Burden and temporal trends of four major road traffic injuries in Asia-Pacific, 1990–2023: A GBD-based study

OBJECTIVES: To evaluate the burden and temporal trends of pedestrian road injuries (PRI), cyclist road injuries (CRI), motorcyclist road injuries (MRI), and motor vehicle road injuries (MVRI) across 42 Asia Pacific countries and territories from 1990 to 2023, and to project trends to 2046. METHODS: Using Global Burden of Disease 2023 data, we analyzed incidence, mortality, and disability adjusted life years (DALYs) in the South East Asia Region (SEARO) and Western Pacific Region (WPRO). Age standardized rates (ASIR, ASMR, ASDR) and estimated annual percentage change (EAPC) were calculated. Pearson correlation assessed associations with the Human Development Index (HDI). The Nordpred model projected mortality and DALYs to 2046 for seven representative countries. RESULTS: Trends diverged by region. In SEARO, PRI and MVRI declined, while CRI and MRI rose. MRI ASMR surpassed MVRI in 2004 and PRI in 2013, becoming the leading cause among the four RTIs; MRI ASDR surpassed MVRI in 2001 and PRI in 2005. In WPRO, all four RTIs declined. In 2023, global PRI ASIR was 137.33 and ASMR 4.78, with EAPC of negative 1.84 and negative 2.77. CRI ASIR was 122.81 and ASMR 1.02, with EAPC of negative 1.30 and negative 0.14. MRI ASIR was 81.64 and ASMR 3.83, with EAPC of negative 0.46 and 0.74. MVRI ASIR was 244.11 and ASMR 6.27, with EAPC of negative 1.84 and negative 1.16. In SEARO, MRI ASMR was 6.25 with EAPC 1.11, and CRI ASMR EAPC was 1.00. WPRO showed declining ASMR and ASDR for all categories. HDI was negatively correlated with EAPC for all RTIs: PRI ASMR r equals negative 0.74, CRI r equals negative 0.73, MRI r equals negative 0.67, MVRI r equals negative 0.68, all p less than 0.001. Nordpred projected persistent high burden in low and middle income countries and Pacific island nations, with rising male CRI and MRI burden in India and the Philippines, while China's PRI burden may approach developed country levels by 2035. CONCLUSIONS: Overall RTI burden declined in Asia Pacific, but disparities remain by region, injury type, and country. Targeted strategies should prioritize vulnerable road users, especially motorcyclists and cyclists, and strengthen prevention, trauma care, and region specific policies.