Spatio-temporal Trends, Multilevel Correlates and Impacts of Public Policy and other factors on Trajectories and Inequalities in Road Traffic Mortality in China
Creators: name: Liu, Jiangmei
Publisher: name: University of Wollongong
Year: 2025
Subjects: classificationCode: 4206
subject: Public health

description: Road traffic injury is one of the leading causes of death in China, according to the results from Global Disease of Burden 2017. The Chinese Government has taken steps to reduce the incidence of road traffic mortality (RTM), including punitive measures (e.g. increasing the severity of punishments for speeding and drinking while under the influence of alcohol) and strategies to limit the number of cars on the road (e.g. number plate lotteries). The implementation of these policies constitutes ‘natural experiments’ that may influence trajectories of, and inequalities in, RTM across mainland China. However, RTM in China has so far only been analyzed in descriptive terms, without any substantial evaluation of these natural experiments using suitably advanced and robust statistical methodologies (e.g. multilevel modelling). The overall aim of my PhD research is to address this gap in knowledge. This research will explore trends in RTM across different areas of China and over time using the best data available, before and after the policy changes, to understand their potential impacts on RTM trajectories and inequalities.Through multilevel modeling, we analyze the spatio-temporal variation trends of road traffic injury deaths at the county level, while exploring influencing factors at the regional level. Using cohort data, we establish a multilevel model at the individual level to analyze the impact of personal behavior on traffic accident mortality. Finally, we analyze the impact of regional road traffic policies(car plate lottery policy) and national road traffic regulations(criminalizing drunk driving) on road traffic injury deaths and evaluate policy effectiveness.This study outlines the temporal and spatial variation of road traffic mortality in China. The mortality rate decreased during 2006-2015, with males consistently having a higher rate than females. Northwest China had the highest rates compared to other regions, even after adjusting for demographic factors. Improvements in socioeconomic status and urbanization may help reduce road traffic mortality.All four behaviors (not using seat belts, driving under the influence of alcohol, fatigue driving, and driving without a license) increased the risk of death from traffic injuries to varying degrees, with drunk driving significantly increasing the risk (RR=3.22). Lower education levels were linked to vulnerable road user roles, such as pedestrians, bicyclists, and motorcyclists, which increased their risk of road traffic injuries. Our findings provide evidence that risky driving behavior, particularly drunk driving, is a major factor in traffic injury deaths.We used interrupted time-series models to assess the car plate lottery policy in Beijing, implemented in 2011, in reducing road traffic mortality. Since the policy's implementation, the growth rate of motor vehicle data volume and the traffic injury death rate in Beijing have significantly decreased. However, the traffic injury death rate in the control group also started declining in 2011, suggesting that the lottery policy may not be the sole reason for the decrease in Beijing's death rate.This research also evaluated the effectiveness of three traffic policy revisions in improving road safety from 2007 to 2015. These revisions included criminalization of drunk driving and increased penalties for license suspension and fines in 2011, as well as revisions to the driving points penalty system in 2010 and 2013. The implementation of the drunk driving law in May 2011 led to a significant reduction in daily and monthly road traffic mortality rates. However, the increase in driving points penalty did not contribute to reducing mortality. This research found an annual decrease of 28.46% in the road traffic mortality rate after the implementation of stricter punishments for drunk driving. It is estimated that before the policy, over 300,000 people died annually from road traffic incidents in China, and this policy would save 88,000 lives every year.In conclusion, this PhD thesis employed a multi-level temporal-spatial model and an interrupted time series model to analyze nationally representative data. The findings reveal a gradual decline in road traffic injury mortality in China. However, this decline varies across different regions of the country. Additionally, the research highlights the significant role of risky driving behaviors as risk factors for traffic injury mortality. It suggests that individuals who engage in dangerous driving practices are more susceptible to fatal road accidents. Moreover, the study emphasizes that the implementation of stricter national penalties for drunk driving has proven to be highly effective in reducing traffic injury deaths in China. It is imperative for policymakers to continue prioritizing and reinforcing such measures, given the evidence of their significant success.