Forecasting the burden of road traffic injuries in Ethiopia through 2035 and implications for emergency care systems and sustainable development goal target 3.6

Road traffic injuries (RTIs) remain a major cause of premature mortality and disability worldwide, affecting low- and middle-income countries. In Ethiopia, however, evidence on long-term trends, future projections, and progress toward Sustainable Development Goal (SDG) Target 3.6 remains limited. A secondary analysis of Global Burden of Disease 2023 data was conducted using annual estimates from 1990 to 2023. Outcomes included deaths, disability-adjusted life years (DALYs), age-standardized mortality rates (ASMRs), and age-standardized DALY rates (ASDRs). Temporal trends were assessed using Estimated Annual Percentage Change (EAPC). Future burden (2024–2035) was projected using autoregressive integrated moving average (ARIMA) models selected based on the Akaike Information Criterion, corrected AIC, Bayesian Information Criterion, and Ljung–Box residual diagnostics. Progress toward SDG Target 3.6 was assessed by comparing the 2015 baseline with observed (2023) and projected (2030) estimates. Between 1990 and 2023, RTI deaths increased by 130.0%, from 15,239.82 (95% Uncertainty Interval [UI]: 9,205.53–22,306.00) to 35,049.51 (95% UI: 23,844.13–49,077.30), while DALYs nearly doubled from 1,007,234 (95% UI: 627,736.3–1,445,420) to 1,974,902 (95% UI: 1,334,495–2,752,337). In contrast, ASMR declined modestly (EAPC = − 0.53%, 95% CI: −1.01% to − 0.04%; p = 0.040) and ASDR declined significantly (EAPC = − 1.06%, 95% CI: −1.58% to − 0.54%; p < 0.001). By 2035, deaths, DALYs, ASMR, and ASDR are projected to reach 66,183.37 (95% PI: 41,319.7–91,047.0), 3,620,858 (95% PI: 2,081,637–5,160,079), 50.31(95% PI: 32.1–68.5), and 2,687.16 (95% PI: 1,491.2–3,883.1), respectively. Compared with the 2015 SDG baseline, both ASMR and ASDR increased by 2023 and are projected to rise further by 2030. Forecasts indicate that both the absolute burden and age-standardized rates will increase through 2035. These findings highlight the need to strengthen trauma and emergency care systems, and injury prevention and surveillance to reduce the future burden of RTIs.