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Abstract
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BACKGROUND: Limited evidence exists about associations between road crash injury and economic status in sub-Saharan Africa from large, population-based data sets. Existing studies generally do not incorporate fatal crashes. This study aims to understand the relationship between relative wealth and road crash injury and severity using population-representative cross-sectional data from Uganda's 2016 Demographic and Health Survey.
METHODS: One-year road crash risk was flexibly modelled as a function of wealth using fractional polynomial models, stratified by sex and rural/urban residence. Wealth was operationalised as 1/20th quantiles of the first principal component from a polychoric principal component analysis. Injury severity was coded as a three-level ordinal variable; associations with wealth were modelled with ordinal logistic regression on quintiles of relative wealth, stratified by residence.
RESULTS: Overall, injury risk peaked in the upper middle of the wealth distribution. Rural resident injury risk increased monotonically with wealth. Urban resident risk had an upside-down U shape. Risk peaked in the distribution's middle at about double the lowest levels. Only urban men had higher risk among the least wealthy than most wealthy (3.2% vs 1.7%; difference=1.5 percentage points, 95% CI 0.2 to 2.7). Among those with road crash injuries, greater relative wealth was associated with decreased likelihood of more severe injury (33.2 percentage points lower in the highest category than lowest, 95% CI 18.4 to 48.1) or death (5.9 percentage points, 95% CI -0.1 to 11.8) for urban residents but not rural residents.
CONCLUSION: Relationships between relative wealth and injury risk and severity are complex and different for urban and rural Ugandans.
Language: en |