February 13, 2012

American Indian motor vehicle deaths need to be addressed

More research and programs are needed to address the elevated rate of motor vehicle–related deaths among American Indian and Alaska Native populations, according to new research from the Johns Hopkins Center for Injury Research and Policy.

To better understand this racial and ethnic disparity, the authors conducted a systematic review of literature published over the past 20 years and found just seven studies describing the problem and seven that tested interventions. This first published review of the evidence on risk factors and interventions addressing this disparity appears in the January issue of Epidemiologic Reviews.

Motor vehicle deaths in the United States, which have declined overall, are highest among American Indian and Alaska Natives, with a death rate that is three times that for the Asian and Pacific Islander population, which has the lowest rate.

“The small number of studies in the peer-reviewed literature is surprising given the enormous human and economic impact of motor vehicle–related deaths in this population,” said lead study author Keshia Pollack, an assistant professor with the Johns Hopkins Center for Injury Research and Policy, part of the Bloomberg School of Public Health. “If injury disparities are going to be eliminated, support for research and programs targeting those groups disproportionately impacted needs to be made more readily available.”

The researchers identified published studies in the peer-reviewed literature by searching public health databases for articles published between Jan. 1, 1990, and Jan. 31, 2011. They also searched relevant websites such as those for the Indian Health Service, the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report and individual electronic issues of the IHS Primary Care Provider, a journal devoted to articles of interest to the Indian Health Service and tribal and urban Indian health care professional providers.

The existing literature suggests that multiple risk factors involving behavior, policy and environmental factors are behind the disparity, including the large number of American Indians and Alaskan Natives who live in rural communities, and the use and availability of alcohol. Another common theme the researchers gleaned from the literature was pedestrian involvement in crashes, likely a result of road conditions in rural areas and/or reservations, which often lack traffic control devices and artificial lighting, and of alcohol use. Despite the frequency of pedestrian-related deaths, the researchers were not able to identify any interventions implemented that specifically sought to improve pedestrian safety.

“Studies like this give a bird’s-eye view on the problem,” Pollack said. “In addition to discovering gaps in the existing research and programs, we’re able to identify promising interventions worthy of replication. Priority should be given to interventions that combine multiple methods and use partnerships to change policy, the environment and individual behavior.”

Additional authors of the study are Shannon Frattaroli, Jessica L. Young, Gail Dana-Sacco and Andrea C. Gielen.

Support for this research was provided by the National Center for Injury Prevention and Control, part of the Centers for Disease Control and Prevention, through a grant to the Johns Hopkins Center for Injury Research and Policy.