The carnage wrought by major economic change: ecological study of traffic related mortality and the reunification of Germany

BMJ 1999;318:1647-1650 ( 19 June )

Papers

Flaura K Winston, director, TraumaLink, ^a Craig Rineer, research assistant, TraumaLink, ^a Rajiv Menon, senior engineer, TraumaLink, ^a Susan P Baker, professor. ^b

^a The Children's Hospital of Philadelphia and University of Pennsylvania, Suite 706, Abramson Research Center, 34th Street and Civic Center Boulevard, Philadelphia, PA 19104, USA, ^b Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Room 537, 624 North Broadway, Baltimore, MD 21205, USA

Correspondence to: Dr Winston flaura{at}mail.med.upenn.edu

Objective: To document the effects of sudden economicchange on death rates for occupants of cars in the former GermanDemocratic Republic (EastGermany).
Design: Ecological time series study of East Germanyin comparison with the former Federal Republic of Germany (WestGermany) before and after reunification in1990.
Setting: East and West Germany from 1985 to1996.
Subjects: Populations of East and West Germany between1985 and1996.
Main outcome measures: Death rates for occupants ofcars.
Results: After the reunification of Germany, East Germanyexperienced a sudden, temporary affluence and a concomitant fourfoldincrease in death rates for car occupants between 1989 and 1991.Although death rates increased in all age groups, young adults(aged 18-24) were most affected. The death rate per 100 000 populationfor those aged 18-20 years increased 11-fold between 1989 and1991; for those aged 21-24 years the increase waseightfold.
Conclusion: A tragic consequence of the reunificationof Germany was a dramatic increase in the death rate for car occupants.Sudden economic change and availability of cars resulted in botha rise in vehicle ownership and an increase in the number of inexperienceddrivers on roads that were ill prepared for the increased traffic.The lesson learnt from Germany is that during times of economicchange and modernisation, measures to prevent the predictableinjury deaths that will result need to beconsidered.

Key messages

German reunification was associated with a fourfold increase in death rates for car occupants in former East Germany between 1989 and 1991, young adults having an 11-fold increase
Access to previously unobtainable cars and the youth and inexperience of drivers contributed to the increased traffic accidents in East Germany after reunification
Although modernisation of underdeveloped nations and their economies is ultimately beneficial, it can prove fatal without appropriate injury prevention measures
Public health and medical communities must take the lead in ensuring that economic change does not adversely affect the health and safety of the public

© BMJ 1999

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