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PAPERS:
Flaura K Winston, Craig Rineer, Rajiv Menon, Susan P Baker, and Mark McCarthy
The carnage wrought by major economic change: ecological study of traffic related mortality and the reunification of Germany • Commentary: Road deaths in European countries
BMJ 1999; 318: 1647-1650 [Abstract] [Full text]
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[Read Rapid Response] Carnage confounded
Ruth Ting   (22 July 1999)

Carnage confounded 22 July 1999
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Ruth Ting,
3rd Year Medical Student
Newcatle University Medical School

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Re: Carnage confounded

Winston et al showed a surprising and dramatic increase in death rates of car occupants following the reunification of Germany. The authors conclude that sudden economic change, the increased availability of cars and numbers of inexperienced drivers were major contributing factors. There are however, other possible explanations for the rise in deaths among car occupants. Hence, more data is needed before public health policy recommendations can be made.

Some of the other factors which may have changed around reunification include: increases in some or all of drink driving, joy-riding, speed limits and number of occupants per car; or reduced use of seat belts, more inefficient policing and poorer emergency responses due to breakdown in public services.

Further information is needed on trends in these factors at population level and more detailed information about the characteristics of individual accidents leading to death (e.g. location, blood alcohol levels, age of driver, type of car, conditions of road and road signs and use of seat belt). Also, details about the geographical location of accidents may show ‘black spots’ which warrant further investigation.

We know that many young people are dying on East German roads but we do not know who they are. Are they the drivers of cars or simply passengers? The accidents may be a result of West Germans or other nationals driving powerful Western cars on unfamiliar roads.

The study highlights the problem which occurred and is a useful tool for sparking further investigation. It faces the problem of all ecological studies in drawing conclusions from non-specific data. Only by combining the information put forward in this study with more focused information can sensible suggestions for public health measures be made for developing countries as the author suggests.

Liza Hirst, Neil Jennings, Ruth Ting, James Wilson Stage 3 MBBS University of Newcastle-upon-Tyne