ABSTRACT:

Objective:

To analyze the spatial distribution of female mortality due to motorcycle accidents in Brazilian municipalities between 2005 and 2015, as well as the variation in rates in the same period.

Methods:

Female mortality rates for the years 2005, 2010 and 2015 were estimated considering a three-year moving average around the base year, standardized by the direct method. Rates were standardized using the same pattern (Brazilian females in 2010) for each year. Then, the empirical Bayes estimator was used to reduce the effect of the random fluctuation. The percentage variation of the standardized rates was also analyzed for different population sizes (less than ten thousand, less than 50 thousand, more than 100 thousand and more than one million inhabitants).

Results:

Bayesian rates showed a clear increase in female mortality due to motorcycle accidents, especially in the North, Northeast and Midwest regions. In the municipalities of the South and Southeast regions, mainly in the period between 2010 and 2015, there was an apparent decrease in mortality. The percentage variation showed a reduction in the indicator analyzed in the period between 2010 and 2015 for the largest municipalities in the South and Southeast regions. For almost all regions and population sizes, the period between 2010 and 2015 showed a deceleration in the growth of rates.

Conclusion:

The analysis clearly shows concentrations of municipalities with higher mortality, while also showing that the phenomenon has spread to a greater number of municipalities. The studied period allows the identification of different dynamics in female mortality, in a period of significant variation in mortality due to motorcycle accidents.

Keywords:
Mortality; Females; Motorcycles; Municipalities

INTRODUCTION

The growth of the motorcycle fleet and the increase in mortality from transport accidents in Brazil is a phenomenon that has gained the attention of researchers, traffic agencies and health services¹1. Vasconcellos EA. Risco de trânsito, omissão e calamidade: impactos da expansão da motocicleta no Brasil. Brasil: Instituto Movimento; 2013.^,22. Chandran A, Sousa TRV, Guo Y, Bishai D, Pechansky F, The Vida no Trânsito Evaluation Team. Road Traffic Deaths in Brazil: Rising Trends in Pedestrian and Motorcycle Occupant Deaths. Traffic Inj Prev 2012; 13(Supl. 1): 11-6. https://doi.org/10.1080/15389588.2011.633289
https://doi.org/https://doi.org/10.1080/... ^,33. Pinheiro PC, Queiroz BL. Análise espacial da mortalidade por acidentes de motocicleta nos municípios do Brasil. Ciênc Saúde Coletiva 2020; 25(2): 683-92. https://doi.org/10.1590/1413-81232020252.14472018
https://doi.org/https://doi.org/10.1590/... ^,44. Morais Neto OL, Andrade AL, Guimarães RA, Mandacarú PMP, Tobias GC. Regional disparities in road traffic injuries and their determinants in Brazil, 2013. Int J Equity Health 2016; 15: 142. https://dx.doi.org/10.1186%2Fs12939-016-0433-6
https://doi.org/https://dx.doi.org/10.11... ^,55. Morais Neto OL, Montenegro MMS, Monteiro RA, Siqueira Júnior JB, Silva MMA, Lima CM, et al. Mortalidade por Acidentes de Transporte Terrestre no Brasil na última década: tendência e aglomerados de risco. Ciênc Saúde Coletiva 2012; 17(9): 2223-36. https://doi.org/10.1590/S1413-81232012000900002
https://doi.org/https://doi.org/10.1590/... ^,66. Ladeira RM, Malta DC, Morais Neto OL, Montenegro MMS, Soares Filho AM, Vasconcelos CH, et al. Acidentes de transporte terrestre: estudo Carga Global de Doenças, Brasil e unidades federadas, 1990 e 2015. Rev Bras Epidemiol 2017; 20(Supl. 1): 157-70. https://doi.org/10.1590/1980-5497201700050013
https://doi.org/https://doi.org/10.1590/... ^,77. Bachierri G, Barros AJD. Acidentes de trânsito no Brasil de 1998 a 2010: muitas mudanças e poucos resultados. Rev Saúde Pública 2011; 45(5): 949-63. https://doi.org/10.1590/S0034-89102011005000069
https://doi.org/https://doi.org/10.1590/... ^,88. Martins ET, Boing AF, Peres MA. Mortalidade por acidentes de motocicleta no Brasil: análise de tendência temporal, 1996-2009. Rev Saúde Pública 2013; 47(5): 931-41. https://doi.org/10.1590/S0034-8910.2013047004227
https://doi.org/https://doi.org/10.1590/... ^,99. Miki N, Martimbianco ALC, Hira LT, Lahoz GL, Fernandes HJA, Reis FB. Profile of trauma victims of motorcycle accidents treated at hospital São Paulo. Acta Ortop Bras 2014; 22(4): 219-22. https://doi.org/10.1590/1413-78522014220400642
https://doi.org/https://doi.org/10.1590/... ^,1010. Companhia de Engenharia de Tráfego (CET). Análise da mortalidade ocorrida por acidentes de trânsito em agosto e setembro de 2016. Brasil: CET; 2016.. In 2019, the National Traffic Department (Denatran) reported a motorcycle fleet of over 22 million units¹¹11. Departamento Nacional de Trânsito (Denatran). Frota de veículos [Internet]. Brasília: Denatran; 2019 [acessado em 7 out. 2019]. Disponível em: Disponível em: http://www.denatran.gov.br/frota.htm
http://www.denatran.gov.br/frota.htm... . In 1990, that number was under 1.5 million¹1. Vasconcellos EA. Risco de trânsito, omissão e calamidade: impactos da expansão da motocicleta no Brasil. Brasil: Instituto Movimento; 2013.. Between 1990 and 2015, the mortality rate due to motorcycle accidents, for both sexes, increased from 3.9 to 5.9 per 100 thousand inhabitants⁶6. Ladeira RM, Malta DC, Morais Neto OL, Montenegro MMS, Soares Filho AM, Vasconcelos CH, et al. Acidentes de transporte terrestre: estudo Carga Global de Doenças, Brasil e unidades federadas, 1990 e 2015. Rev Bras Epidemiol 2017; 20(Supl. 1): 157-70. https://doi.org/10.1590/1980-5497201700050013
https://doi.org/https://doi.org/10.1590/... . In some states, motorcycles make up the largest portion of the vehicle fleet; likewise, mortality rates vary significantly between municipalities, states and regions¹1. Vasconcellos EA. Risco de trânsito, omissão e calamidade: impactos da expansão da motocicleta no Brasil. Brasil: Instituto Movimento; 2013.^,22. Chandran A, Sousa TRV, Guo Y, Bishai D, Pechansky F, The Vida no Trânsito Evaluation Team. Road Traffic Deaths in Brazil: Rising Trends in Pedestrian and Motorcycle Occupant Deaths. Traffic Inj Prev 2012; 13(Supl. 1): 11-6. https://doi.org/10.1080/15389588.2011.633289
https://doi.org/https://doi.org/10.1080/... ^,33. Pinheiro PC, Queiroz BL. Análise espacial da mortalidade por acidentes de motocicleta nos municípios do Brasil. Ciênc Saúde Coletiva 2020; 25(2): 683-92. https://doi.org/10.1590/1413-81232020252.14472018
https://doi.org/https://doi.org/10.1590/... ^,44. Morais Neto OL, Andrade AL, Guimarães RA, Mandacarú PMP, Tobias GC. Regional disparities in road traffic injuries and their determinants in Brazil, 2013. Int J Equity Health 2016; 15: 142. https://dx.doi.org/10.1186%2Fs12939-016-0433-6
https://doi.org/https://dx.doi.org/10.11... ^,55. Morais Neto OL, Montenegro MMS, Monteiro RA, Siqueira Júnior JB, Silva MMA, Lima CM, et al. Mortalidade por Acidentes de Transporte Terrestre no Brasil na última década: tendência e aglomerados de risco. Ciênc Saúde Coletiva 2012; 17(9): 2223-36. https://doi.org/10.1590/S1413-81232012000900002
https://doi.org/https://doi.org/10.1590/... ^,66. Ladeira RM, Malta DC, Morais Neto OL, Montenegro MMS, Soares Filho AM, Vasconcelos CH, et al. Acidentes de transporte terrestre: estudo Carga Global de Doenças, Brasil e unidades federadas, 1990 e 2015. Rev Bras Epidemiol 2017; 20(Supl. 1): 157-70. https://doi.org/10.1590/1980-5497201700050013
https://doi.org/https://doi.org/10.1590/... ^,77. Bachierri G, Barros AJD. Acidentes de trânsito no Brasil de 1998 a 2010: muitas mudanças e poucos resultados. Rev Saúde Pública 2011; 45(5): 949-63. https://doi.org/10.1590/S0034-89102011005000069
https://doi.org/https://doi.org/10.1590/... ^,88. Martins ET, Boing AF, Peres MA. Mortalidade por acidentes de motocicleta no Brasil: análise de tendência temporal, 1996-2009. Rev Saúde Pública 2013; 47(5): 931-41. https://doi.org/10.1590/S0034-8910.2013047004227
https://doi.org/https://doi.org/10.1590/... ^,1111. Departamento Nacional de Trânsito (Denatran). Frota de veículos [Internet]. Brasília: Denatran; 2019 [acessado em 7 out. 2019]. Disponível em: Disponível em: http://www.denatran.gov.br/frota.htm
http://www.denatran.gov.br/frota.htm... .

Accidents involving motorcycle riders are more common in men¹1. Vasconcellos EA. Risco de trânsito, omissão e calamidade: impactos da expansão da motocicleta no Brasil. Brasil: Instituto Movimento; 2013.^,22. Chandran A, Sousa TRV, Guo Y, Bishai D, Pechansky F, The Vida no Trânsito Evaluation Team. Road Traffic Deaths in Brazil: Rising Trends in Pedestrian and Motorcycle Occupant Deaths. Traffic Inj Prev 2012; 13(Supl. 1): 11-6. https://doi.org/10.1080/15389588.2011.633289
https://doi.org/https://doi.org/10.1080/... ^,44. Morais Neto OL, Andrade AL, Guimarães RA, Mandacarú PMP, Tobias GC. Regional disparities in road traffic injuries and their determinants in Brazil, 2013. Int J Equity Health 2016; 15: 142. https://dx.doi.org/10.1186%2Fs12939-016-0433-6
https://doi.org/https://dx.doi.org/10.11... ^,1010. Companhia de Engenharia de Tráfego (CET). Análise da mortalidade ocorrida por acidentes de trânsito em agosto e setembro de 2016. Brasil: CET; 2016.^,1212. Instituto de Pesquisa Econômica Aplicada (IPEA); Polícia Rodoviária Federal (PRF). Acidentes de Trânsito nas Rodovias Federais Brasileiras: Caracterização, Tendências e Custos para a Sociedade. Relatório de Pesquisa. Brasil: Instituto de Pesquisa Econômica Aplicada; 2015.^,1313. Oliveira NLB, Sousa RMC. Fatores associados ao óbito de motociclistas nas ocorrências de trânsito. Rev Esc Enferm USP 2012; 46(6): 1379-86. https://doi.org/10.1590/S0080-62342012000600014
https://doi.org/https://doi.org/10.1590/... . The Mortality Information System (SIM) shows that, in 2017, approximately 90% of motorcycle deaths registered were in the male population. In general, the explanations for male over-mortality involve biological and behavioral reasons¹⁴14. Cullen MR, Baiocchi M, Eggleston M, Loftus P, Fuchs V. The Weaker Sex? Vulnerable Men, Resilient Women, and Variations in Sex Differences In Mortality Since 1900. Nber Working Paper Series 2015. Working Paper 21114 [Internet]. 2015 [acessado em 27 jun. 2019]. Disponível em: Disponível em: http://www.nber.org/papers/w21114
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https://doi.org/https://dx.doi.org/10.13... . Schünemann et al.¹⁶16. Schünemann J, Strulik H, Trimborn T. The gender gap in mortality: How much is explained by behavior? J Health Econ 2017; 54: 79-90. https://doi.org/10.1016/j.jhealeco.2017.04.002
https://doi.org/https://doi.org/10.1016/... , for example, estimate that behavioral factors explain about 70% of the differential. External causes are responsible for an important part of this picture¹⁸18. Leite IC, Valente JG, Schramm JMA, Daumas RP, Rodrigues RN, Santos MF, et al. Carga de doença no Brasil e suas regiões, 2008. Cad Saúde Pública 2015; 31(7): 1551-64. https://doi.org/10.1590/0102-311X00111614
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https://doi.org/https://doi.org/10.1590/... ^,2020. Moura EC, Gomes R, Falcão MTC, Schwarz E, Neves ACM, Santos W. Desigualdades de gênero na mortalidade por causas externas no Brasil, 2010. Ciênc Saúde Coletiva 2015; 20(3): 779-88. https://doi.org/10.1590/1413-81232015203.11172014
https://doi.org/https://doi.org/10.1590/... ^,2121. Campos MR, von Doellinger VR, Mendes LVP, Costa MFS, Pimentel TG, Schramm JMA. Morbidity and mortality associated with injuries: results of the Global Burden of Disease study in Brazil, 2008. Cad Saúde Pública 2015; 31(1): 1-17. http://dx.doi.org/10.1590/0102-311X00191113
https://doi.org/http://dx.doi.org/10.159... .

However, although lower than among men, mortality from motorcycle accidents is also increasing among women and represents an important portion of the total number of female deaths. Considering women aged between 15 and 49, motorcycle accidents accounted for approximately 10% of deaths from external causes in 2015. These were responsible for 17% of all female deaths for that age group.

In motorcycle accidents, women are more often passengers⁹9. Miki N, Martimbianco ALC, Hira LT, Lahoz GL, Fernandes HJA, Reis FB. Profile of trauma victims of motorcycle accidents treated at hospital São Paulo. Acta Ortop Bras 2014; 22(4): 219-22. https://doi.org/10.1590/1413-78522014220400642
https://doi.org/https://doi.org/10.1590/... ^,2222. Seerig LM, Bacchieri G, Nascimento GG, Barros AJD, Demarco FF. Use of motorcycle in Brazil: users profile, prevalence of use and traffic accidents occurrence - a population-based study. Ciênc Saúde Coletiva 2016; 21(12): 3703-10. https://doi.org/10.1590/1413-812320152112.28212015
https://doi.org///doi.org/10.1590/1413-8... ^,2323. Santos AMR, Moura MEB, Nunes BMV, Leal CFS, Teles JBM. Perfil das vítimas de trauma por acidente de moto atendidas em um serviço público de emergência. Cad Saúde Pública 2008; 24(8): 1927-38. https://doi.org/10.1590/S0102-311X2008000800021
https://doi.org/https://doi.org/10.1590/... ^,2424. Mascarenhas MDM, Souto MCVS, Malta DCM, Silva MMA, Lima CM, Montenegro MMS. Características de motociclistas envolvidos em acidentes de transporte atendidos em serviços públicos de urgência e emergência. Ciênc Saúde Coletiva 2016; 21(12): 3661-71. https://doi.org/10.1590/1413-812320152112.24332016
https://doi.org/https://doi.org/10.1590/... . In a survey conducted at a hospital in Teresina (PI)²³23. Santos AMR, Moura MEB, Nunes BMV, Leal CFS, Teles JBM. Perfil das vítimas de trauma por acidente de moto atendidas em um serviço público de emergência. Cad Saúde Pública 2008; 24(8): 1927-38. https://doi.org/10.1590/S0102-311X2008000800021
https://doi.org/https://doi.org/10.1590/... , in 2006, less than 5% of motorcycle drivers who received care were women. In 2012, in Pelotas (RS), 20.2% of the motorcycle drivers interviewed were women²²22. Seerig LM, Bacchieri G, Nascimento GG, Barros AJD, Demarco FF. Use of motorcycle in Brazil: users profile, prevalence of use and traffic accidents occurrence - a population-based study. Ciênc Saúde Coletiva 2016; 21(12): 3703-10. https://doi.org/10.1590/1413-812320152112.28212015
https://doi.org///doi.org/10.1590/1413-8... . However, an important part of the care provided is registered in the female population²³23. Santos AMR, Moura MEB, Nunes BMV, Leal CFS, Teles JBM. Perfil das vítimas de trauma por acidente de moto atendidas em um serviço público de emergência. Cad Saúde Pública 2008; 24(8): 1927-38. https://doi.org/10.1590/S0102-311X2008000800021
https://doi.org/https://doi.org/10.1590/... ^,2424. Mascarenhas MDM, Souto MCVS, Malta DCM, Silva MMA, Lima CM, Montenegro MMS. Características de motociclistas envolvidos em acidentes de transporte atendidos em serviços públicos de urgência e emergência. Ciênc Saúde Coletiva 2016; 21(12): 3661-71. https://doi.org/10.1590/1413-812320152112.24332016
https://doi.org/https://doi.org/10.1590/... ^,2525. Andrade SSCA, Mello-Jorge MHP. Mortality and potential years of life lost by road traffic injuries in Brazil, 2013. Rev Saúde Pública 2016; 50: 59. https://doi.org/10.1590/S1518-8787.2016050006465
https://doi.org/https://doi.org/10.1590/... . The National Health Survey (PNS) shows that women accounted for 31.1% of reports of transport accidents⁴4. Morais Neto OL, Andrade AL, Guimarães RA, Mandacarú PMP, Tobias GC. Regional disparities in road traffic injuries and their determinants in Brazil, 2013. Int J Equity Health 2016; 15: 142. https://dx.doi.org/10.1186%2Fs12939-016-0433-6
https://doi.org/https://dx.doi.org/10.11... . The Hospital Information System (SIH) indicates an increase in their relative importance in total admissions for motorcycle accidents between 2005 (13.9%) and 2015 (17.4%).

The impact of transport accidents is observed in society, in individuals and in families¹²12. Instituto de Pesquisa Econômica Aplicada (IPEA); Polícia Rodoviária Federal (PRF). Acidentes de Trânsito nas Rodovias Federais Brasileiras: Caracterização, Tendências e Custos para a Sociedade. Relatório de Pesquisa. Brasil: Instituto de Pesquisa Econômica Aplicada; 2015.^,2626. Gururaj G. Road traffic deaths, injuries and disabilities in India: Current scenario. Natl Med J India 2008; 21(1): 14-20.^,2727. Mohan D. Social Cost of Road Traffic Crashes in India. In: Proceedings First Safe Community Conference on Cost of Injury. Viborg; 2002, p. 33-8.^,2828. Miller TR. Costs and consequences of U.S. roadway crashes. Accid Anal Prev 1993; 25(5): 593-607. https://doi.org/10.1016/0001-4575(93)90011-k
https://doi.org/https://doi.org/10.1016/... ^,2929. Blincoe LJ, Miller TR, Zaloshnja E, Lawrence BA. The economic and societal impact of motor vehicle crashes, 2010. (Revised) (Report No. DOT HS 812 013). Washington, D.C.: National Highway Traffic Safety Administration; 2015.^,3030. World Bank. The High Toll of Traffic Injuries: Unacceptable and Preventable. World Bank; 2017.. According to the Institute for Applied Economic Research (IPEA), in 2014, the estimated cost of accidents on federal highways was BRL 12.3 billion. Low- and middle-income countries account for 90% of deaths from traffic accidents in the world and 50% of total vehicles³⁰30. World Bank. The High Toll of Traffic Injuries: Unacceptable and Preventable. World Bank; 2017.. The same study indicates that the reduction of traffic accidents in these countries would have a positive impact on the gross domestic product (GDP), since most of the victims belong to the economically active group¹1. Vasconcellos EA. Risco de trânsito, omissão e calamidade: impactos da expansão da motocicleta no Brasil. Brasil: Instituto Movimento; 2013.^,22. Chandran A, Sousa TRV, Guo Y, Bishai D, Pechansky F, The Vida no Trânsito Evaluation Team. Road Traffic Deaths in Brazil: Rising Trends in Pedestrian and Motorcycle Occupant Deaths. Traffic Inj Prev 2012; 13(Supl. 1): 11-6. https://doi.org/10.1080/15389588.2011.633289
https://doi.org/https://doi.org/10.1080/... ^,44. Morais Neto OL, Andrade AL, Guimarães RA, Mandacarú PMP, Tobias GC. Regional disparities in road traffic injuries and their determinants in Brazil, 2013. Int J Equity Health 2016; 15: 142. https://dx.doi.org/10.1186%2Fs12939-016-0433-6
https://doi.org/https://dx.doi.org/10.11... ^,99. Miki N, Martimbianco ALC, Hira LT, Lahoz GL, Fernandes HJA, Reis FB. Profile of trauma victims of motorcycle accidents treated at hospital São Paulo. Acta Ortop Bras 2014; 22(4): 219-22. https://doi.org/10.1590/1413-78522014220400642
https://doi.org/https://doi.org/10.1590/... ^,1313. Oliveira NLB, Sousa RMC. Fatores associados ao óbito de motociclistas nas ocorrências de trânsito. Rev Esc Enferm USP 2012; 46(6): 1379-86. https://doi.org/10.1590/S0080-62342012000600014
https://doi.org/https://doi.org/10.1590/... ^,2222. Seerig LM, Bacchieri G, Nascimento GG, Barros AJD, Demarco FF. Use of motorcycle in Brazil: users profile, prevalence of use and traffic accidents occurrence - a population-based study. Ciênc Saúde Coletiva 2016; 21(12): 3703-10. https://doi.org/10.1590/1413-812320152112.28212015
https://doi.org///doi.org/10.1590/1413-8... .

The expansion of the motorcycle fleet is related to lower costs compared to other means of travel and to the available public transport modes¹1. Vasconcellos EA. Risco de trânsito, omissão e calamidade: impactos da expansão da motocicleta no Brasil. Brasil: Instituto Movimento; 2013.^,3131. Silva ER, Cardoso BC, Santos MPS. O aumento da taxa de motorização de Motocicletas no Brasil. Rev Bras Adm Científica 2011; 2(2): 49-63.^,3232. Souza AR, Vasconcelos TSL. Transporte e Mobilidade Urbana: O Fluxo de Motocicletas em Mossoró, RN. GEOTemas 2016; 6(1): 67-81.. The cost of traveling by motorcycle is lower than that of conventional public transport¹1. Vasconcellos EA. Risco de trânsito, omissão e calamidade: impactos da expansão da motocicleta no Brasil. Brasil: Instituto Movimento; 2013.^,3131. Silva ER, Cardoso BC, Santos MPS. O aumento da taxa de motorização de Motocicletas no Brasil. Rev Bras Adm Científica 2011; 2(2): 49-63.. Carvalho³³33. Carvalho CHR. Desafios da mobilidade urbana no Brasil. Brasil: IPEA; 2016. points out that several public policies have encouraged individual transport, at the same time that bus fares have increased above inflation since the beginning of the 2000s. The associated cost is directly related to the type of transport adopted by individuals³⁴34. Barczak R, Duarte F. Impactos ambientais da mobilidade urbana: cinco categorias de medidas mitigadoras. Rev Bras Gestão 2012; 4(1): 13-32. https://doi.org/10.1590/S2175-33692012000100002
https://doi.org/https://doi.org/10.1590/... .

Souza and Vasconcelos³²32. Souza AR, Vasconcelos TSL. Transporte e Mobilidade Urbana: O Fluxo de Motocicletas em Mossoró, RN. GEOTemas 2016; 6(1): 67-81. note that one of the reasons for the growth of the motorcycle fleet in Mossoró (RN) is the inability of public transport to meet the commuting demands. The growth in mototaxi services largely reflects this demand, especially in low-income groups³²32. Souza AR, Vasconcelos TSL. Transporte e Mobilidade Urbana: O Fluxo de Motocicletas em Mossoró, RN. GEOTemas 2016; 6(1): 67-81.^,3535. Silva AR, Silva TAA. O Desemprego e o Mototaxismo no Município de Moreno-PE. Rev Cad Ciênc Sociais UFRPE 2013; 1(2): 39-61.^,3636. Pinto MAT, Schor T. Precarização Sobre Duas Rodas: Uma Análise do Serviço de Mototáxi nas Cidades de Itacoatiara e Parintins, Amazonas-Brasil. Cad Prudentino Geografia 2013; 2(35): 5-27.. In 2017, 46% (2,560) of the municipalities had a mototaxi service, with the most significant concentration in medium-sized ones³⁷37. Instituto Brasileiro de Geografia e Estatística. Perfil dos municípios brasileiros: 2017. Brasil: IBGE; 2018.. The same study indicates that only 30.1% (1,679) of the municipalities had some type of public transport available through municipal buses.

Brazilian municipalities are extremely heterogeneous and, of course, have different patterns of mortality. Analyzing the mortality dynamics of female motorcycle riders at the municipal level will help to understand the dimension of this phenomenon and its related challenges. In this context, this study aimed to analyze the spatial distribution of female mortality from motorcycle accidents in Brazilian municipalities between 2005 and 2015, as well as the variation in rates in the same period.

METHODOLOGY

This is a trend analysis study, using SIM data from 2005 to 2015. The analysis of the distribution of mortality rates was based on the empirical Bayesian estimator (EBE)³⁸38. Carvalho AXY, Silva GDM, Almeida Júnior GR, Albuquerque PHM. Taxas bayesianas para o mapeamento de homicídios nos municípios brasileiros. Cad Saúde Pública 2012; 28(7): 1249-62. https://doi.org/10.1590/S0102-311X2012000700004
https://doi.org/https://doi.org/10.1590/... ^,3939. Assunção RM, Barreto SM, Guerra HL, Sakurai M. Mapas de taxas epidemiológicas: uma abordagem Bayesiana. Cad Saúde Pública 1998; 14(4): 713-23. https://doi.org/10.1590/S0102-311X1998000400013
https://doi.org/https://doi.org/10.1590/... ^,4040. Marshall RJ. Mapping disease and mortality rates using empirical Bayes estimators. J R Stat Soc Ser C Appl Stat 1991; 40(2): 283-94.^,4141. Justino JR, Freire FHMA, Lucio PS. Estimação de sub-registros de óbitos em pequenas áreas com os métodos bayesiano empírico e algoritmo EM. Rev Bras Estud Popul 2012; 29(1): 87-100. https://doi.org/10.1590/S0102-30982012000100006
https://doi.org/https://doi.org/10.1590/... . Due to the small population, often a single death registered in a municipality significantly impacts the estimated crude rate, not adequately representing the risk associated with the phenomenon of interest³⁸38. Carvalho AXY, Silva GDM, Almeida Júnior GR, Albuquerque PHM. Taxas bayesianas para o mapeamento de homicídios nos municípios brasileiros. Cad Saúde Pública 2012; 28(7): 1249-62. https://doi.org/10.1590/S0102-311X2012000700004
https://doi.org/https://doi.org/10.1590/... ^,3939. Assunção RM, Barreto SM, Guerra HL, Sakurai M. Mapas de taxas epidemiológicas: uma abordagem Bayesiana. Cad Saúde Pública 1998; 14(4): 713-23. https://doi.org/10.1590/S0102-311X1998000400013
https://doi.org/https://doi.org/10.1590/... ^,4040. Marshall RJ. Mapping disease and mortality rates using empirical Bayes estimators. J R Stat Soc Ser C Appl Stat 1991; 40(2): 283-94.^,4141. Justino JR, Freire FHMA, Lucio PS. Estimação de sub-registros de óbitos em pequenas áreas com os métodos bayesiano empírico e algoritmo EM. Rev Bras Estud Popul 2012; 29(1): 87-100. https://doi.org/10.1590/S0102-30982012000100006
https://doi.org/https://doi.org/10.1590/... . As observed by Assunção et al.³⁹39. Assunção RM, Barreto SM, Guerra HL, Sakurai M. Mapas de taxas epidemiológicas: uma abordagem Bayesiana. Cad Saúde Pública 1998; 14(4): 713-23. https://doi.org/10.1590/S0102-311X1998000400013
https://doi.org/https://doi.org/10.1590/... , the degree of random variability is linked to the size of the units of analysis. EBE estimates risk rates with less influence from random fluctuation and thus minimizes the effects of small numbers on the denominator³⁸38. Carvalho AXY, Silva GDM, Almeida Júnior GR, Albuquerque PHM. Taxas bayesianas para o mapeamento de homicídios nos municípios brasileiros. Cad Saúde Pública 2012; 28(7): 1249-62. https://doi.org/10.1590/S0102-311X2012000700004
https://doi.org/https://doi.org/10.1590/... ^,3939. Assunção RM, Barreto SM, Guerra HL, Sakurai M. Mapas de taxas epidemiológicas: uma abordagem Bayesiana. Cad Saúde Pública 1998; 14(4): 713-23. https://doi.org/10.1590/S0102-311X1998000400013
https://doi.org/https://doi.org/10.1590/... ^,4040. Marshall RJ. Mapping disease and mortality rates using empirical Bayes estimators. J R Stat Soc Ser C Appl Stat 1991; 40(2): 283-94.. EBE also deals well with cases in which there was no record of death. Often there is no record of the phenomenon of interest in the analyzed period, which does not mean that the risk associated with the event is equal to zero.³⁸38. Carvalho AXY, Silva GDM, Almeida Júnior GR, Albuquerque PHM. Taxas bayesianas para o mapeamento de homicídios nos municípios brasileiros. Cad Saúde Pública 2012; 28(7): 1249-62. https://doi.org/10.1590/S0102-311X2012000700004
https://doi.org/https://doi.org/10.1590/...

The process of smoothing crude rates through EBE considers a defined neighborhood structure. In other words, rates, especially for less populous municipalities, will be contracted towards the average rate for neighbors in such locations. Marshall⁴⁰40. Marshall RJ. Mapping disease and mortality rates using empirical Bayes estimators. J R Stat Soc Ser C Appl Stat 1991; 40(2): 283-94. points out that a certain homogeneity between neighboring areas is implicit in the use of EBE. The estimator uses information from other locations to minimize random fluctuation³⁹39. Assunção RM, Barreto SM, Guerra HL, Sakurai M. Mapas de taxas epidemiológicas: uma abordagem Bayesiana. Cad Saúde Pública 1998; 14(4): 713-23. https://doi.org/10.1590/S0102-311X1998000400013
https://doi.org/https://doi.org/10.1590/... . The EBE weighting factor is inversely proportional to the population at risk³⁸38. Carvalho AXY, Silva GDM, Almeida Júnior GR, Albuquerque PHM. Taxas bayesianas para o mapeamento de homicídios nos municípios brasileiros. Cad Saúde Pública 2012; 28(7): 1249-62. https://doi.org/10.1590/S0102-311X2012000700004
https://doi.org/https://doi.org/10.1590/... ^,3939. Assunção RM, Barreto SM, Guerra HL, Sakurai M. Mapas de taxas epidemiológicas: uma abordagem Bayesiana. Cad Saúde Pública 1998; 14(4): 713-23. https://doi.org/10.1590/S0102-311X1998000400013
https://doi.org/https://doi.org/10.1590/... . That is, for the larger municipalities, the Bayesian estimator approaches the estimated gross rate.

The first step in the construction of EBE was the estimation of motorcycle mortality rates standardized by the direct method, by municipality, for the years 2005, 2010 and 2015. In the numerator of rates, the three-year average of deaths around the base years was considered. In addition to deaths registered under “motorcycle rider injured in transport accident” (V20-V29), the occurrences registered under “other land transport accidents” (OLTA) (V80-V89) were redistributed according to the proportion of deaths of motorcycle riders from the total deaths from transport accidents in each of the municipalities. OLTA represent an important portion of deaths due to transport accidents (TA) and, in general, indicate problems in the registration of these events, corresponding to causes that are not well defined in the chapter. For cases in which there were deaths registered as OLTA, but not as motorcycle accidents, the distribution considered the proportion of deaths of motorcycle riders in relation to all transport accidents in the microregion to which the municipality belonged. In both groups, motorcycle riders (V20-V29) and OLTA (V80-V89), deaths in which the record ignored age and/or municipality were redistributed considering the proportion of deaths per age group in the municipalities and states.

In the denominator of the rates, the resident female population for the years 2005 and 2015 was considered, based on population estimates made by the Interagency Network for Health Information (Ripsa)⁴²42. Brasil. Ministério da Saúde. Estimativa da população por sexo e idade, 2005 e 2015. Brasil: Ministério da Saúde; 2018. and, for 2010, based on the Brazilian Census⁴³43. Instituto Brasileiro de Geografia e Estatística (IBGE). Censo Demográfico de 2010. Brasil: IBGE ; 2010.. Rates were standardized considering the age structure of Brazilian women in 2010.

The neighborhood structure for the EBE estimate considered the 20 municipalities closest to each unit of analysis. The use of a defined number of neighbors ensures that all municipalities have similarly sized neighborhood structures. Alternatively, eight or 15 neighboring municipalities were considered, however, mainly in 2005, the smoothing proved to be less efficient when compared to the structure made considering 20 neighbors, especially due to the high number of municipalities without a death record that year.

The operationalization of EBE followed Marshall’s proposal⁴⁰40. Marshall RJ. Mapping disease and mortality rates using empirical Bayes estimators. J R Stat Soc Ser C Appl Stat 1991; 40(2): 283-94., as presented in Equation (1):

In which:

• θ^ = the empirical Bayesian estimator;
• m = the average rate of neighbors;
• c_i = the contraction factor;
• x_i = the standardized rate for municipalities.

The analysis of the variation in mortality rates by region and by different population cuts (less than ten thousand, less than 50 thousand, more than 100 thousand and more than one million inhabitants in three different periods - 2005 to 2015, 2005 to 2010 and 2010 to 2015) sought to identify different regional dynamics. This analysis was based on the percentage variation in mortality rates between two periods. The rates were calculated, by population size and region, by the sum of the expected number of deaths considering the standardized rates of each municipality and the total population in each group, in the three years analyzed. The variation was calculated using the ratio of the rates observed in the second and first periods, subtracted by 1.

RESULTS

The evolution of mortality rates estimated with the empirical Bayesian estimator (Figures 1, 2 and 3) shows the increase in municipalities with registered deaths of female motorcyclists, as well as the increase in observed rates. The same range of classes was used on the maps to enable comparison between years. The highest concentration of municipalities with a high mortality rate is observed in the North, Northeast and Midwest regions throughout the period.

In the Northeast region, between 2005 and 2015, there was a clear increase in the number of municipalities with records of the analyzed event. In 2005, as Figure 1 indicates, there was a small concentration of those events with high rates in Piauí. In addition, with lower levels than those observed in this state, there was a concentration of municipalities in Maranhão, Ceará and Sergipe. In 2010 (Figure 2), motorcycle accident mortality spreads to cities in all states in the region. Also noteworthy is the increase in events in the group with higher rates, represented by darker tones in Figure 2 and Figure 3, mainly in Maranhão, Piauí and on the border between Ceará and Rio Grande do Norte. In Bahia, in a less expressive way, there is an increase in rates, especially in the central portion of the state.

Between 2010 and 2015 (Figure 3), in the Northeast region, there was an increase in the level of rates in municipalities that were already in the group with higher rates. In the previous period (2005-2010), both the expansion of the phenomenon to a greater number of municipalities and the increase in the magnitude of rates were observed in locations that already had high levels.

In the Midwest Region, in 2005 (Figure 1), there was a large concentration of municipalities with high mortality rates. Between 2005 and 2015 (Figure 3), as well as in the Northeast, there was an increase in levels in municipalities in all states in the region. In the last year analyzed, only the surroundings of Brasilia were colored in the lightest shade of the scale used. The states of Rondônia, Tocantins and the southern portion of Pará, which already had a set of municipalities with higher rates in 2005, showed an increase in these indicators and an increase in the number of municipalities in groups with high levels. Between 2005 and 2015, on a smaller scale, there was an increase in female mortality in municipalities in other states in the North Region.

In the Southeast Region, in 2005 (Figure 1), there were small groups of municipalities with higher rates in the north, in the Triangle and in the east of Minas Gerais, in the north of Espírito Santo and in the north of Rio de Janeiro, in addition to small spots in the west and in the center of São Paulo. In 2010, there was an increase in the distribution of municipalities with higher rates and a change in the shade of these spots, indicating an increase in mortality. The second period of analysis (2010-2015) seems to indicate a different trend. In the Southeast Region, there is both a decrease in the extent of concentrations of municipalities with high rates and an apparent decrease in them.

Municipalities in the South Region also showed an increase in mortality in the first period, followed by a decrease. In 2005 (Figure 1), the municipalities with the highest motorcycle mortality were concentrated basically in western Paraná and eastern Santa Catarina. In 2010 (Figure 2), there is an increase in mortality in these regions, as well as spreading to other areas. In 2010, only a small number of municipalities in Paraná and Santa Catarina are located in the group with the lowest rates. Between 2010 and 2015, there was an apparent reduction of municipalities in the group with lower rates, as well as a decrease in classes among the municipalities that had higher rates in previous years.

Table 1 shows the percentage variation in female mortality rates due to motorcycle accidents for groups of municipalities with less than ten thousand, less than 50 thousand, more than 100 thousand and more than one million inhabitants in each region, considering the whole interval (2005-2015) and each of the periods in isolation (2005-2010 and 2010-2015). Taking the entire period into account, for all regions and population profiles, female mortality from motorcycle accidents increased. The variation was more expressive in smaller municipalities.

In the Northeast Region, for example, between 2005 and 2015, mortality increased by almost 200% in municipalities with less than 50 thousand inhabitants. For those with less than ten thousand inhabitants, the variation was always positive, in all regions and in both periods. For this same population group, between 2010 and 2015, with the exception of the Northeast region, the percentage variation was lower than in the first five years considered.

When we take the analysis to the other population sections, Table 1 reinforces the impression that female mortality from motorcycle accidents decreased between 2010 and 2015 in the South and Southeast regions, as highlighted in the analysis of Figures 2 and 3. In the municipalities with 50 thousand inhabitants or less, in those with 100 thousand and one million or more, mortality decreased between 2010 and 2015. The negative percentage variation was, in all population segments, more expressive in the South. For municipalities with more than one million inhabitants, the Midwest Region joins the South and Southeast regions in the negative variation recorded between 2010 and 2015.

DISCUSSION

The results presented point to an increase in motorcycle accident mortality between 2005 and 2015 for the female population, as well as for the male and general population²2. Chandran A, Sousa TRV, Guo Y, Bishai D, Pechansky F, The Vida no Trânsito Evaluation Team. Road Traffic Deaths in Brazil: Rising Trends in Pedestrian and Motorcycle Occupant Deaths. Traffic Inj Prev 2012; 13(Supl. 1): 11-6. https://doi.org/10.1080/15389588.2011.633289
https://doi.org/https://doi.org/10.1080/... ^,33. Pinheiro PC, Queiroz BL. Análise espacial da mortalidade por acidentes de motocicleta nos municípios do Brasil. Ciênc Saúde Coletiva 2020; 25(2): 683-92. https://doi.org/10.1590/1413-81232020252.14472018
https://doi.org/https://doi.org/10.1590/... ^,44. Morais Neto OL, Andrade AL, Guimarães RA, Mandacarú PMP, Tobias GC. Regional disparities in road traffic injuries and their determinants in Brazil, 2013. Int J Equity Health 2016; 15: 142. https://dx.doi.org/10.1186%2Fs12939-016-0433-6
https://doi.org/https://dx.doi.org/10.11... ^,55. Morais Neto OL, Montenegro MMS, Monteiro RA, Siqueira Júnior JB, Silva MMA, Lima CM, et al. Mortalidade por Acidentes de Transporte Terrestre no Brasil na última década: tendência e aglomerados de risco. Ciênc Saúde Coletiva 2012; 17(9): 2223-36. https://doi.org/10.1590/S1413-81232012000900002
https://doi.org/https://doi.org/10.1590/... ^,66. Ladeira RM, Malta DC, Morais Neto OL, Montenegro MMS, Soares Filho AM, Vasconcelos CH, et al. Acidentes de transporte terrestre: estudo Carga Global de Doenças, Brasil e unidades federadas, 1990 e 2015. Rev Bras Epidemiol 2017; 20(Supl. 1): 157-70. https://doi.org/10.1590/1980-5497201700050013
https://doi.org/https://doi.org/10.1590/... ^,77. Bachierri G, Barros AJD. Acidentes de trânsito no Brasil de 1998 a 2010: muitas mudanças e poucos resultados. Rev Saúde Pública 2011; 45(5): 949-63. https://doi.org/10.1590/S0034-89102011005000069
https://doi.org/https://doi.org/10.1590/... ^,88. Martins ET, Boing AF, Peres MA. Mortalidade por acidentes de motocicleta no Brasil: análise de tendência temporal, 1996-2009. Rev Saúde Pública 2013; 47(5): 931-41. https://doi.org/10.1590/S0034-8910.2013047004227
https://doi.org/https://doi.org/10.1590/... . Among the main determinants of motorcycle accidents, we can list the vulnerability of the vehicle, the increase in the fleet, road and vehicle safety, risky behavior, the growing use of motorcycles as a work tool, inexperience in driving the vehicle, sex, age, alcohol consumption and attention level⁴4. Morais Neto OL, Andrade AL, Guimarães RA, Mandacarú PMP, Tobias GC. Regional disparities in road traffic injuries and their determinants in Brazil, 2013. Int J Equity Health 2016; 15: 142. https://dx.doi.org/10.1186%2Fs12939-016-0433-6
https://doi.org/https://dx.doi.org/10.11... ^,2424. Mascarenhas MDM, Souto MCVS, Malta DCM, Silva MMA, Lima CM, Montenegro MMS. Características de motociclistas envolvidos em acidentes de transporte atendidos em serviços públicos de urgência e emergência. Ciênc Saúde Coletiva 2016; 21(12): 3661-71. https://doi.org/10.1590/1413-812320152112.24332016
https://doi.org/https://doi.org/10.1590/... .

The spatial distribution of the municipalities with the highest rates in Figures 1, 2 and 3 is largely similar to the distribution observed in other studies, with significant concentration in the municipalities of the Midwest, Northeast and North regions³3. Pinheiro PC, Queiroz BL. Análise espacial da mortalidade por acidentes de motocicleta nos municípios do Brasil. Ciênc Saúde Coletiva 2020; 25(2): 683-92. https://doi.org/10.1590/1413-81232020252.14472018
https://doi.org/https://doi.org/10.1590/... ^,44. Morais Neto OL, Andrade AL, Guimarães RA, Mandacarú PMP, Tobias GC. Regional disparities in road traffic injuries and their determinants in Brazil, 2013. Int J Equity Health 2016; 15: 142. https://dx.doi.org/10.1186%2Fs12939-016-0433-6
https://doi.org/https://dx.doi.org/10.11... ^,55. Morais Neto OL, Montenegro MMS, Monteiro RA, Siqueira Júnior JB, Silva MMA, Lima CM, et al. Mortalidade por Acidentes de Transporte Terrestre no Brasil na última década: tendência e aglomerados de risco. Ciênc Saúde Coletiva 2012; 17(9): 2223-36. https://doi.org/10.1590/S1413-81232012000900002
https://doi.org/https://doi.org/10.1590/... ^,66. Ladeira RM, Malta DC, Morais Neto OL, Montenegro MMS, Soares Filho AM, Vasconcelos CH, et al. Acidentes de transporte terrestre: estudo Carga Global de Doenças, Brasil e unidades federadas, 1990 e 2015. Rev Bras Epidemiol 2017; 20(Supl. 1): 157-70. https://doi.org/10.1590/1980-5497201700050013
https://doi.org/https://doi.org/10.1590/... ^,77. Bachierri G, Barros AJD. Acidentes de trânsito no Brasil de 1998 a 2010: muitas mudanças e poucos resultados. Rev Saúde Pública 2011; 45(5): 949-63. https://doi.org/10.1590/S0034-89102011005000069
https://doi.org/https://doi.org/10.1590/... ^,88. Martins ET, Boing AF, Peres MA. Mortalidade por acidentes de motocicleta no Brasil: análise de tendência temporal, 1996-2009. Rev Saúde Pública 2013; 47(5): 931-41. https://doi.org/10.1590/S0034-8910.2013047004227
https://doi.org/https://doi.org/10.1590/... . In addition, the maps presented show that the empirical Bayesian estimator was a good tool to deal with the random fluctuation of small numbers and enabled visualization gains in relation to standardized rates³3. Pinheiro PC, Queiroz BL. Análise espacial da mortalidade por acidentes de motocicleta nos municípios do Brasil. Ciênc Saúde Coletiva 2020; 25(2): 683-92. https://doi.org/10.1590/1413-81232020252.14472018
https://doi.org/https://doi.org/10.1590/... ^,3838. Carvalho AXY, Silva GDM, Almeida Júnior GR, Albuquerque PHM. Taxas bayesianas para o mapeamento de homicídios nos municípios brasileiros. Cad Saúde Pública 2012; 28(7): 1249-62. https://doi.org/10.1590/S0102-311X2012000700004
https://doi.org/https://doi.org/10.1590/... ^,3939. Assunção RM, Barreto SM, Guerra HL, Sakurai M. Mapas de taxas epidemiológicas: uma abordagem Bayesiana. Cad Saúde Pública 1998; 14(4): 713-23. https://doi.org/10.1590/S0102-311X1998000400013
https://doi.org/https://doi.org/10.1590/... ^,4040. Marshall RJ. Mapping disease and mortality rates using empirical Bayes estimators. J R Stat Soc Ser C Appl Stat 1991; 40(2): 283-94.^,4141. Justino JR, Freire FHMA, Lucio PS. Estimação de sub-registros de óbitos em pequenas áreas com os métodos bayesiano empírico e algoritmo EM. Rev Bras Estud Popul 2012; 29(1): 87-100. https://doi.org/10.1590/S0102-30982012000100006
https://doi.org/https://doi.org/10.1590/... .

The South and Southeast regions presented, in all years and in relation to the other regions, a less expressive distribution of municipalities with high rates. To some extent, this result may reflect the protective effect of higher levels of development in relation to mortality⁴³43. Instituto Brasileiro de Geografia e Estatística (IBGE). Censo Demográfico de 2010. Brasil: IBGE ; 2010.^,4444. van Beeck EF, Borsboom GJ, Mackenbach JP. Economic development and traffic accident mortality in the industrialized world, 1962-1990. Int J Epidemiol 2000; 29(3): 503-9. https://doi.org/10.1093/ije/29.3.503
https://doi.org/https://doi.org/10.1093/... ^,4545. Law TH, Noland RB, Evans AW. Factors associated with the relationship between motorcycle deaths and economic growth. Accid Anal Prev 2008; 41(2): 234-40. https://doi.org/10.1016/j.aap.2008.11.005
https://doi.org/https://doi.org/10.1016/... . The relationship between mortality from transport accidents and economic development has an inverted “U” shape⁴⁴44. van Beeck EF, Borsboom GJ, Mackenbach JP. Economic development and traffic accident mortality in the industrialized world, 1962-1990. Int J Epidemiol 2000; 29(3): 503-9. https://doi.org/10.1093/ije/29.3.503
https://doi.org/https://doi.org/10.1093/... ^,4545. Law TH, Noland RB, Evans AW. Factors associated with the relationship between motorcycle deaths and economic growth. Accid Anal Prev 2008; 41(2): 234-40. https://doi.org/10.1016/j.aap.2008.11.005
https://doi.org/https://doi.org/10.1016/... ^,4646. Kopits E, Cropper M. Traffic fatalities and economic growth. Accid Anal Prev 2005; 37(1): 169-78. https://doi.org/10.1016/j.aap.2004.04.006
https://doi.org/https://doi.org/10.1016/... . In other words, for lower income levels, economic growth can be associated with increased mortality; once a certain degree of development is reached, this relationship is reversed.

The results point to the growing importance of motorcycles as a means of transportation for women. This phenomenon is probably related to the lack of public transport and/or high fares¹1. Vasconcellos EA. Risco de trânsito, omissão e calamidade: impactos da expansão da motocicleta no Brasil. Brasil: Instituto Movimento; 2013.^,3232. Souza AR, Vasconcelos TSL. Transporte e Mobilidade Urbana: O Fluxo de Motocicletas em Mossoró, RN. GEOTemas 2016; 6(1): 67-81.^,3636. Pinto MAT, Schor T. Precarização Sobre Duas Rodas: Uma Análise do Serviço de Mototáxi nas Cidades de Itacoatiara e Parintins, Amazonas-Brasil. Cad Prudentino Geografia 2013; 2(35): 5-27.^,3737. Instituto Brasileiro de Geografia e Estatística. Perfil dos municípios brasileiros: 2017. Brasil: IBGE; 2018.. Carvalho and Pereira⁴⁷47. Carvalho CHR, Pereira RHM. Efeitos da variação da tarifa e da renda da população sobre a demanda de transporte público coletivo urbano no Brasil. Brasil: IPEA ; 2011. show that, between 1995 and 2008, the price of bus, subway and train fares in nine capitals increased above inflation, and that rising prices affect the demand for public transport. The same authors point out that persistent increases in the price of fares, accompanied by an increase in income, may lead to the substitution of the use of public transport for private means of transport. In addition, in recent years, there has been a government incentive for the purchase of automobiles and motorcycles through tax exemption¹1. Vasconcellos EA. Risco de trânsito, omissão e calamidade: impactos da expansão da motocicleta no Brasil. Brasil: Instituto Movimento; 2013.^,3333. Carvalho CHR. Desafios da mobilidade urbana no Brasil. Brasil: IPEA; 2016.^,4747. Carvalho CHR, Pereira RHM. Efeitos da variação da tarifa e da renda da população sobre a demanda de transporte público coletivo urbano no Brasil. Brasil: IPEA ; 2011.. Vasconcellos¹1. Vasconcellos EA. Risco de trânsito, omissão e calamidade: impactos da expansão da motocicleta no Brasil. Brasil: Instituto Movimento; 2013. notes that the cost of a seven-kilometer motorcycle trip in large and medium-sized cities corresponds to a third of the public transport fare and the same fraction of time spent.

For all population segments, in all regions, the period between 2005 and 2010 indicated an increase in female mortality from motorcycle accidents. Analyzing Brazil as a whole, Morais Neto et al.⁵5. Morais Neto OL, Montenegro MMS, Monteiro RA, Siqueira Júnior JB, Silva MMA, Lima CM, et al. Mortalidade por Acidentes de Transporte Terrestre no Brasil na última década: tendência e aglomerados de risco. Ciênc Saúde Coletiva 2012; 17(9): 2223-36. https://doi.org/10.1590/S1413-81232012000900002
https://doi.org/https://doi.org/10.1590/... identify a positive variation in motorcycle mortality (both sexes) for all population sizes. In the second period (2010-2015), the variation of municipalities with less than ten thousand inhabitants was positive, albeit at lower levels. In the Northeast Region, the variation in the second period was greater for this group. Smaller municipalities and less developed regions, due to the lack of public transport infrastructure, are probably those that depend most heavily on motorcycle as a means of transport⁸8. Martins ET, Boing AF, Peres MA. Mortalidade por acidentes de motocicleta no Brasil: análise de tendência temporal, 1996-2009. Rev Saúde Pública 2013; 47(5): 931-41. https://doi.org/10.1590/S0034-8910.2013047004227
https://doi.org/https://doi.org/10.1590/... ^,3232. Souza AR, Vasconcelos TSL. Transporte e Mobilidade Urbana: O Fluxo de Motocicletas em Mossoró, RN. GEOTemas 2016; 6(1): 67-81.^,3636. Pinto MAT, Schor T. Precarização Sobre Duas Rodas: Uma Análise do Serviço de Mototáxi nas Cidades de Itacoatiara e Parintins, Amazonas-Brasil. Cad Prudentino Geografia 2013; 2(35): 5-27.^,3737. Instituto Brasileiro de Geografia e Estatística. Perfil dos municípios brasileiros: 2017. Brasil: IBGE; 2018.. A study by the National Public Transport Association (ANTP)⁴⁸48. Associação Nacional de Transportes Públicos (ANTP). Sistema de Informações da Mobilidade Urbana da Associação Nacional de Transportes Público - Simob/ANTP. Relatório Geral 2016. Brasil: ANTP; 2018. with municipalities with at least 60 thousand inhabitants shows that, in 2016, the share of commutes made by public transport decreased with the size of the municipalities. The situation is likely to be even more significant in even smaller municipalities.

In addition, the low regulatory and inspection capacity in smaller municipalities may also explain part of the increase in mortality in the period. In general, only the largest municipalities have municipal inspection actions, which results in a low capacity to impose fines and carry out regulatory actions¹¹11. Departamento Nacional de Trânsito (Denatran). Frota de veículos [Internet]. Brasília: Denatran; 2019 [acessado em 7 out. 2019]. Disponível em: Disponível em: http://www.denatran.gov.br/frota.htm
http://www.denatran.gov.br/frota.htm... ^,4949. Bavoso NC. O Sistema Nacional de Trânsito o os Municípios de Pequeno Porte [dissertação]. Belo Horizonte: Escola de Engenharia da Universidade Federal de Minas Gerais (UFMG); 2014.^,5050. Malta DC, Soares-Filho AM, Montenegro MMS, Mascarenhas MDM, Silva MMA, Lima CM, et al. Análise da mortalidade por acidentes de transporte terrestre antes e após a Lei Seca - Brasil, 2007-2009. Epidemiol Serv Saúde 2010; 19(4): 317-28. http://dx.doi.org/10.5123/S1679-49742010000400002
https://doi.org/http://dx.doi.org/10.512... . Sloan et al.⁵¹51. Sloan FA, Reilly BA, Schenzler C. Effects of Prices, Civil and Criminal Sanctions, and Law Enforcement on Alcohol-Related Mortality. J Stud Alcohol 1994; 55(4): 454-65. https://doi.org/10.15288/jsa.1994.55.454
https://doi.org/https://doi.org/10.15288... note, for example, that the presence of police officers negatively impacted mortality due to transport accidents. Greater police presence would increase the chances of punishment for inappropriate behavior. In 2014⁵²52. Instituto Brasileiro de Geografia e Estatística. Perfil dos municípios brasileiros: 2014. IBGE; 2015., 22.7% of the municipalities had a public security department. In 2017, around 25% did not have a municipal transport management agency³⁷37. Instituto Brasileiro de Geografia e Estatística. Perfil dos municípios brasileiros: 2017. Brasil: IBGE; 2018.. The percentage of motorcycle accident victims who declare not wearing a helmet and having consumed alcohol is quite high in some capitals. It is likely to be even lower in smaller municipalities²³23. Santos AMR, Moura MEB, Nunes BMV, Leal CFS, Teles JBM. Perfil das vítimas de trauma por acidente de moto atendidas em um serviço público de emergência. Cad Saúde Pública 2008; 24(8): 1927-38. https://doi.org/10.1590/S0102-311X2008000800021
https://doi.org/https://doi.org/10.1590/... ^,2424. Mascarenhas MDM, Souto MCVS, Malta DCM, Silva MMA, Lima CM, Montenegro MMS. Características de motociclistas envolvidos em acidentes de transporte atendidos em serviços públicos de urgência e emergência. Ciênc Saúde Coletiva 2016; 21(12): 3661-71. https://doi.org/10.1590/1413-812320152112.24332016
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Between 2005 and 2015, the Brazilian GDP showed growth and retraction movements⁵³53. Banco Nacional de Desenvolvimento Social (BNDS). Perspectivas Depec 2018: O Crescimento da Economia Brasileira 2018-2023. BNDS; 2018.. There are a number of studies that portray a pro-cyclical relationship between economic dynamism and mortality from transport accidents⁵⁴54. Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. Effects of the 2008 recession on health: a first look at European data. Lancet 2011; 378(9786): 124-5. https://doi.org/10.1016/S0140-6736(11)61079-9
https://doi.org/https://doi.org/10.1016/... ^,5555. Gerdtham U, Ruhm C. Deaths Rise in Good Economic Times: Evidence From the OECD. Econ Hum Biol 2006; 4(3): 298-316. https://doi.org/10.1016/j.ehb.2006.04.001
https://doi.org/https://doi.org/10.1016/... ^,5656. Ruhm C. Are recessions good for your health? Q J Econ 2000; 115(2): 617-50. https://doi.org/10.1162/003355300554872
https://doi.org/https://doi.org/10.1162/... ^,5757. Tapia-Granados J. Macroeconomic fluctuations and mortality in postwar Japan. Demography 2008; 45(2): 323-43. https://dx.doi.org/10.1353%2Fdem.0.0008
https://doi.org/https://dx.doi.org/10.13... . In times of crisis, there is a decrease in the circulation of people and, consequently, less exposure to risk⁵⁸58. Michas G, Micha R. Road traffic accidents in Greece: have we benefited from the financial crisis? J Epidemiol Community Health 2013; 67(10): 894. https://doi.org/10.1136/jech-2013-202827
https://doi.org/https://doi.org/10.1136/... . GDP grew annually between 2005 and 2010, with the exception of 2009⁵³53. Banco Nacional de Desenvolvimento Social (BNDS). Perspectivas Depec 2018: O Crescimento da Economia Brasileira 2018-2023. BNDS; 2018.. The same period showed an increase in female mortality due to motorcycle accidents. Especially for the lower income classes, the increase in income allows the purchase of a first vehicle, often a motorcycle⁸8. Martins ET, Boing AF, Peres MA. Mortalidade por acidentes de motocicleta no Brasil: análise de tendência temporal, 1996-2009. Rev Saúde Pública 2013; 47(5): 931-41. https://doi.org/10.1590/S0034-8910.2013047004227
https://doi.org/https://doi.org/10.1590/... . To a large extent, the regions that concentrate municipalities with high mortality rates are regions of outstanding economic dynamism³3. Pinheiro PC, Queiroz BL. Análise espacial da mortalidade por acidentes de motocicleta nos municípios do Brasil. Ciênc Saúde Coletiva 2020; 25(2): 683-92. https://doi.org/10.1590/1413-81232020252.14472018
https://doi.org/https://doi.org/10.1590/... ^,88. Martins ET, Boing AF, Peres MA. Mortalidade por acidentes de motocicleta no Brasil: análise de tendência temporal, 1996-2009. Rev Saúde Pública 2013; 47(5): 931-41. https://doi.org/10.1590/S0034-8910.2013047004227
https://doi.org/https://doi.org/10.1590/... .

In the second analysis period (2010-2015), after 2014, there was a significant drop in GDP and an increase in unemployment, especially in 2015 and 2016⁵³53. Banco Nacional de Desenvolvimento Social (BNDS). Perspectivas Depec 2018: O Crescimento da Economia Brasileira 2018-2023. BNDS; 2018.. The reduction in mortality, especially in the South and Southeast, may, to some extent, reflect a slowdown in economic activity. ⁵⁴54. Stuckler D, Basu S, Suhrcke M, Coutts A, McKee M. Effects of the 2008 recession on health: a first look at European data. Lancet 2011; 378(9786): 124-5. https://doi.org/10.1016/S0140-6736(11)61079-9
https://doi.org/https://doi.org/10.1016/... ^,5555. Gerdtham U, Ruhm C. Deaths Rise in Good Economic Times: Evidence From the OECD. Econ Hum Biol 2006; 4(3): 298-316. https://doi.org/10.1016/j.ehb.2006.04.001
https://doi.org/https://doi.org/10.1016/... ^,5656. Ruhm C. Are recessions good for your health? Q J Econ 2000; 115(2): 617-50. https://doi.org/10.1162/003355300554872
https://doi.org/https://doi.org/10.1162/... . In the same sense, in other regions, in practically all population segments, there was a deceleration in the growth rate of mortality due to motorcycle accidents between 2010 and 2015.

The present study demonstrated that the period between 2005 and 2015 was marked by major changes in female mortality from motorcycle accidents, a phenomenon that was already observed for the male population. The analysis makes it clear that there are concentrations of municipalities with higher mortality, while showing that the phenomenon has grown for a larger number of municipalities. Among the possible explanations, the lacking public transport in many municipalities can be highlighted. This, to a large extent, explains the growing importance of motorcycles as a means of transport and the low regulatory capacity in small cities.

This time frame allowed the identification of different dynamics in female mortality, in a period of significant variation in mortality due to motorcycle accidents at the municipal level. Likewise, the period was marked by different cycles in economic activity, which, in turn, may have influenced the observed rates. The results presented show that exploring the relationship between economic variables and motorcycle accident mortality can be an important line of research to expand knowledge about the phenomenon and its implications.

ACKNOWLEDGEMENTS

The authors would like to thank the Department of Health Surveillance of the Ministry of Health for financing the project.

References

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