Severe work-related road traffic injuries: identifying targets for prevention from a national administrative dataset in Chile, 2013–2023

Background Work-related road traffic injuries (WRTIs) are a leading cause of occupational mortality and disability, yet severity predictors remain unclear. This study identified individual, organisational and contextual predictors of severe WRTIs outcomes using national administrative data from Chile. Methods We conducted a retrospective analysis of 193 079 WRTIs recorded between 2013 and 2023. Severity was classified dichotomously using official health criteria. Binary logistic regression examined severity by worker demographics, employment context, injury type and temporal factors. Outcome-consequential variables (medical costs, days of rest) were excluded and used for external validation to avoid endogeneity bias. Results Severe injuries accounted for 12.3% of cases. Severity odds were higher among older workers (≥55 years: OR=2.219, 95% CI 2.110 to 2.340), males (vs females: OR=0.491, 95% CI 0.473 to 0.509) and workers in small enterprises (≤50 employees; dose-response gradient by size). Occupational injuries were more severe than commuting incidents (OR=0.534, 95% CI 0.516 to 0.553), and evening crashes (18:00–24:00) were more severe than night crashes (OR=1.154, 95% CI 1.070 to 1.250). Only accommodation and food services showed significantly elevated odds (OR=1.439, 95% CI 1.140 to 1.840). Model discrimination was modest (area under the curve=0.661). Discussion These findings indicate that WRTIs severity reflects individual vulnerability, work context and exposure conditions acting in combination. Occupational injuries carry greater institutional accountability than commuting injuries, and regional variation suggests differences in post-crash care capacity. Conclusions Findings support targeted prevention for older workers, small enterprises, night-time roles and accommodation and food services, alongside reforms extending employer responsibility to commuting injuries.