Publica. 2005 maio-jun;21(3):815-22. reported similar results when analyzing the profile of road traffic accident victims that were rescued by the pre-hospital care service in the city of Londrina-PR. These findings, in general, have similar results concerning studies on road traffic accident victims whose damages affect, mainly, young individuals, in productive phase.¹⁴14. Bastos YGL, Andrade SM, Soares DA. Características dos acidentes de trânsito e das vítimas atendidas em serviço pré-hospitalar em cidade do Sul do Brasil,1997/2000. Cad Saude Publica. 2005 maio-jun;21(3):815-22.

The occurrence of road traffic accidents related to the Transport and Trade sectors, and that affects mainly delivery-service motorcyclists and salespeople, respectively, points to a similar direction to Lacerda et al. study¹⁵15. Lacerda KM, Fernandes RCP, Nobre LCC. Acidentes de trabalho fatais em Salvador, BA: descrevendo o evento subnotificado e sua relação com a violência urbana. Rev Bras Saude Ocup. 2014 jan-jun;39(129):63-74. on fatal work-related accidents in Salvador-BA, where most of victims were workers in the trade, construction, real state, lodging and food, transport and stocking sectors. Another study conducted by Lacerda et al.¹⁶16. Lacerda KM, Fernandes RCP, Nobre LCC, Pena PGL. A (in)visibilidade do acidente de trabalho fatal entre as causas externas: estudo qualitativo. Rev Bras Saude Ocup. 2014; 39(130):127-35. also presents the occurrence of road traffic accidents with workers in public roads; in that study, both the occupational and commuting accidents were identified. These findings may reflect the workers' vulnerability, the lack of traffic security and the deficiency of the transports used for commuting and in situations where the work is performed in a public road.

It is also important to highlight that agriculture temporary workers represented almost all cases of the Agriculture, Cattle Farming, Forestry, Fishing and Aquaculture sectors that were notified by health sentinel units. Alves et al.¹⁷17. Alves MMM, Nomellini PF, Pranchevicius MCS. Mortalidade por acidente de trabalho no estado do Tocantins, Brasil: estudo descritivo, 2000-2010. Epidemiol Serv Saude. 2013 abr-jun;22(2):243-54. found similar results in mortality due to work-related accidents in the state of Tocantins, for the period 2000-2010, when there was a high mortality number among workers in occupations related to the Agriculture and Civil Construction sectors. Those authors also analyzed common causes of death, observing that the most frequent were those of the W group (Other injuries from external causes) and V group (Commuting accidents) of ICD-10.

It is possible that the involvement of agriculture workers, observed in the aforementioned studies, is related to commuting accidents, because the commuting conditions of these workers is usually precarious. Some studies also state that the disrespect for traffic laws, bad conditions of roads, lack of preventive maintenance of vehicles and not using equipment for individual protection may contribute to the occurrence and severity of those accidents.¹⁸18. Mendes R. Transporte: o perigo que ronda os trabalhadores. Rev Rural. 2001 jul;(43):[1 tela].

Pordeus et al.¹⁹19. Pordeus AMJ, Vieira LJES, Almeida PC, Andrade LM, Silva ACG, Lira SVG. Fatores associados à ocorrência do acidente de motocicleta na percepção do motociclista hospitalizado. Rev Bras Promoç Saude. 2010 jul-set;23(3):206-12. stated that the use of motorcycle by workers of small Brazilian towns or in rural areas, as a work instrument to replace horses or donkeys in the transport of people and goods, have reverberated on the profile of emergency care in larger cities, for example, in the emergency care service of a hospital in Fortaleza-CE. This replacement may be attributed to the quickness, easy commute and low cost of these vehicles.

The highest frequency of commuting accidents is possibly connected to the use of motorcycles from the residence to work and vice versa. Strengthening this scenario, according to the National Traffic Department (Denatran), along the years there was a growth in the number of motorcycles, in relation to other vehicles.²⁰20. Departamento Nacional de Trânsito. Anuário da distribuição automotiva no Brasil. [Internet]. Brasília: Fenabrav; 2014 [citado 2016 mar 11]. Disponível em: http://www3.fenabrave.org.br:8082/plus/modulos/listas/index.php?tac=indices-e-numeros&idtipo=6&layout=indices-e-numeros 21.

The results on vehicles used at the time of the accident strengthened Denatran's data, showing that most victims were using motorcycles at the moment of the accident. This finding is similar to the one of Barros et al.,²¹21. Legay LF, Santos SA, Lovisi GM, Aguiar JS, Borges JC, Mesquita RM, et al. Acidentes de transporte envolvendo motocicletas: perfil epidemiológico das vítimas de três capitais de estados brasileiros, 2007. Epidemiol Serv Saude. 2012 abr-jun; 21(2):283-92. who verified the registers from police reports on the victims of traffic accidents in Pelotas-RS. Legay et al. also confirmed this finding, highlighting the motorcycle as the most reported vehicle in the occurrences of traffic accidents with victims in Vitoria-ES, Rio Branco-AC and Palmas-TO.²²22. Barros AJD, Amaral RL, Oliveira MSB, Lima SC, Gonçalves EV. Acidentes de trânsito com vítimas: sub-registro, caracterização e letalidade. Cad Saude Publica. 2003 jul-ago;19(4):979-86.

It is evident that the motorcycle occupants are more vulnerable when involved in traffic accidents, suffering, most of the time, more serious injuries comparing to individuals that are in other types of vehicles.¹⁴14. Bastos YGL, Andrade SM, Soares DA. Características dos acidentes de trânsito e das vítimas atendidas em serviço pré-hospitalar em cidade do Sul do Brasil,1997/2000. Cad Saude Publica. 2005 maio-jun;21(3):815-22. Specific measures are highly necessary in order to reduce the amount of victims in the country.

Collisions involving cars appeared as the most frequent accidents, which is similar to the data found by Almeida et al.,²³23. Almeida RLF, Bezerra Filho JG, Braga JU, Magalhães FB, Macedo MCM, Silva KA. Via, homem e veículo: fatores de risco associados à gravidade dos acidentes de trânsito. Rev Saude Publica. 2013 ago;47(4):718-31. when describing that the main traffic accidents in Fortaleza-CE, in the period 2004-2008, where collisions involving cars/pickup were the most frequent. Validating the discoveries of that research, the present study also identified the drivers as the main reported victims.

The fact that most accidents occurred in working days (Monday and Wednesday) is possibly related to the habit of concentrating working activities on weekdays. This result should be used as an indicator for the creation and implementation of intersectoral actions, with the goal of preventing the occurrence of traffic accidents and consequent harm to the health of workers.

Most accidents occurred in urban areas, and similar results were found by Marín-Leon et al.²⁴24. Marín-León L, Belon AP, Barros MBA, Almeida SDM, Restitutti MC. Tendência dos acidentes de trânsito em Campinas, São Paulo, Brasil: importância crescente dos motociclistas. Cad Saude Publica. 2012 jan;28(1):39-51. in an analysis of the social distribution of fatal traffic accidents in Campinas-SP, from 1995 to 2008, which observed higher occurrence of accidents in urban areas and in roads that pass through the city of Campinas.

With regard to the accidents' risk factors, most victims denied having consumed alcoholic beverages, being in high speed, using the cellphone while driving or being tired. A similar result was reported by Silva et al.,²⁵25. Silva DW, Andrade SM, Soares 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 Saude Publica. 2008 nov;24(11):2643-52. in a research carried out with motoboys in the state of Parana, in 2005-2006: most of them denied having consumed alcoholic beverages before driving, as they also denied high speed and the use of cellphone/radio communicator. However, concerning tiredness while driving, according to the same study, most of the interviewees assumed that they still drive even when they are tired.

Although most motorcyclists that were victims of work-related RTA were wearing a helmet, approximately 1/5 of them were not wearing this equipment of protection at the moment of the accident. A study conducted by Dutra²⁶26. Dutra VC, Caregnato RCA, Figueiredo MRB, Schneider DS. Traumatismos craniocerebrais em motociclistas: relação do uso de capacete e gravidade. Acta Paul Enferm. 2014 set-out;27(5):485-91. in Porto Alegre-RS, in 2012-2013, recorded that: 51.6% of the victims of accidents with motorcycle said that they were wearing a helmet at the time of the accident; 17.6% were not wearing it adequately, admitting that the equipment had fallen at the time of the accident; 6.4% were wearing it; and in 24.5% of the cases, there was no register of the use of helmet.

In the analysis of the variable use of the seatbelt by the victim at the time of the accident, there was little difference between victims that were using the seatbelt and those who were not using it at the time of the accident. In a study conducted by Yokota et al.²⁷27. Yokota RTC, Iser BPM, Andrade RLM, Santos J, Meiners MMMA, Assis DM, et al. Vigilância de fatores de risco e proteção para doenças e agravos não transmissíveis em município de pequeno porte, Brasil, 2010. Epidemiol Serv Saude. 2012 jan-mar;21(1):55-68., in 2010, in Brazilian capitals and the Federal District, more than 70% of the victims said they were using seatbelt in the front seat and 40% in the back seat.

The present analysis revealed that the Information System on Road Traffic Accidents is a useful source of information, although it presents some limitations. Despite the fact that this study is not an evaluative research, it identified limitations in the filling of the variable occupation. The study suggests that filling this field in the report should be mandatory. Especially when the road traffic accident is reported as work-related accident, it is important to establish the casual link between the circumstances of the accident and the nature of the occupation.

The findings presented here confirm the importance of the knowledge on the profile of illness and death related to recording workers victims of road traffic accidents. Such information contributes and supports the organization of surveillance services and health assistance for workers, decision-making, planning of health actions, in addition to guiding policies for the prevention of accidents in the intersectoral context, involving urban planning, road safety, social security and assistance. These actions should be directed specially to men, young adults, workers in Transport and Trade sectors, especially motorcyclists, to search for mechanisms that enable the reduction of road traffic accidents in Pernambuco and in Brazil.

References

Publication Dates

History