Global, regional, and national burden of road injuries 1990-2023: a systematic analysis from the Global Burden of Disease Study 2023

Background
Road injuries are a leading cause of mortality and morbidity worldwide. Years of international efforts have aimed to strengthen policy engagement, including the 2020 United Nations (UN) General Assembly’s proclamation of the Second Decade of Action for Road Safety (2021–2030), targeting a 50% reduction in road-traffic deaths and serious injuries by 2030. To monitor progress and identify intervention gaps, timely evidence is pivotal.

Methods
As part of the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2023, we estimated incidence, mortality, and morbidity of road injuries for 204 countries and territories from 1990 to 2023. Four road injury types and 47 nature-of-injury categories were examined. Morbidity and mortality data from clinical records, vital registration, and police reports were harmonised using meta-analytic techniques to ensure consistency and correct for systematic bias. Incidence was modelled with the meta-regression tool, Disease Modelling-Meta-Regression version 2.1 (DisMod-MR 2.1), and cause-specific mortality with the Cause of Death Ensemble model (CODEm), both incorporating location-specific covariates to support interpolation. Years lived with disability (YLDs) were estimated from the prevalence and severity of the nature of road injury, and years of life lost (YLLs) from the number of cause-specific deaths multiplied by the standard life expectancy at the age of death. Disability-adjusted life-years (DALYs) were the sum of YLLs and YLDs. All metrics include 95% uncertainty intervals.

Findings
In 2023, there were 50·9 million (95% uncertainty interval [UI] 46·1–56·1) road injury incident cases, 1·34 million (1·04–1·58) deaths and 75·3 million (59·8–89·2) DALYs globally. Road injuries were the leading global cause of death among males aged 10–39 years. Between 1990 and 2023, age-standardised incidence and mortality rates declined by 38·3% (36·9–39·7) and 32·3% (6·1–49·0), respectively, but progress varied widely by income groups. Mortality rates in low-income countries (43·8 [31·7–56·0] deaths per 100 000) were approximately six times higher than in high-income countries (HICs) (7·5 [7·1–7·9] deaths per 100 000), despite the HICs showing the highest age standardised incidence rates (858·1 [781·9–947·1] cases per 100 000). In the past decade, many countries achieved notable reductions in road injuries, but others, including Ghana and the United States, saw increases. More severe injuries tended to occur in low- and middle-income countries (LMICs).

Interpretation
Although global incidence, mortality, and DALY rates from road injuries have declined, progress remains uneven, with pronounced disparities across income groups reflecting systemic inadequacies in infrastructure, vehicle standards, enforcement, and post crash care. Strengthening emergency response, improving road design, enforcing safety measures, and adapting policies to the evolving demographics remain essential.