摘要:زمینه و هدف: حوادث ترافیکی و مرگ و میر ناشی از آن، یک مشکل مهم بهداشت و سلامت در کشور ایران است. وضعیت اقتصادی اجتماعی از فاکتورهای مهم مرتبط با وضعیت سلامت محسوب میشود. هدف این مطالعه بررسی ارتباط فاکتورهای اجتماعی- اقتصادی با پیامد مرگ و شدت مصدومیت ناشی از حوادث ترافیکی در بین بیماران ترومایی بیمارستان پورسینای شهر رشت سال 1394 است. روش بررسی: مطالعه حاضر یک مطالعه مقطعی-تحلیلی است. برای بدست آوردن فاکتورهای اصلی اجتماعی اقتصادی از روش تحلیل مولفه های اصلی استفاده شد. ارتباط این فاکتورها با پیامد مرگ و شدت تروما بیماران با استفاده از آنالیز رگرسیون لجستیک مورد بررسی قرار گرفت. یافته ها: در این مطالعه تعداد 300 نفر از مصدومان حوادث ترافیکی مورد بررسی قرار گرفتند. از لحاظ جنسی 234 نفر مرد (78%) و 66 نفر زن (22%) بود. میانگین سنی مصدومان 25/34 سال (07/19) بود. مقیاس ISS بالای 15 به عنوان آسیب دیدگی شدید در نظر گرفته شد که تعداد 245 نفر از بیماران (7/81%) دارای نمره ISS کمتر و مساوی 15 بودند. برخی از فاکتور های اقتصادی اجتماعی با پیامد مرگ و شدت مصدومیت دارای ارتباط بودند. مقادیر نسبت شانس برای این فاکتورها به ترتیب 45/0 (فاصله اطمینان 95%: 836/0- 242/0) و 65/0 (فاصله اطمینان 95% : 95/0- 45/0) بدست آمد. نتیجه گیری: نتایج این مطالعه نشان داد که عوامل اقتصادی اجتماعی با مرگ و میر و میزان مصدومیت های ناشی از حوادث ترافیکی ارتباط دارد.
其他摘要:Background and aims:Roadtraffic crashes and its deaths and injuries are one of the main public health problems in all over the world especially in Low and Middle Income Countries (LMICs).Roadtraffic crashes resulting in deaths, physical and psychological problems, and economic costs which have damages on families and communities. The number of roadtrafficdeaths was exceeded from 1.3 million in 2016.Most of the roadtraffic injuries are belong to low and middle-income countries of the world. Road traffic injury is the eight leading causes of deaths for all ages, while it is largely neglected. There are several effective factors in roadtraffic crashes. The socio-economicstatus is known as important factors related to healthstatus, although its influence is notfullyunderstood on different aspects of health.People who live in lowsocioeconomicstatussuffer from the disease and injuries two times more than others. The results of the studies show that fatal and non-fatal injuries have an inverse relationship with socio-economicstatus. The socio-economicstatus is known as important factors related to health status.People who live in lowsocioeconomicstatussuffer from the disease and injuries two times more than others. The results of the studies show that fatal and non-fatal injuries have an inverse relationship with SES. However, there is a lack of enough information about the effects of socioeconomic status on road traffic crashes and its related outcomes. The incidence rate of road traffic injuries and its related deaths have a relationship with socio-economic status. In the international level, these incidencesvary between the High-income countries and Low and Middle-income countries.Moreover, the incidences of road traffic injuries and deathsvary between the differentsocio-economic groups in each country. The socio-economicstatus is known as the main predictor factor in different aspects of health. The importance of socio-economicstatus will increase in regarding this point which the outcomes of road traffic crashes are sometimes irreversible. However, the effect of socioeconomicstatus on the many aspects of health is notfullyunderstood.Identifying the socio-economicstatus factors related to the outcomes of road traffic crashes can provide a good opportunity for policy makers and managers to use preventive interventions in high-risk groups. Methods: This studyused an analytical cross-sectional design. The studied sample waspeople who injured because of road traffic crashes and referred to Pour-Sinahospital in the city of Rasht.Rashtis the central city of Guilanprovince.Guilanprovince is located in the north of Iran and the rate of road traffic crashes is high in this province. The collection of data has been done by two researchers. The data collection questioner trained in order tomeet the quality assurance and prevention the information bias. The using questionnaires consisted of two parts. The first partwas a checklist to collecting the demographic information including the;age, gender, a marital status which obtained from hospital records.Moreover, collecting the crash information such as; the location of the injury, the type of injury, the severity of injury(based on Injury Severity Score), the clinical outcome of the patient which were extracted from hospital records. The second part of the instrument was related to socio-economic issues. For this purpose, the standardized questionnaire was used which the validity and reliability of that were confirmed in the previous study. In the cases that the injured people had died or were unable to interviewdue to the severity of the injuries, the interview was conducted with one of the close relatives (father, mother, brother or sister) and after obtaining informed consent. In order todetermine the socio-economic status factors(that are a combination of variables), the principal components analysis was used. Principal component analysis simplifies the data and reduces the number of variables. To extracted the factor/factors from the variables, the Varimax rotation method was used. The Varimax rotation is used if factors are assumed to be uncorrelated which is known as orthogonal rotation. In this study, the Eigenvalue greater than 1 was chosen. After determining the factor, the variables that were present in each factor were identified. To obtain the main socio-economic status factors themethod of principal component analysis was used. To assess the interest of the implementation of the principal component analysis on a data, Bartlett’s sphericity test and the KMO index were used. The main SES factors were determined and in order toassess the relationship between these factors and death and severity of injuries related to road traffic crashes, the logistic regression with the Backward-LR method was used. The analysis was adjusted on the variable of age and sex of patients. For the severity of the injury, the ISS scale was grouped(ISS> 15, ISS = <15) and it is considered as the dependent variable in the Logistic Regression model. The ISS scale above 15 is considered to be a severe injury All analyses were performedusing the SPSS software version 20. The significance level of the tests in this study was considered 0.05. Results: In this study, 300 traumatic patients were recruited. From all, 234 patients(78%) were male. The mean age of injured patientswas 34.25 years old (19.07). The ISS scale was grouped(ISS> 15, ISS = <15).theISS scale above 15 is considered to be a severe injury. The severe injury (ISS > 15) was observed among 245 (81.7%)patients. Bartlett’s sphericity test and the KMO index showed that there is a good correlation between the studied variables and the using of principal component analysis is feasible. The p-value for the Bartlett test is significant and the KMO index is more than 0.5. Some socio-economic status factors had a relationship with the outcomes of death and the severity of the injury of patients.There were three factors which affect the outcome of road traffic crashes. The first factorincludes the following variables; household cost, the education level of an injured person, and the education level of the mother. The second factorincludes the variables of;job, owning the mobile and motorcyclist. The third factorincludes the variables of;income and fathers job. The results of logistic regression analysis showed that factor 3 (family income and father's job) had a significant relationship with the outcome of traumatic death. For this factor, the odds ratios of 0.45 (CI 95%;0.042- 0.83) for deaths and 0.65 (CI 95%;0.45- 0.90) for the severity of injuries was obtained. The highest SES had the lowestdeaths and injuries. There was a relationship between economic factors and the severity of the trauma, the economic-social third factor including variables;family income and father's occupation were identified as an effective factor in the severity of trauma. The odds ratio for the third factor (household income and father's occupation) was 0.68 (95% confidence interval: 0.452-0.908). Conclusion: The results of this studyshowed that social economic factors affect both the deaths and the severity of injuries. The results of this study showed that the third factor (family income and father's job) had a significant relationship with traumatic death.In other words, the mortality rate of road traffic crashes is high among families with a low level of socio-economic status.Considering the high rates of deaths and severe injuries caused by traffic accidents in Iran compared to other countries, it is necessary economic and social factors will be considered as effective factors on deaths and injuries in road traffic policy-making and planning.
关键词:حوادث ترافیک جاده ای; وضعیت اقتصادی اجتماعی; آسیب; مرگ و میر