Topics in Minority Health Motor Vehicle Crashes and Injuries in an Indian Community -- Arizona

In 1985 and 1986, the Whiteriver Service Unit of the Indian Health Service (IHS) investigated motor vehicle (MV) crashes* on the White Mountain Apache Reservation in eastern Arizona (Figure 1). The reservation is located on 2600 square miles in a rural area with varied topography and climate. In 1986, the population of the White Mountain Apaches was 9302 (3.6 persons per square mile, compared with the 1980 U.S. average of 64.4 persons per square mile). More than 3900 tribal members reside in the community of Whiteriver, approximately 180 miles northeast of Phoenix. To determine the incidence of injuries attributable to MV crashes and to identify risk factors amenable to prevention strategies, the investigators reviewed White Mountain Apache Tribal Police Department crash reports, Arizona Department of Transportation (ADOT) data, and emergency department records at the Whiteriver IHS Hospital.

For the 2-year period, 571 MV crashes were identified. Serious injury or death occurred in 120 (21%) crashes, resulting in 128 hospitalizations and 24 fatalities. The total annual MV-related fatality rate was 129 deaths per 100,000 population; the rate was four times higher for males (206 per 100,000) than for females (53 per 100,000).

Two priority injury events were identified that were readily amenable to prevention: 1) crashes involving pedestrians and 2) collisions with animals. Pedestrians were involved in only 30 (5%) crashes, but accounted for seven (29%) fatalities and 17 (13%) hospitalizations. Ten crashes involving pedestrians occurred along a 1-mile stretch of highway with heavy pedestrian traffic in the Whiteriver community. Although posted with a 25-mile-per-hour speed limit, this section of road had inadequate lighting. Eighty (14%) crashes involved animals; 63 of these involved domestic livestock. Nineteen human injuries, but no fatalities, resulted from collisions with animals. Most (63%) pedestrian injuries and most (77%) collisions involving animals occurred at night. The 461 (81%) MV crashes not involving pedestrians or animals accounted for 17 fatalities and 104 hospitalizations.

In addition, although most (73%) of the crashes occurred on state highways, ADOT had records for only 58% of crashes recorded by tribal police. Of 185 crashes that occurred on one state highway, ADOT received reports on 57 (30%). A third of all severe injuries and fatalities occurred along this highway. Reported by: A Kane, White Mountain Apache Tribal Police Dept, Whiteriver; DR Olivarez, Arizona Dept of Transportation; SJ Englender, MD, State Epidemiologist, Arizona Dept of Health Svcs. GL Rothfus, Office of Health Program Research and Development, Tucson, C Alchesay-Nachu, White river Svc Unit, Whiteriver, Arizona, D Akin, Div of Environmental Health, Indian Health Svc, Rockville, Maryland. Program Surveillance Section, Program Development and Implementation Br, Div of Injury Epidemiology and Control, Center for Environmental Health and Injury Control, CDC.

Editorial Note

Editorial Note: In 1985, the crude annual MV-related fatality rate for the White Mountain Apaches (129 per 100,000) was three times higher than that for all American Indians and Alaskan Natives (43 per 100,000) and nearly seven times higher than that for the total U.S. population (19 per 100,000) (1). Although American Indians and Alaskan Natives are younger than the overall U.S. population, and MV-related fatalities occur disproportionately among the young, age-adjusted fatality rates for American Indians and Alaskan Natives for 1981-1985 have been greater than 2 times the rate for all U.S. residents and other minority groups (1; IHS, unpublished data).

Because MV fatality rates correlate inversely with population density in the United States, the tribe's rural location may account in part for the elevated MV-related death rate. Some researchers have attributed higher MV fatality rates in the rural western United States to greater driving distances in those states, although one study found rural MV death rates to be elevated even when the data were adjusted for distance traveled (2). Other factors that may contribute to the elevated risk in rural areas include greater distances between emergency facilities, reduced access to major trauma centers, travel at higher speeds, and poor roads in rural areas where traffic volume is low. In this study, reliable data were not available to assess the contribution of alcohol and the use/nonuse of occupant-protection devices.

This investigation provided baseline information used to develop local prevention measures. Intervention strategies developed in the community focused on MV-related injury events identified as priorities. Because inadequate lighting was identified as contributing to many pedestrian injuries, the tribe, IHS, and ADOT provided funding for street lights, which were installed in December 1988 along the route where pedestrians were most frequently injured. To reduce the number of crashes involving domestic animals, the White Mountain Apache Tribe is developing legislation to remove domestic livestock from roadways, require penning of animals, and fine the owners of stray livestock.

ADOT allocates funds for road maintenance and highway safety improvement based on the frequency of MV crashes on state roads. Because MV crashes on the Whiteriver reservation were underreported to ADOT, fewer state resources had been allocated to make necessary environmental modifications. However, ADOT administrators and design engineers are using data from this investigation to review the priority status of planned Whiteriver highway improvements. In 1990, some two-lane roads are scheduled for expansion to four lanes, and traffic lights in high-risk areas are to be relocated to facilitate safer pedestrian crossings. To more accurately document MV injuries on the reservation and to evaluate highway safety interventions, the White Mountain Apache Tribal Police Department has developed an improved system of reporting MV crashes to ADOT.  The Whiteriver investigation has been used as a model for MV-related injury prevention in the IHS Injury Prevention Program (3). Begun in 1987, this community-action program trains selected IHS employees and tribal representatives in injury surveillance, epidemiology, and intervention strategies. Thirty graduates of the 1-year program are promoting injury prevention in American Indian and Alaskan Native communities.

References

1. Indian Health Service. Chart series book. Washington, DC: US Department of Health and Human Services, Public Health Service, 1988.

2. Baker SP, Whitfield RA, O'Neill B. Geographic variations in mortality from motor vehicle crashes. N Engl J Med 1987;316:1384-7.

3. Smith RJ. IHS fellows program aimed at lowering injuries, deaths of Indians, Alaska Natives. Public Health Rep 1988;103:204. *A crash or collision involving an MV in motion, excluding events in public parking areas.

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