In the period analysed (2008–2019), SUS performed 12,566,104 hospitalizations for external causes. Of them, 1,937,064 (15%) were cause-related to land transport accidents, with an average of 13,453 per month. The hospitalization rate for land transport accidents increased from 49.7 to 91.5 per 100,000 inhabitants between 2008 and 2019 (Fig. 1).
All age groups increased the hospitalization rate for land transport accidents from 2008 to 2019. People from the 20–29 age group ranked first in the hospitalization rate for land transit accidents during the whole period investigated. However, the 40–49 age group presented the highest growth, with an increase of 114.0% between 2008 and 2019 (Table 2).
Table 2
Hospitalization rate for land transport accident stratified by age group from 2008 to 2019, Brazil.
Age group
|
Year
|
Growth
2008–2019
|
2008
|
2009
|
2010
|
2011
|
2012
|
2013
|
2014
|
2015
|
2016
|
2017
|
2018
|
2019
|
0–4
|
12.7
|
17.7
|
18.4
|
18.2
|
18.3
|
20.4
|
18.9
|
16.9
|
16.3
|
16.8
|
15.9
|
15.2
|
20.0%
|
5–9
|
23.2
|
30.1
|
31.9
|
30.9
|
31.4
|
31.4
|
29.1
|
27.2
|
25.9
|
24.7
|
23.6
|
24.5
|
5.4%
|
10–14
|
28.0
|
34.9
|
38.5
|
39.1
|
39.1
|
41.0
|
39.3
|
36.7
|
35.6
|
35.4
|
33.0
|
31.8
|
13.6%
|
15–19
|
62.7
|
77.9
|
89.6
|
100.5
|
105.3
|
114.0
|
118.8
|
115.2
|
114.2
|
112.6
|
105.4
|
105.2
|
68.0%
|
20–29
|
83.4
|
107.2
|
127.1
|
132.0
|
132.9
|
139.4
|
142.9
|
142.8
|
149.0
|
149.8
|
150.0
|
159.4
|
91.0%
|
30–39
|
59.7
|
77.6
|
95.5
|
98.8
|
100.7
|
107.5
|
110.5
|
109.6
|
113.8
|
111.9
|
115.5
|
119.5
|
100.2%
|
40–49
|
49.3
|
64.2
|
76.8
|
80.5
|
84.2
|
91.3
|
940
|
94.6
|
97.8
|
96.3
|
98.8
|
105.5
|
114.0%
|
50–59
|
41.3
|
53.9
|
62.2
|
65.6
|
68.1
|
72.8
|
773
|
76.4
|
78.6
|
80.1
|
83.8
|
87.1
|
110.9%
|
60–69
|
40.3
|
49.7
|
56.1
|
56.6
|
61.4
|
64.6
|
63.8
|
60.8
|
62.3
|
63.5
|
62.5
|
66.5
|
65.0%
|
70–79
|
45.7
|
54.9
|
60.0
|
60.4
|
63.8
|
65.6
|
65.0
|
63.2
|
59.5
|
58.0
|
59.3
|
60.5
|
32.3%
|
80 +
|
51.7
|
65.6
|
71.0
|
64.9
|
65.1
|
70.5
|
69.8
|
61.5
|
58.3
|
58.3
|
56.9
|
59.7
|
15.6%
|
Males accounted for approximately 73% of all hospitalizations cause-related to land transport accidents in the period analysed. From 2008 to 2019, both sexes presented an increase of approximately 85% in the hospitalization rate per 100,000 inhabitants, taking into account the entire county (Table 3).
Table 3
Hospitalizations (absolute and rate) for land transport accidents stratified by sex from 2008 to 2019, Brazil.
Year
|
Men
N
|
Woman
N
|
Hospitalization rate per 100,000
|
Men
|
Woman
|
2008
|
74,796
|
20,366
|
78.9
|
21.1
|
2009
|
96,074
|
27,429
|
100.3
|
28.1
|
2010
|
114,406
|
31,660
|
118.3
|
32.0
|
2011
|
120,487
|
33,145
|
123.4
|
33.2
|
2012
|
124,778
|
34,438
|
126.7
|
34.2
|
2013
|
133,562
|
37,243
|
134.5
|
36.6
|
2014
|
137,924
|
38,083
|
137.7
|
37.1
|
2015
|
137,062
|
37,771
|
135.8
|
36.5
|
2016
|
142,007
|
38,436
|
139.6
|
36.8
|
2017
|
141,801
|
39,333
|
138.4
|
37.4
|
2018
|
143,407
|
40,043
|
139.0
|
37.8
|
2019
|
151,102
|
41,711
|
145.5
|
39.1
|
Table 4 shows the regression estimates for the hospitalization rate for land transport accidents per 100,000 inhabitants in Brazil and its regions. For Brazil, the initial hospitalization rate was estimated at 4.165953 per 100,000 inhabitants (January 2008). In the period prior to the introduction of the new zero-tolerance drinking and driving law, the trend sharply increased, with an increase of 0.054758 per 100,000 inhabitants per month (p < 0.01; 95% CI 0.0419406 to 0.0675755). After the intervention was implemented (December 2012), the hospitalization rate decreased by 0.400841 per 100,000 inhabitants in the first month (p = 0.052; 95% CI -0.8060128 to -0.0043307). In the following months, the monthly trend of hospitalization rate increased by 0.0065 (p < 0.01; 95% CI 0.0035 to 0.0096), indicating a weaker upward trend (or -0.0482 in relation to the trend in the period prior to the intervention). Figure 2 (a) shows the hospitalization rate for land transport accidents before and after the intervention.
Table 4
Results from the interrupted time series regression for Brazil and regions, 2008–2019
Variables
|
Brazil
|
North
|
Northeast
|
Southeast
|
South
|
Mid-west
|
Time
|
0.054758***
|
0.0526151***
|
0.0619794***
|
0.0455077***
|
0.0565731***
|
0.0800397***
|
|
(0.0064831)
|
(0.0069301)
|
(0.0073732)
|
(0.0072904)
|
(0.0052262)
|
(0.0160402)
|
Level
|
-0.400841**
|
0.2184163
|
0.1109826
|
-0.4344186*
|
-0.7082692***
|
-2.208351***
|
|
(0.2029371)
|
(0.3197663)
|
(0.2721336)
|
(0.2370381)
|
(0.1884518)
|
(0.5667303)
|
Trend
|
-0.048215***
|
-0.0193178**
|
-0.0570121***
|
-0.0472338***
|
-0.0556164***
|
-0.0426279**
|
|
(0.0066955)
|
(0.008758)
|
(0.0081061)
|
(0.0076535)
|
(0.0057194)
|
(0.0176499)
|
Constant
|
4.165953***
|
2.310172***
|
3.572928***
|
5.070214***
|
3.344445***
|
4.91043***
|
|
(0.2305902)
|
(0.2462093)
|
(0.2551009)
|
(0.2572111)
|
(0.2016175)
|
(0.5748081)
|
Observation
|
144
|
144
|
144
|
144
|
144
|
144
|
Standard errors in parentheses: |
*** p < 0.01, ** p < 0.05, * p < 0.1 |
The zero-tolerance drinking and driving law seems to play a similar role in the mid-west, southeast and south regions as it did in Brazil as a whole (Fig. 2a, 2d, 2e and 2f). In the north and northeast, we did not identify a significant reduction in the hospitalization rate immediately after Law 12760 was enacted. Although there was no change in the hospitalization level, the annual trend coefficient was statistically significant and negative, suggesting a weaker upward trend after the new zero-tolerance drinking and driving law (Fig. 2b and 2c).
In general, estimates from sensitivity analyses suggested similar results to the base model, except for the coefficient “level” from North and Northeast Brazil, which did not reach statistical significance at the 5% level in any specification. North also did not reach statistical significance in the “trend” variable in two specifications (sensitivity analyses 4 and 5) (Supplementary material, Table S2).
Our results suggested that 436,581 hospitalizations for land transport accidents were averted by the new zero-tolerance drinking and driving law from Dec. 2012 to Dec. 2019 in Brazil. This means an avoidable cost of Int$ 245.48 million for the same period. Additionally, avoidable hospitalizations would allow the reallocation of 2,663,144 days of hospitalization in SUS in a 7-year period. Taking the worst scenario from the sensitivity analysis, the results would be 312,953 hospitalizations averted, 1,909,013 hospital days averted, and Int$ 175.97 million averted (Table 5).
Table 5
Predicted hospitalizations, hospital days and costs averted by the new zero-tolerance drinking and driving law, Brazil.
Model
|
Number of hospitalizations averted
|
Hospital days averted
|
Costs averted (Int$, in million PPP)
|
Base model
Period (Jan/08 – Dec/19); exposure (Dec/2012)
|
436,581
|
2,663,144
|
245.48
|
Sensitivity analysis 1
Period (Jan/08 – Dec/19); exposure (Jan/2013)
|
415,396
|
2,533,916
|
233.57
|
Sensitivity analysis 2
Period (Jan/08 – Dec/19); exposure (Feb/2013)
|
413,027
|
2,519,465
|
232.24
|
Sensitivity analysis 3
Period (Mar/08 – Dec/19); exposure (Dec/2012)
|
378,473
|
2,308,685
|
212.81
|
Sensitivity analysis 4
Period (Mar/08 – Dec/19); exposure (Jan/2013)
|
312,953
|
1,909,013
|
175.97
|
Sensitivity analysis 5
Period (Mar/08 – Dec/19); exposure (Feb/2013)
|
360,127
|
2,196,775
|
202.49
|