Mortality due to road injuries in the states of India: the Global Burden of Disease Study 1990–2017

BACKGROUND: A systematic understanding of population-level trends in deaths due to road injuries at the subnational level over time for India's 1·4 billion people, by age, sex, and type of road user is not readily available; we aimed to fill this knowledge gap. METHODS: As part of the Global Burden of Diseases, Injuries, and Risk Factors Study, we estimated the rate of deaths due to road injuries in each state of India from 1990 to 2017 based on several verbal autopsy data sources. We calculated the number of deaths and death rate for road injuries by type of road user, and assessed the age and sex distribution of these deaths over time. Based on the trends of the age-standardised death rate from 1990 to 2017, we projected the age-standardised death rate to 2030 to assess if the states of India would meet the Sustainable Development Goal (SDG) target to halve the death rate for road injuries from 2015 by 2020 or 2030. We calculated 95% uncertainty intervals (UIs) for the point estimates. FINDINGS: In 2017, 218 876 deaths (95% UI 201 734 to 231 141) due to road injuries occurred in India, with an age-standardised death rate for road injuries of 17·2 deaths (15·7 to 18·1) per 100 000 population, which was much higher in males (25·7 deaths [23·5 to 27·4] per 100 000) than in females (8·5 deaths [7·2 to 9·1] per 100 000). The number of deaths due to road injuries in India increased by 58·7% (43·6 to 74·7) from 1990 to 2017, but the age-standardised death rate decreased slightly, by 9·2% (0·6 to 18·3). In 2017, pedestrians accounted for 76 729 (35·1%) of all deaths due to road injuries, motorcyclists accounted for 67 524 (30·9%), motor vehicle occupants accounted for 57 802 (26·4%), and cyclists accounted for 15 324 (7·0%). India had a higher age-standardised death rate for road injury among motorcyclists (4·9 deaths [3·9–5·4] per 100 000 population) and cyclists (1·2 deaths [0·9–1·4] per 100 000 population) than the global average. Road injury was the leading cause of death in males aged 15 to 39 years in India in 2017, and the second leading cause in this age group for both sexes combined. The overall age-standardised death rate for road injuries varied by up to 2·6 times between states in 2017. Wide variations were seen between the states in the percentage change in age-standardised death rate for road injuries from 1990 to 2017, ranging from a reduction of 38·2% (22·3 to 51·7) in Delhi to an increase of 17·0% (0·6 to 34·7) in Odisha. If the trends estimated up to 2017 were to continue, no state in India or India overall would achieve the SDG 2020 target in 2020 or even in 2030. INTERPRETATION: India's contribution to the global number of deaths due to road injuries is increasing, and the country is unlikely to meet the SDG targets if the trends up to 2017 continue. India needs to implement evidence-based road safety interventions, promote strong policies and traffic law enforcement, have better road and vehicle design, and improve care for road injuries at the state level to meet the SDG goal. FUNDING: Bill & Melinda Gates Foundation and Indian Council of Medical Research, Department of Health Research, Ministry of Health and Family Welfare, Government of India.