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Trends in fatal motorcycle injuries in the Americas,
1998–2010
Eugênia M. S. Rodrigues
a
, Andrés Villaveces
b
, Antonio Sanhueza
a
& José A. Escamilla-
Cejudo
a
a
Pan American Health Organization / World Health Organization, Washington, DC
b
Cisalva Institute, Universidad del Valle, Cali, Colombia
Published online: 28 May 2013.
To cite this article: Eugênia M. S. Rodrigues, Andrés Villaveces, Antonio Sanhueza & José A. Escamilla-Cejudo , International
Journal of Injury Control and Safety Promotion (2013): Trends in fatal motorcycle injuries in the Americas, 1998–2010,
International Journal of Injury Control and Safety Promotion, DOI: 10.1080/17457300.2013.792289
To link to this article: http://dx.doi.org/10.1080/17457300.2013.792289
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3. Trends in fatal motorcycle injuries in the Americas, 1998–2010
Eug^enia M. S. Rodriguesa
*, Andres Villavecesb
, Antonio Sanhuezaa
and Jose A. Escamilla-Cejudoa
a
Pan American Health Organization / World Health Organization, Washington, DC; b
Cisalva Institute,
Universidad del Valle, Cali, Colombia
(Received 11 December 2012; final version received 18 February 2013)
Injuries, disabilities and deaths among motorcyclists have been rising worldwide but what is happening in the American
Continent is not completely known. Deaths from motorcycle crashes of the Pan American Health Organization database
(PAHO/WHO, 1998–2010) were included in an ecologic multi-national study to quantify the temporal trends and to esti-
mate the association between motorcycle riders’ deaths and selected socio-economic indicators. Mortality rates increased
in all sub-regions. The highest increase was reported in the countries of the Andean sub-region (Ecuador, 78.3%) and Mes-
oamerica (Costa Rica, 60.0%). Poorer countries fared worse in terms of motorcycle mortality relative to richer countries,
as did more unequal ones. Recent economic changes, rapid increment of motorisation rates, affordability of motorcycles
over public transportation, lack of adequate public transportation policies and other insufficient measures aimed at improv-
ing safety can explain these trends.
Keywords: motorcycles; trends; mortality; surveillance; Americas
Introduction
In the last two decades, injuries, disability and deaths
among motorcycle users have been rising worldwide dis-
proportionally affecting young males (Franco Arias, 2010a;
Instituto de Pesquisa Econ^omica Aplicada, 2006; Zentner,
Dellinger, Adkins, Greene, 1995). Motorcycle riders are
especially vulnerable to injuries because of the high speeds
they can acquire, coupled with small vehicular structures
that offer poor protection and are more difficult to be seen
in traffic. Consequently riders involved in crashes are more
likely to die or be severely injured due to high frequency of
head, chest and leg injuries (Peden et al., 2004).
In the Americas and the Caribbean, the number of reg-
istered vehicles has been estimated at over 387 million of
which approximately 24 and a half million are motor-
cycles. Motorisation rates vary from country to country
from 55 per 1000 in Peru to 779 per 1000 in the United
States as well as difference of the type of vehicles is
observed (Pan American Health Organization, 2009).
There are also several sub-regional variations.
In this region, traffic-related injuries are the number
one cause of death among children aged 5 to 14 years and
the second cause among those aged 15 to 44 years. In
2007, 142,252 traffic-related deaths occurred in this
region and an estimated 5 million people were injured
(Pan American Health Organization, 2009). The standar-
dised road traffic mortality rate in the region is 15.8 per
100,000 population with great disparity among countries,
ranging from 4.3 per 100,000 in Uruguay to 21.8 per
100,000 in Venezuela. Motorcyclists accounted for 12%
of all traffic-related fatalities. The percentage among sub-
regions varies from 14% in the Southern Cone to 6% in
Mesoamerica. Since the late nineties, fatal and non-fatal
motorcycle injuries have been rising in several countries
with the consequent economic and social costs associated,
hence increasing the public health burden in the region
(Pan American Health Organization, 2009). A study from
the United States documented that motorcyclists incurred
higher costs with respect to injury incidence. In 2000,
motorcyclists accounted for 6% of fatal and non-fatal
injuries, but 12% of the costs, totalling approximately
$12 billion of the $99 billion total cost of motorcycle
fatalities and injuries (Naumann, Dellinger, Zaloshnja,
Lawrence, Miller, 2010).
Young adult males are the main users of motorcycles
in Latin America. As a consequence, they account for the
largest proportion of motorcycle deaths and injuries. Inju-
ries among these young populations further increase the
public health burden in the region through longer periods
of rehabilitation, disability and economic losses. The
Latin American population is relatively young and about
28% of Latin Americans are under 15 years of age
(Franco Arias, 2010b). Considering that young adults are
mostly at risk for being involved in motorcycle crashes,
motorcycle safety constitutes an even greater priority for
the region (Hazen Ehiri, 2006).
While many studies have looked at motorcycle inju-
ries trends in the US and Canada (Beck, Dellinger,
*Corresponding author. Email: rodrigem@paho.org
Ó 2013 The Author(s). Published by Taylor Francis.
This is an Open Access article. Non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly attributed, cited, and is not
altered, transformed, or built upon in any way, is permitted. The moral rights of the named author(s) have been asserted.
International Journal of Injury Control and Safety Promotion, 2013
http://dx.doi.org/10.1080/17457300.2013.792289
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4. O’Neil, 2007; Watson, Zador, Wilks, 1980), evaluated
policies (Hertz, 1989; Hijar, Perez-Nunez, Inclan-
Valadez, Silveira-Rodrigues, 2012; Villaveces et al.,
2003), and looked at economic consequences of motorcy-
cle injuries in those countries (Muelleman, Mlinek,
Collicott, 1992; National Highway Traffic Safety Admin-
istration, 2011), very few have focused on motorcycle
morbidity and mortality in the rest of the Americas. A
couple of studies from Brazil have documented increases
in motorcycle injuries at a national level (Chandran,
Sousa, Guo, Bishai, Pechansky, 2012; Instituto
de Pesquisa Econ^omica Aplicada, 2006) or described
motorcycle injuries in more detail in Sao Paulo state
(Gawryszewski et al., 2009; Silva, Cardoso, Santos,
2011). Another study from Cali, Colombia documented
increases in motorcycle mortality and estimated changes
associated to the implementation of a helmet law
(Espitia-Hardeman, V et al., 2008), and one from Jamaica
documented associated morbidity and mortality among
people seen at a large hospital (Crandon, Harding,
Cawich, McDonald, Fearron-Boothe, 2009).
The dearth of information about motorcycle mortality
in the Americas highlights the need to document overall
regional trends. This study addresses the magnitude of the
problem at a regional level, by sub-regions, and by com-
paring countries with similar economic indicators to high-
light the seriousness of the problem, and to raise
hypotheses that could explain this phenomenon.
Materials and methods
To investigate the mortality risk throughout the time of a
motorcycle rider injured in a transport crash in the Ameri-
can Continent, we undertook an ecologic comparison –
trend study among Member Countries of the Pan Ameri-
can Health Organization, the regional office of the World
Health Organization in the Americas (PAHO/WHO). We
initially considered 48 countries with an approximate total
population of 930 million in 2009. Countries were
included in the final analysis if they complied with the fol-
lowing conditions: (a) they had data for at least 7 years of
the 13-year study period, (b) they had a minimum popula-
tion of 400 thousand inhabitants and (c) if they had a
medium to good data quality index as assessed in 2008 by
common PAHO health indicators for the Americas (Pan
American Health Organization, 2008). Our final selection
of countries yielded 17 nations for the overall regional
comparison. Puerto Rico has been considered as a nation
although it is an unincorporated territory of the United
States of America. The sub-regional comparison (second
level of inference), included country groupings according
to commonly used PAHO categories: North America
(United States of America and Canada); Mesoamerica
(Costa Rica, Mexico, Nicaragua, Panama); Latin Carib-
bean (Cuba, Puerto Rico); Andean (Colombia, Ecuador,
Venezuela); Southern Cone (Argentina, Brazil, Chile,
Paraguay); and Non-Latin Caribbean (Suriname, Trinidad
Tobago).
Mortality data were drawn from the Regional Data-
base on Mortality compiled by PAHO’s Health Analysis
Unit from 1998 to 2010. The Regional Database on Mor-
tality compiles information from the national death regis-
tries of all Member Governments provided on an annual
basis. Deaths from motorcycle riders injured in transport
crashes were classified according to the International
Classification of Diseases, 10th revision (ICD – 10) under
codes V20 – V29 “Motorcycle rider injured in transport
crash”.
Data analysis included descriptive statistics by coun-
try, sub-region and region. Crude mortality rates were
calculated using as the numerator the number of deaths
in motorcycle crashes and as denominator the annual
mid-period population by age and sex, provided by the
United Nations, Population Division for the study period.
For between country and between sub-regions compari-
sons we used age-adjusted mortality rates, using as
standard population the WHO world population
age-structure constructed for the period 2000–2025. The
use of an average world population, as well as a time
series of observations, removes the effects of historical
events such as wars and famine on population age
composition (Ahmad, Boschi-Pinto C, Murray, Lozano,
Inoue, 2001).
Using negative binomial models we explored indepen-
dently the bivariate association between motorcycle mor-
tality and sub-region, sex and age group respectively. We
also considered the association of socio-economic indica-
tors and motorcycle deaths using these models. Our expo-
sure variables for this latter model included Gross
National Income (GNI) converted to international dollars
using purchasing power parity rates and the Highest 20%/
Lowest 20% income ratio (H20%/L20%). The median
value of H20%/L20% was computed to generate two
groups of countries: one with the highest indicator values
(meaning lower income sharing) and lower values (higher
income sharing). We included only bivariate models due
to the number of countries being small and some of these
variables are collinear.
Results
In the Americas, the overall motorcycle-related mortality
rate was 1.6 per 100,000 in the period 1998–2010. These
rates have been increasing very fast, varying from 0.8 per
100,000 in 1998 to 3.5 per 100,000 in 2010. The trend
analysis showed that the average percentage variation
(APV) from 1998 to 2010 was 12.9% overall. Although
the highest rates in the Americas were found in the South-
ern Cone (2.5 per 100,000) and Andean Area sub-regions
(2.3 per 100,000), the highest increase was reported in the
countries of the Andean sub-region (Ecuador, 78.3%) and
Mesoamerica (Costa Rica, 60.0%).
2 E.M.S. Rodrigues et al.
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5. Countries with the highest mortality rates were Colom-
bia (3.6 per 100,000), Brazil (2.9 per 100,000), Paraguay
(2.5 per 100,000) and Suriname (2.2 per 100,000). On the
other hand, Chile and Ecuador (0.2 per 100,000) had the
lowest mortality rates. However, the countries with the
greatest increases in rates in the Southern Cone were Chile
and Paraguay. Table 1 summarises the current situation on
mortality deaths and rates as well as the APV by sub-
regions and countries within them. Our rates are different
from the ones reported in the WHO Global Status Report
(World Health Organization, 2009) because the latter report
only computed rates for one year unlike ours that includes
the whole period 1998–2010.
In all the Americas, overall the relative risk (RR) of
dying for men was 7.8 times greater than for women
(95% CI [6.0, 10.2]). Among males, rates varied from
1.4 per 100,000 in 1998 to 6.0 per 100,000 in 2010.
Figure 1 shows mortality rate trends from motorcycle
crashes by sex and for the overall.
The age groups 15 to 24 and 25 to 34 had the highest
risk of dying from motorcycles over the whole study
period and region, and among those less than 15 years of
age is the one with the lowest rate. Notably, those aged 15
to 24 had a risk 24.3 times higher than those less than
15 years (95% CI [18.1, 32.6]). Figure 2 presents the
trends of mortality rates by age groups, where one can see
that all the age groups had increasing rates.
Table 1. Motorcycle-related mortality, rates per 100,000 pop
and average percent variation (APV), Americas, 1998–2010
Sub-region Country Deaths Rate APV (%)
Southern Cone Brazil 70085 2.9 20.2
Paraguay 1691 2.5 35.2
Argentina 4316 0.9 14.4
Chile 477 0.2 37.4
Total 76569 2.5 20.8
Andean Colombia 16557 3.6 1.0
Venezuela 2636 1.0 25.6
Ecuador 323 0.2 78.3
Total 19516 2.3 5.4
Latin Caribbean Cuba 1405 1.4 À4.2
Puerto Rico 422 1.2 26.6
Total 1827 1.4 20.2
North America United States
of America
38387 1.3 8.2
Canada 1505 0.6 4.6
Total 39892 1.3 8.2
Non-Latin
Caribbean
Suriname 109 2.2 50.9
Trinidad and
Tobago
36 0.3 À1.1
Total 145 0.9 39.3
Mesoamerica Costa Rica 857 1.7 60.0
Nicaragua 262 0.4 45.0
Panama 151 0.4 26.5
Mexico 4851 0.4 12.2
Total 6121 0.4 10.0
AMERICAS All countries 144070 1.6 12.9
Figure 1. Motorcycle-related mortality by sex, Americas rate per 100,000.
Source: Pan American Health Organization, Health Information and Analysis, Mortality database May, 2012.
International Journal of Injury Control and Safety Promotion 3
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6. Table 2 shows the estimated rate ratio, confidence inter-
vals and p-values by sub-region, sex and age
(Mesoamerica, Female and less than 15 years old serve as
the reference, as they have the lowest mortality rates).
Motorcycle-related mortality rate ratios by region were
greater in the Southern Cone followed by the Andean
region, were more common among males, and occurred
most commonly among riders aged 25–34 years. Figure 3
Figure 2. Motorcycle-related mortality by age group, Americas rate per 100,000.
Source: Pan American Health Organization, Health Information and Analysis, Mortality database May, 2012.
Table 2. Mortality rate ratios (and 95% confidence intervals) among motorcyclists in the Americas
95% CI
Rate Ratio Inferior Limit Superior Limit p-value
Sub-Region
Southern Cone 6.3 4.3 9.1 Á0001
Andean 5.7 3.9 8.3 Á0001
Latin Caribbean 3.1 2.1 4.6 Á0001
North America 3.2 2.1 4.7 Á0001
Non-Latin Caribbean 3.2 2.0 4.9 Á0001
Mesoamerica (reference) – – –
Sex
Male 7.8 6.0 10.2 Á0001
Female (reference) – – –
Age
15–24 24.3 18.1 32.6 Á0001
25–34 26.2 19.6 35.2 Á0001
35–44 17.5 13.0 23.5 Á0001
45 þ 9.3 6.9 12.5 Á0001
15 À (reference) – – –
4 E.M.S. Rodrigues et al.
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7. Figure 3. Age-adjusted motorcycle mortality trends by sub-region per 100,000. (a) Andean Region, (b) Latin Caribbean,
(c) Mesoamerica, (d) Non-Latin Caribbean, (e) North America, (f) Southern Cone.
International Journal of Injury Control and Safety Promotion 5
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8. Figure 3. (Continued)
6 E.M.S. Rodrigues et al.
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9. shows the trends of motorcycles age-adjusted mortality rates
for the countries within each sub-region. Over this period,
Colombia had higher rates than Venezuela and Ecuador in
the Andean Region, Cuba had decreasing rates in the Latin
Caribbean and Costa Rica showed higher rates than Mexico,
Nicaragua and Panama in the Mesoamerican sub-region.
Suriname had greater rates than Trinidad and Tobago in the
Non-Latin Caribbean, the USA reports greater rates than
Figure 3. (Continued)
International Journal of Injury Control and Safety Promotion 7
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10. Canada, and Brazil had in general greater rates, compared to
Argentina, Chile and Paraguay in the Southern Cone.
Motorcycle crash mortality rates are unevenly dis-
tributed throughout the Americas. Part of the explanation
might be related to differentials in socio-economic char-
acteristics. We also explored this by assessing the rela-
tion between poverty (gross national income – GNI
converted to international dollars using purchasing
power parity rates) as well as how income is distributed
across the population: how income is shared between the
20% richest versus the 20% poorest families of a coun-
try. Table 3 shows that income distribution seems to be
more associated to mortality rates than income levels:
countries with better income distribution tend to have
lower age-adjusted mortality rates, with a mean mortal-
ity rate 2.3 times higher among the poorest. Table 4
shows the association between motorcycle-related mor-
tality and selected socio-economic indicators. Results
suggest that countries that are poorer tend to have greater
rates of motorcycle fatalities as well as countries that
have more inequalities as measured by the percentage of
share of income by the highest and lowest 20% of the
population.
Discussion
To the best of our knowledge, this is the first paper to
show the overall status of motorcycle fatalities over a
period of time for the entire region of the Americas. In
this region overall, motorcycle-related fatalities have been
steadily increasing in the last few years. Despite this, there
are important differences in magnitude between countries
with some having alarmingly high rates such as Paraguay,
Brazil and Colombia, while others despite lower rates,
show marked increases in fatalities. For the majority of
countries in this region, patterns of mortality are similar
to those reported in other studies or from other parts of the
globe. Young males are the most affected and most deaths
occur in urban settings (Agnihotri Joshi, 2006; Chi
Wang, 2007).
Our analysis has some limitations. First, it relies on
country-reported information and many countries have
different systems. Mortality rates may be underestimated
due to data quality problems such as the proportion of
deaths that have not been registered, and the proportion of
injuries-related deaths of unknown intention.
Our data are country-based and consequently miss any
detailed information within country that might provide
additional clues about where motorcycle fatalities are
higher or lower. We used a series of economic indicators
Table 3. Age-adjusted motorcycle mortality rates per 100,000
pop by income and shared income among countries with avail-
able information for these variables (2000–2010)
Country (a)
H20%/
L20% (b)
GNI
($ ppp) (c)
Mortality
Ratex
Mean
mortality
rate
United States of
America
8.40 40,650 1.30
Costa Rica 12.80 8020 1.70
Mexico 12.80 11,480 0.30
Venezuela 14.00 8660 1.00
Nicaragua 14.40 2090 0.40
Chile 14.95 10,350 0.20
ArgentinaÃ
15.90 9120 0.90 0.84
Ecuador 17.40 5860 0.20
Suriname 18.60 5250 2.20
Paraguay 19.10 3660 2.30
Brazil 23.00 7830 2.70
Panama 23.95 7820 0.40
Colombia 24.05 6600 3.60 1.97
(a) Countries sorted from lowest to highest indicator value (lower values
indicate better income sharing)
(b) Percentage of income sharing (poorest and richest 20% of population)
(c) GNI ($ ppp) is gross national income converted to international dol-
lars using purchasing power parity rates. An international dollar has the
same purchasing power over GNI as a US dollar has in the United States.
(x
) Mortality rate per 100,000 in period 1998–2010.
(Ã
) Median value of percentage share of income (poorest and richest 20%
of population)
Table 4. Association of mortality rate ratios and 95% confidence intervals among motorcyclists in relation to selected socio-economic
indicators
95% CI
Covariate Rate Ratio Inferior Limit Superior Limit p-value
H20%/L20%
Lower Income Sharing 2.4 1.1 5.2 0.0308
Higher Income Sharing (reference) - - -
GNI (Ã
)
Lower income 1.5 0.4 5.4 0.5077
Upper middle income 1.5 0.6 3.5 0.3484
High income (reference) - - -
(Ã
) Based on the income group classification developed by the World Bank:
Lower income ¼ GNI $3,975 or less
Upper middle income ¼ GNI $3,976–12,275
High income ¼ GNI $12,276 or more
8 E.M.S. Rodrigues et al.
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11. as proxies for social conditions in the country that might be
modulating changes in motorcycle fatalities. At an ecologi-
cal level for example, we found that measures of low
income distribution or higher inequalities were related to
mortality rates, more than income levels per capita: coun-
tries with better income sharing had the lowest mortality
rates. Finally, we could not include information from all
countries, as some of the data coming from some nations is
non-existent or not reliable enough to extrapolate to the
entire country. Despite these shortcomings, we believe this
study shows differences within the region of the Americas
as well as important economic differences related to motor-
cycle mortality and overall trends of motorcycle-related
deaths in several countries of this region.
While the economic situation in several richer coun-
tries has been stagnant in the last five years, Latin Amer-
ica has experienced during the same period economic
growth that has contributed to an overall reduction in pov-
erty indexes and an increase in wealth (World Bank
Group, 2011). These improvements however, have not
been equal among different nations and some have fared
better than others.
Parallel to these economic changes, increases in
motorcycle fatalities have also been greater in Latin
America relative to North America. One consequence of
economic growth is increased motorisation. With
increased wealth and reduced poverty, there is evidence
that populations experience shifts in modes of transporta-
tion as they acquire more means to purchase certain prod-
ucts (Chi Wang, 2007). As countries become motorised
and populations acquire more economic means, a percent-
age of the population shifts from pedestrians and bicy-
clists to motorcyclists, or from motorcyclists to
automobile drivers.
In addition, economic growth is associated with
increased demands from transport infrastructure, and
mobility becomes a basic factor for satisfying economic
needs (Chi Wang, 2007). More demand or use of
motorcycles and automobiles has increased the pressure
on urban infrastructures (E. Vasconcellos, 2008). This fur-
ther complicates mobility issues as more motorcycles are
competing for space used by automobiles and potentially
further exacerbating risks of injury, and mortality among
riders. In Latin America, the rapid growth of cities and
urban populations has considerably outpaced the develop-
ment of urban transport infrastructures and as a conse-
quence mobility in many large cities has been seriously
compromised. To address this, many cities have passed
legislation aimed at curbing large motor pools mostly by
restricting access to urban areas. These strategies include
limiting the use of automobiles on selected days based on
the license plate registration numbers (E. A. Vasconcellos,
2012). Such a strategy initially used in Mexico City
though for controlling air pollution, is now widely spread
through the region to address mobility. However, in
countries like Colombia, some of these measures do not
apply to motorcycle riders. In this country, to circumvent
these measures, people have either opted to buy another
vehicle, which they use when the other one has restric-
tions, or buy motorcycles, for which mobility restriction
legislation does not apply. A result of this is that popula-
tions with lesser resources are buying motorcycles for the
first time (da Fonseca Holz Lindau, 2009; E. A. Vas-
concellos, 2012), and individuals with more resources are
also buying these and other vehicles to circumvent mobil-
ity restrictions. Added to this, are the increasing costs of
public transportation that hinder access to work for popu-
lations with the least socio-economic resources (de Avila
Gomide, 2004).
In cities with large levels of congestion, motorcycles
are used in delivery services, as mototaxis, and for moto-
freight (Silva et al., 2011). Groups working in delivery
services in Brazil are known as motoboys who tradition-
ally work under time pressure, and in poor and unsafe
conditions leading to a large increase in motorcycle
crashes (E. Vasconcellos, 2008). Mototaxi service offer
has also increased and in Brazil legislation was passed to
regulate this service almost a decade ago (Barros Loren-
zetti, 2003). Data from this country shows that mototaxis
are now offered in 90% of the country’s towns and 50%
of the major cities (Instituto Brasileiro de Geografia e
Estatistica, 2009). Motorcycle types and types of users
might also have different risks. This is an area of study
that will require further research in Latin America espe-
cially because it can have direct implications among cer-
tain occupations or in some regions.
Research has shown that excessive automobile depen-
dence can reduce economic productivity, and policy
reforms that improve mobility management by reducing
per capita vehicle travel can increase transport system
efficiency (Litman, 2010). Motorcycles seem to have
some advantages for urban mobility because of their size
however they are perhaps the most dangerous type of
motor vehicle because of their inherent lack of protection
for users.
While this study provides no evidence that these eco-
nomic issues are in fact driving such increases, it shows
the important increase of mortality risk in the region of
the Americas among motorcycle riders in a short period
of time and calls for much-needed research on the human,
public health, transportation and social-economic costs
associated with motorcycle injuries. The PAHO Plan of
Action on Road Safety (Pan American Health Organiza-
tion, 2011) and the Road Safety Decade of Action (World
Health Organization, 2009) reports highlight relevant
interventions that can be considered in order to slow or
reverse the increasing trend of motorcycle injury mortal-
ity. Examples of such measures could include the devel-
opment and implementation of motorcycle safety
standards regulations.
International Journal of Injury Control and Safety Promotion 9
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12. Implications for safety promotion and public policy
The highlighted socio-economic scenario is further
affected by insufficient legislation and enforcement of
helmet use. Less than half (40.6%) of the countries in this
region have an adequate helmet law implying that helmets
should be worn by all passengers of all ages, for all engine
types of motorised two wheelers, on all roads, and with
helmets required to meet specific safety standards. On a
PAHO/WHO generated scale of 0–10 where zero repre-
sents no enforcement and 10 is full enforcement, the aver-
age regional helmet law enforcement is 5.1/10 while
enforcement of speeding laws was reported to be low,
with a value of 3.7/10 (Hijar et al., 2012).
It is imperative for the region of the Americas to docu-
ment more clearly what social and economic costs are
associated with increased motorcycle-related mortality
and morbidity and what are the benefits of managing these
modal changes within countries as well as throughout the
region. Consequently legislative frameworks will likely
need to address issues going beyond helmet use, speed lim-
its and motorcycle driver’s licensing procedures to include
motorcycle industry responsibilities and occupational
safety provisions for workers. Both legislative frameworks
as well as infrastructure characteristics need to respond to
these challenges so as to reduce morbidity and mortality
amongst one of the most productive sectors of population.
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