Do crashes happen more frequently at sunset in Ramadan than the rest of the year?

OBJECTIVES: Because the epidemiology of road traffic injuries (RTIs) can differ in time due to differences in traffic dynamics or behaviors, this paper aims to examine whether RTIs are more likely to occur at sunset in Ramadan than in other months in KSA. METHODS: A nationwide cross-sectional study of all RTIs recorded in the Saudi Red Crescent Authority database. Cases were those who sought emergency care following any RTI in 2021. Differences in counts of RTIs between Ramadan and other months were compared using Chi-2 tests. A logistic regression model was constructed to evaluate the association between Ramadan and the likelihood of sunset RTIs. RESULTS: The total number of RTIs was 112,188, of which 9922 (8.8%) occurred in Ramadan. Higher percentages of RTIs during Ramadan as compared to other months were observed among males (82.2% vs. 79.6%; P < .01) and non-Saudis (42.7% vs. 38.9%; P < .01). Interaction effects between Ramadan and region were significant in the regression model (P < .01). RTIs in Ramadan were almost two times more likely to occur at sunset than in other months in the Northern Borders (OR = 2.14; 95% CI:1.44–3.17), while a negative association was found in Bahah region (OR = 0.67; 95% CI: 0.44–0.99). CONCLUSION: RTI burden is higher in Ramadan than in other months, and that varies by region. Further investment in prevention strategies, such as increased enforcement and awareness programs, is warranted in regions with a higher RTIs burden to improve traffic safety and population health.