Global, regional, and national burden of fractures due to road injuries: Based on the global burden of disease 2021.

Abstract

Road injury is a major cause of fractures, but its global burden remains unclear. Based on data from the Global Burden of Disease (GBD) 2021 study, this study systematically analyzed the incidence, prevalence, and years lived with disability (YLDs) of road injury-related fractures at the global, regional, and national levels, as well as the trends in disease burden from 1990 to 2021. Additionally, the risk factors for road injury deaths and disability-adjusted life years (DALYs) were evaluated through the GBD study's Comparative Risk Assessment framework. In 2021, global fracture cases from road injuries were 19,113 thousand (95 % uncertainty interval [UI]: 16,571 thousand - 21,839 thousand), a 6.1 % decrease from 1990. From 1990 to 2021, the age-standardized incidence rate (ASIR) fell from 376.5 (95 % UI: 324.43 - 430.91) to 238.2 (95 % UI: 206.63 - 271.01), age-standardized prevalence rate (ASPR) from 1364.4 (95 % UI: 1258.88 - 1471.32) to 825.2 (95 % UI: 764.72 - 884.41), and age-standardized YLD rate (ASYR) from 78.6 (95 % UI: 54.34 - 109.89) to 45.9 (95 % UI: 31.60 - 64.55) per 100,000 population. Among fractures, patellar, tibial/fibular, or ankle fractures had the heaviest burden, with 2021 ASIR of 65.8 (95 % UI: 49.26 - 87.90) per 100,000. Geographically, disease burden varied by region and country: parts of the Middle East, South Asia, Africa, and Latin America remained heavily burdened, while ASIR rose in 19 countries (including Paraguay). Correlation analysis showed ASIR, ASPR, and ASYR correlated positively with Socio-Demographic Index (SDI). Occupational injuries, low bone mineral density, alcohol consumption, high temperature, and smoking have been identified as risk factors for road injuries. Among these, occupational injuries remain the primary global risk factor, though their proportion is decreasing; meanwhile, the risk proportion of low bone mineral density is on the rise. Over the past three decades, the global burden of road injury-related fractures has declined, but regional and national disparities persist. While high SDI regions achieved significant reductions, severe challenges remain in the regions such as the Middle East and West Asia. Additionally, apart from occupational injuries, the risk of low bone mineral density in road injury cannot be ignored.