Comprehensive Indicators of Traffic-Related Premature Mortality

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Comprehensive indicators of trafficrelated premature mortality

a
Raquel Beatriz Jimenez & Nicolas Caceres Bronfman
Engineering Science Department, Universidad Andres Bello,

Santiago, Chile
Version of record first published: 25 Jul 2012.
To cite this article: Raquel Beatriz Jimenez & Nicolas Caceres Bronfman (2012): Comprehensive
indicators of traffic-related premature mortality, Journal of Risk Research, 15:9, 1117-1139
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Vol. 15, No. 9, October 2012, 11171139
Comprehensive indicators of trafc-related premature mortality

Raquel Beatriz Jimenez* and Nicolas Caceres Bronfman
Engineering Science Department, Universidad Andres Bello, Santiago, Chile
Downloaded by [Corporacion CINCEL] at 12:16 19 November 2012
(Received 27 July 2011; nal version received 16 April 2012)

Motor vehicle circulation is associated with multiple social benets; nevertheless,
it is widely acknowledged that it also produces a variety of adverse health
effects, of which the most relevant are associated with mortality from road
accidents and exposure to atmospheric pollution. Though in Chile these impacts
have been quantied and evaluated independently, no indicators have been
developed so far to account for this activitys global impact on public health, or
to express the individual impact that can be attributed to each vehicle category.
In order to ll this void, the present study aimed at designing and quantifying
indicators that account for the global impact on health that different motor
vehicle categories impose on Chilean society. Health impact was quantied as
the number of expected premature deaths caused by road accidents and exposure
to atmospheric pollutants. Total premature mortality was understood as the total
annual deaths that occurred as a consequence of road accidents and the exposure
to O3 and PM2.5 derived from trafc-related emissions of its precursors. All estimations were made considering Chiles Metropolitan Region in 2005 as a basic
scenario. Differentiated indicators were obtained for 15 vehicle categories as a
function of different parameters: traveled kilometer, vehicle, and vehicle lifetime.
According to our results, when the health impact of trafc accidents and
exposure to trafc-related air pollution are considered simultaneously, major
differences were observed with the indicators traditionally used by regulators
involved in the trafc-related decision-making process. The implications of our
results on risk management strategies are discussed.
Keywords: trafc-related premature mortality; motorized vehicles; health
impact; assessment; trafc accidents; exposure to trafc-related air pollution
1. Introduction
Chile has been experiencing accelerated economic growth during the past decades.
A great portion of its commercial activity takes place in the Metropolitan Region
(MR) where Santiago, the capital of Chile, is located. By the year 2005, the population of the MR was 6,538,896, equivalent to 41% of the national population (Instituto Nacional de Estadsticas 2012).
Historically, this region has registered unusually high levels of atmospheric pollution, and although they have decreased considerably in the last few years, there
are frequent incidents where levels of air pollution exceed the air quality standards
established by local authorities. Industrial activity and over one million vehicles circulating in the region about 42% of the national total are the main contributors
*Corresponding author. Email: rjimenez@unab.cl
ISSN 1366-9877 print/ISSN 1466-4461 online
2012 Taylor & Francis
http://dx.doi.org/10.1080/13669877.2012.705314
http://www.tandfonline.com
1118
R.B. Jimenez and N.C. Bronfman
to this problem. While the increase in the proportion of private vehicles in relation
to the total MR vehicle eet reects a common tendency in developing countries,
poorly functioning public transportation has also been a determinant in the growing
number of private vehicles in recent years. All of the aforementioned factors contribute to the worsening of the already serious issues in this region, including trafc
congestion, air pollution, ambient noise levels, and road accidents, among others.
Nearly 40% of the countrys road accidents and nearly 25% of all resulting national
fatalities take place in the MR.1 Despite these gures, Chilean society does not perceive vehicular risks as unacceptable (Bronfman and Cifuentes 2003).
1.1. Impacts on public health from motorized vehicle transit
Motor vehicle circulation causes external impacts that have negative effects on public health, the most recognizable of which are road accidents and atmospheric pollution, followed by lesser-studied impacts such as those related to reduced physical
activity, high ambient noise levels, and the disposal of out-of-use vehicles, among
others.
Negative health impacts from motorized trafc differ signicantly. For a clear
illustration of this difference, consider trafc accidents, which result in injuries of
varying severity, and exposure to air pollution, which results in cardiovascular and
respiratory diseases. Exposure to both trafc accidents and air pollution has been
associated with mortality, so mortality has been widely used to quantify these
effects. In fact, several studies measuring such impacts in terms of trafc-related
mortality have been published in recent years (Fisher et al. 2002; Knzli et al.
2000; World Heatlh Organization [WHO] 2009).
The development of impact indicators is fundamental for measuring and monitoring the effects of motorized transit on public health, especially in high-risk areas
(WHO 2000). For example, in the Netherlands, De Hartog et al. (2010) quantied
the impact on all-cause mortality derived from the modal shift of 500,000 people
from car to bicycle, by calculating the number of life years gained and lost associated with increased physical activity, trafc accidents, and air pollution, respectively.
In Chile, the National Environmental Committee (CONAMA) has developed
health impact estimates of exposure to trafc-related air pollution in order to evaluate how the implementation of new regulations benets public health. Similarly, the
National Commission of Trafc Safety (CONASET) annually develops road accident indicators based on historical records as a quantitative measure of the impact
of trafc accidents. Nevertheless, so far no indicators have been developed in Chile
to account for the global effect that vehicle circulation has on public health, particularly in terms of premature mortality, whose major causes are exposure to air pollution and road accidents.
1.2. Trafc-related air pollution
As a result of different processes, motor vehicle circulation generates a number of
different pollutants resulting from varying processes, mainly through exhaust gases,
brake and tire wear, and Resuspended Dust (RSD). This results in a complex mixture of pollution being emitted into the atmosphere, including particulate material
and gaseous pollutants such as NOx, SOx, VOCs, and greenhouse gases, among others. These primary pollutants are precursors of the secondary formation of ne
1119
particulate material (PM2.5) and ground level ozone (O3) in the atmosphere. Therefore, the presence of these pollutants has also been associated with vehicle activity
(WHO 2000).
Road trafc contributes signicantly to the high levels of air pollution observed
in urban areas around the world. In Chile, the latest emission inventory carried out
by CONAMA for the MR estimated that mobile sources contributed 37% of the
PM10, 35% of the PM2.5, and 73% of the NOx emitted into the atmosphere during
the year 2005 (Escobar 2007).
1.2.1. Emission estimates
Motor vehicle emissions are usually estimated as a function of the distance traveled
in a given time and area, and as a function of an emission factor (EF), as shown in
the following equation:
Ei NAj EFij
where Ei is the emitted amount of pollutant i in grams, NAj is the activity level or
the distance in kilometers traveled by a vehicle of the category j in the area and
period under observation, and EFij is the EF of pollutant i for this category, in
grams per kilometer. Both parameters in Equation (1) are inuenced by several factors. Caserini, Giugliano, and Pastorello (2008) estimated the relation of the NA of
passenger cars and their age according to the type of fuel, using information from
the circulating vehicle stock in Italy during 2004. These authors proposed the following function:
NAaf h eba
where NA(a)f are the kilometers traveled by a vehicle of age a that uses type f fuel.
EFs for exhaust emission depend directly on circulation speed and fuel
consumption. These factors are generally differentiated according to the emission
abatement technology, quality standards performance, and fuel type. Ntziachristos
and Samaras (2000) developed EFs for different sizes of particulate matter and a
number of gas pollutants, in the frame of the COPERT III2 project, a European
model for vehicular emission estimates.
Exhaust EFs are also affected by usage, age, and poor vehicle maintenance.
The effect of these factors on the emission quantity and its chemical composition
can be integrated by correcting the EF with damage factors (DF). Ntziachristos and
Samaras (2000) developed damage curves for passenger cars according to
kilometers traveled and circulation speed. In Chile, CONAMA has estimated local
DF based on measurements made in technical revision plants (TRP).
The EFs for RSD traditionally used in literature are found in the US EPAs AP42,3 a compilation of EFs for different activities. According to this publication, the
RSD-related EF for evaluations that consider prolonged periods of time is dened
as follows:
"
#

0;65
1;5
sL
W
P
3
FELP k

C 1
2
3
4N
1120
where, FELP = paved road RSD-related EF, g/vehicle-km; k = particle size-related

constant, g/vehicle-km; sL = silt load, g/m2; W = average weight of categories under
consideration, ton; C = brake and tire wear correction factor, g/vehicle-km; P = days
with rainfall over 0.254 mm during the evaluation period; N = number of days in the
evaluation period.
1.2.2. Environmental pollutant concentration
Environmental pollution levels are determined by complex transportation and transformation processes that pollutants go through once they are emitted into the atmosphere. The relationship between the atmospheric concentration of a secondary
pollutant and the emission of its precursors can be estimated using a simple speciated rollback model (National Research Council 1993). This model assumes that the
concentration of a secondary pollutant x (Cx) exceeding the background concentration (Cbx) is directly proportionate to the total emission of y (Ey), an x precursor, in
the area and period of study, shown in the following equation:
Cx Cbx kxy Ey
The proportionality constant kxy can be used as an emission concentration factor

(ECF). Its estimation is based on historical records of atmospheric pollutant measurements, emission inventories, and the chemical constitution of atmospheric pollution in the area under study. This apparently simple approximation has been applied
in cost-benet assessments for implementation of environmental standards for air
pollution showing good results (CONAMA 2009).
1.3. Health impacts from exposure to trafc-related air pollution
Adverse health effects from exposure to atmospheric pollutants have been intensively studied and analyzed in recent years, establishing that short- and long-term
exposure to atmospheric pollutants constitute a signicant health risk factor (see
studies by Jerrett et al. 2009; Laden et al. 2006; Pope III et al. 2004). The effects
from such exposure vary in severity: from loss of work days, increases in medical
care needs and diseases, to premature death; the most frequently studied effect.
The association between premature mortality and exposure to PM2.5 has been
widely analyzed in epidemiologic literature throughout the last decades. Pope III
et al. (2002) evaluated the relationship between mortality and long-term exposure to
PM2.5, identifying a 4% increase in risk of premature death due to all causes facing
a 10 g/m3 increase in the environmental PM2.5 concentration. No signicant association was found between mortality and the coarse fraction of PM10 (PM2.510). In
another study, Cifuentes et al. (2000) estimated the effects of PM2.5 vs. PM2.510
and other pollutants have on daily mortality in Santiago, Chile, and found consistent relationships between PM2.5 and the gaseous pollutants CO, NOx y O3. More
specically, it has been determined that combustion particles from mobile sources
in the ne fraction are strongly associated with increased mortality (Cifuentes et al.
2000; Finkelstein, Jerrett, and Sears 2004; Laden et al. 2000).
Numerous studies have also shown negative effects on human health from exposure to ground-level ozone. However, only in the last decade could a signicant
relationship be established between mortality mainly because of respiratory
1121
diseases and chronic and acute exposure to this pollutant (Bell et al. 2004). For
instance, Jerrett et al. (2009) studied the relationship between death by various
causes and chronic exposure to O3. The authors found an increase of 1.029 (95%
CI; 1.0101.048) in the relative risk of death due to respiratory diseases, associated
with an increase of 10 ppb in environmental O3 concentration.
The increase in the risk of premature death due to exposure to trafc-related air
pollution has been estimated as a function of various parameters. Hoek et al. (2002)
developed risk indicators in accordance with the residential proximity to highly
transited roads, as did Finkelstein, Jerrett, and Sears (2004), Kim et al. (2004) and
Brauer et al. (2003), among others. Biwer and Butler (1999) developed death risk
indicators per traveled kilometer, associated with the emissions of heavy duty
vehicles during transportation of hazardous substances. In London, Kaur and
Nieuwenhuijsen (2009) estimated death risk indicators from personal exposure to
PM2.5 and carbon monoxide in a transport microenvironment for different modes of
transport.
1.4. Estimates of health impacts from exposure to air pollution

In recent years, several studies have been published that measure the impacts of air
pollution from motor vehicles on health, in terms of trafc-related mortality. Knzli
et al. (2000) estimated the impact of exposure to trafc-related air pollution on public health in Austria, France, and Switzerland, by calculating the number of deaths
attributable to exposure to trafc-related air pollution in these countries. Their ndings indicate mortality rates of 370 annual premature deaths per million habitants
for Austria, and of 340 for France and Switzerland. Similarly, the impact of trafcrelated air pollution on public health has been estimated for New Zealand by Fisher
et al. (2002), and for the city of Hai Pong in Vietnam by Dhondt et al. (2010).
Generally, estimates of public health impacts of air pollution are derived from
concentration-response (C-R) functions that describe the relative increase in an
observed effect in response to changes in exposure levels for a given population.
C-R functions are obtained from epidemiologic studies that use multivariate
models (Poisson, Cox proportional hazards survival, among others) in order to associate environmental pollution levels with mortality records in the population under
investigation, while controlling the inuence of confounding factors, such as humidity or temperature, and additional risk factors, such as smoking and others.
In these models, the expected number of health effects j as a consequence of
exposure to a pollutant i (Eij) is estimated as a function of coefcient C-R (ij),
the base rate of incidence of effect j in the affected population (TB0j), and the
affected population (Pob j) when atmospheric concentration of pollutant i changes
by Ci. The functional form of the model most frequently used in the literature is
the log-linear form (US EPA 1999), represented in Equation (5):
j
Ei j ebi Ci 1 Pob j TBoj
The selection of parameters to be used in the model must be made with special prudence and care. If possible, locally obtained C-R coefcients should be used, given
that they account for the unique characteristics of both local population and local
pollutant mixture. The use of coefcients obtained from studies developed in other
1122
countries is considered reasonable when there is no local information available.

Depending on the time frame in which the evaluated effects manifest themselves,
coefcients from cohort studies should be used to estimate chronic effects, and from
time series studies should be used to estimate acute effects.
Generally, air pollutants are highly correlated in time and space, as they share
common sources. Therefore, including various pollutants in the analysis of a specic effect may result in an overestimation of the total effects if the C-R functions
have been determined independently and their effects added later (Knzli et al.
2000). On the other hand, an analysis that considers only one pollutant would
underestimate the total effects, given the already established fact that the total risk
associated with exposure to air pollution increases when more than one pollutant is
considered in the estimation (Cifuentes et al. 2000).
Bearing this in mind, certain pollutants are used as representative indicators of
the mixture of chemical species that constitute air pollution. Given that their effects
contribute consistently and independently to increasing morbidity and mortality
levels observed in the population (Jerrett et al. 2009), this study will consider two
pollutants as indicators of trafc-related air pollution: secondary PM2.5 and groundlevel O3.
1.5. Road trafc accidents

Road accidents are a well-known public health problem all over the world. Over
1.2 million people die each year on roads around the world, and between 20 and
50 million suffer nonfatal injuries (WHO 2009). In Chile, road accidents constitute
the main external cause of death, and the rst cause of death among youth (Medina
and Kaempffer 2007). During 2005, a total of 2301 road accident fatalities were
registered nationwide, of which 30% occurred in the MR.4 The number of road
accident fatalities is expected to continue growing worldwide in the coming years
(Jacobs et al. 2000).
Differences in physical attributes of vehicles, such as weight, size, materials,
and height of the center of gravity, to name just a few, make certain vehicle categories incompatible with others in terms of trafc safety. The presence of one class of
vehicle may become detrimental for another in terms of risk of accidents with serious consequences (Attewell, McFadden, and Seyer 1999). For example, the heavier
the vehicle involved in a car crash, the lower its passengers risk of death, and the
higher the risk for the passengers of the other vehicle involved (Evans 2004).
Generally speaking, these attributes are highly correlated, which makes it difcult
to establish each partys relative responsibility regarding the consequences of the
accident (Evans and Frick 1992).
1.6. Overview
Motorized transportation plays a fundamental role in the economic development
process and in satisfying personal transportation needs. However, it also generates
negative externalities that signicantly impact the populations quality of life,
mainly through atmospheric pollution and road accidents. The current organization
of modern societies and their unsustainable mobility patterns have made these
impacts more and more evident.
1123
A number of studies have quantied direct and indirect impacts of motor transportation on public health. On one hand, epidemiologic studies have established
indicators that relate the exposure to atmospheric pollutants to an increase in the
incidence of adverse health effects, including premature death. On the other hand,
annual indexes of road accident mortality show that this is a manifested public
health problem and one of the major reasons for death due to external causes
worldwide. Although the elaboration of health impact indicators is fundamental in
order to identify, evaluate, and monitor impacts that can be attributed to vehicle circulation, no global indicators have been developed so far to reect the accumulation
of impacts that this activity causes on public health.
Furthermore, no existing indicators express the individual impact of each class
of vehicle on public health and safety simultaneously. For instance, factors such as
type of fuel, age of vehicle, and motor technology, among others, are responsible
for differences in emission quantity and composition. At the same time, differences
in vehicle attributes such as weight, height, and circulation speed inuence accident
risk and the magnitude of its consequences.
The main goal of this study was to design and quantify indicators of premature
mortality caused by exposure to atmospheric pollutants and road accidents that
different motor vehicle classes inict on society.
Given that motor vehicle circulation generates a number of pollutants, each of a
different nature, whose effects are highly correlated, we considered the pollutants
PM2.5 and O3 as indicators of trafc-related air pollution. This is supported by the
fact that the effects of these pollutants independently contribute to increase the
observed levels of morbidity and mortality in the population (Jerrett et al. 2009).
2. Methodology
In this study, we designed indicators to account for the total premature mortality
associated with the circulation of different types of vehicles. Total premature
mortality is understood as the total number of premature deaths that occurred as a
consequence of road accidents and exposure to O3 and PM2.5 derived from the
pollutant emissions from the MRs vehicle eet, in a given year.
Indicators for different vehicle categories will be obtained as a function of
different parameters: per traveled kilometer, vehicle, lifetime of the vehicle, and
category. All estimations will be made with the MR in 2005 as a basic scenario, as
this is the most recent year for which the information required for this study is
available.
2.1. Vehicle stock characteristics

The vehicles in circulation were described according to year of manufacture,
weight, technology, fuel type, activity level, and number of vehicles per category,
among others. The disaggregation level for each category was determined by the
information requirements needed to assign EF to the different vehicle categories in
the emission estimation process.
The technical characteristics of the vehicle eet were obtained from information
provided by the MR TRP. The total number of vehicles in circulation during 2005,
by vehicle category, was provided by the National Bureau of Statistics (INE).
1124
2.2. Premature mortality from exposure to trafc-related air pollution

Health impact from exposure to trafc-related air pollution was estimated as the
number of premature deaths attributable to acute and chronic exposure to O3 and
PM2.5, respectively. For this purpose, Equation (1) will be used, following the
guidelines established in previous studies (Cifuentes et al. 2000; Knzli et al. 2000;
Ostro 1996; US EPA 1999).
The PJ coefcients used to estimate the effects of acute and chronic exposure
were obtained from studies performed by Cifuentes et al. (2000) in Chile and by
Pope III et al. (2002) in the US.
The base rate of effects BR0J was obtained from public records, namely by processing death certicates from the year 2005 in the MR. Deaths due to all causes
were considered, excluding those in which traumatisms were a secondary cause
(Letters AU of the ICD-10). The affected population is the total MR inhabitants in
2005, obtained from census information.
In order to achieve impact estimates differentiated by category, the selected values for Ci from Equation (5) correspond to the change in ambient concentrations
of pollutants O3 and PM2.5 attributed to each type of vehicle per traveled kilometer.
Each type of vehicles contribution to the atmospheric levels of O3 and PM2.5
was estimated based on their precursors emission levels and relationship to the
environmental concentration of the secondary pollutants O3 and PM2.5 observed
during the study period. This was done using the ECF corresponding to the given
area and period of study.
Emissions of O3 and PM2.5 precursors from motor vehicle circulation were estimated as a function of their activity level and the EF, using Equation (1).
The distance traveled annually by private passenger cars was estimated using
Equation (2), and the adjustment to this model made by Lepeley and Cifuentes
(1999) in order to achieve a proper representation of the local scenario. For the
remaining vehicle categories, activity levels were obtained from the available literature, particularly from the contribution of Samaras and Ntziachristos (2008).
In exhaust emission estimations, EF from Ntziachristos and Samaras (2000) was
used, evaluated at 41 and 23 km/h for private passenger cars and public transportation,
respectively.5 For motorcycles, trucks, and rural and interurban buses, the following
circulation speeds were considered: 45, 50, 40, and 55 km/h, respectively. Fuel consumption was estimated based on the previously determined vehicular activity level
and the fuel consumption factors provided by Ntziachristos and Samaras (2000). The
sulfur content of the fuel was obtained from information provided by ENAP (Empresa
Nacional del Petrleo). The NOx and VOC EFs for light vehicles were corrected
according to vehicle age, using local DF provided by CONAMA (2007).
RSD EFs for the different vehicle categories were calculated according to Equation (3), using parameters proposed by the US EPA in the AP-42, and meteorological information pertinent to the study area.
2.2.2. Pollutant atmospheric concentration
The PM2.5 and O3 atmospheric concentration increment associated with its precursors emission was estimated for each vehicle type using a simple rollback model,
1125
Table 1. Emission concentration factor (ECF) for PM2.5.

Primary pollutants
NOx
SOx
NH3
PM2.5
RSD
ECF
[g/m3] PM2.5/ton
1.01E04
2.01E04
1.59E04
3.04E03
4.42E05
Source: CONAMA (2009).
Table 2. Emission concentration factor (ECF) for O3.

Primary pollutants
ECF
ppbO3/ton
NOx
VOC
5.80E04
2.64E04
Source: Rizzi (2008).
as described in Equation (4). The ECF used in this study was obtained from Rizzi
(2008) and CONAMA (2009), as detailed in the Tables 1 and 2.
Their authors estimated these ECF specically for the MR, based on information
pertinent to the year 2005.
2.3. Mortality resulting from trafc accidents
The health impact associated with road accidents was estimated as the number of
deaths that occurred in the MR during 2005 as a consequence of this type of accident, attributable to different vehicle categories.
The total number of deaths from road accidents in the MR during 2005 was
obtained from information from death certicates. Only fatalities with secondary
diagnoses classied under the letter V of the ICD-10 were considered. However,
death certicates do not contain details about characteristics of the accident, nor
about the vehicles implicated, information that is essential to determine the responsibility of the fatalities resulting from trafc accidents between the participating
vehicles. In order to explore the contribution of each type of vehicle on total mortality from trafc accidents, data from historical records of road accidents from
CONASET were used. Both the level of involvement in accidents with fatal results
and the magnitude of the impact were estimated.
The characteristics of all accidents that occurred in the area and period of study,
and that resulted in at least one fatality, were analyzed, classifying the accidents
according to the number of vehicle categories involved. In cases where two or more
categories were involved, it was assumed that each participating vehicle carries the
responsibility for all the resulting deaths. In order to attribute the responsibility of
the resulting fatalities to the different vehicle categories, in cases where two or more
categories were involved, it was assumed that each participating vehicle was
responsible for all the resulting deaths. The implications of this assumption, among
1126
others, are analyzed further on. The percentage of the total number of deaths from
historical records for trafc accidents associated with each category was used to
determine each categorys responsibility in the real mortality levels from road accidents, according to the registry of death certicates.
Finally, the total number of deaths per category was distributed across the number of vehicles in circulation belonging to each category and their annual activity
level, in order to obtain differentiated indicators of mortality from road accidents
per driven km for each category.
3. Results
3.1. Vehicle stock characteristics
Signicant variations were found among data from different sources, especially with
regard to the total number of vehicles. This may be due to the rule that exempts
new vehicles from the otherwise mandatory vehicle inspections and maintenance
during the rst years of use.6 Furthermore, some drivers have their required vehicle
inspections done outside the region, while others simply evade the process.
The circulating vehicle eet was classied into 15 categories. In order to obtain
vehicle subcategories compatible with the EF used in the emission estimation process, all categories were disaggregated according to fuel type, emission abatement
technology, and compliance with emission standards. The technological composition
of each category was obtained from TRP-derived information and then projected
over the total number of vehicles per category reported by INE. The results of these
analyses are shown in the rst four columns of Table 3. The total sum of vehicles
in circulation in the area and period of study was 1,068,294, of which 63% were
private passenger cars.
3.2. Mortality from exposure to trafc-related air pollution

Table 3 shows the results of the emission estimation process for O3 and secondary
PM2.5 precursors (primary PM2.5, NOx, SOx, NH3, VOC, and RSD), for each subcategory. Our results indicate that heavier vehicle categories (buses and trucks) generate the highest amount of all primary pollutants per traveled kilometer, with two
exceptions: VOC and NH3. The highest VOC contribution per traveled kilometer is
made by motorcycles, followed by gasoline vehicles without a catalytic converter.
The highest contribution of NH3 is made by gasoline vehicles with a catalytic converter. Bus categories generate the highest quantities of SOx.
As expected, given their vehicular attributes, heavy trucks emit the highest RSD
quantity per traveled kilometer: almost twice as much as the next category (Urban
Public Transportation Buses, four times higher than the RSD emission attributed to
other trucks and buses, and nine times higher than private passenger cars).
Natural gas vehicles emit neither PM2.5, NH3 nor SOx exhaust, which are
directly related to the use of diesel and gasoline. However, their VOC and NOx
emission levels are comparable to those of heavier vehicles, such as Van Type I,
Type 2 Heavy Trucks, or even higher.
The results in Table 3 indicate that almost all PM2.5 exhaust emissions can be
attributed to circulation of diesel vehicles. The conventional bus and truck
30.775
65.632
7.338
36.244
16.453
8.184
Jeep
Minibus, van
School bus
Light truck
Medium-sized
truck
Heavy truck
150.470
14.264
Collective taxi
Pickup
26.539
677.773
Number of
vehicles
Private passenger
car
Taxi
Category
Private passenger car catalytic type 1

Private passenger car noncatalytic
Catalytic taxi type 1
Noncatalytic taxi
Natural gas taxi
Collective taxi catalytic type 1
Collective taxi noncatalytic
Collective taxi natural gas
Catalytic pickup Type 1
Pickup noncatalytic
Pickup diesel
Jeep catalytic Type 1
Jeep noncatalytic
Jeep diesel
Minibus, van catalytic Type 1
Minibus, van noncatalytic
Minibus, van diesel
Minibus, van natural gas
School bus catalytic Type 1
School bus noncatalytic
Diesel school bus
Conventional light diesel truck
Light diesel truck Type 1
Light diesel truck Type 2
Conventional medium diesel truck
Medium diesel truck l Type 1
Medium diesel truck type 2
Conventional heavy diesel truck
Heavy diesel truck Type 1
Subcategory
c
80
20
96
2
3
87
1
12
70
17
13
83
11
7
39
18
41
2
12
4
84
23
37
40
37
33
30
45
32
Composition
(%)
19,052
9859
60,000
60,000
60,000
60,000
60,000
60,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
30,000
55,000
55,000
55,000
46,000
46,000
46,000
86,000
86,000
Annual
kma
NA
NA
NA
NA
NA
NA
NA
NA
NA
NA
0.23
NA
NA
0.23
NA
NA
0.23
NA
NA
NA
0.23
0.25
0.16
0.10
0.53
0.35
0.21
0.66
0.43
PM2.5b
0.56
3.66
0.48
2.22
0.40
0.48
2.22
0.40
0.39
2.50
1.05
0.39
2.50
1.05
0.39
2.50
1.05
0.40
0.39
2.50
1.05
2.47
1.73
1.23
5.13
3.59
2.57
11.74
6.46
NOx
0.003
0.004
0.01
0.01
NA
0.01
0.01
NA
0.00
0.005
0.01
0.005
0.005
0.01
0.005
0.005
0.01
NA
0.005
0.005
0.01
0.01
0.01
0.01
0.02
0.02
0.02
0.03
0.03
SOx
0.07
0.002
0.07
0.002
NA
0.07
0.002
NA
0.07
0.002
0.001
0.07
0.002
0.001
0.07
0.002
0.001
NA
0.07
0.002
0.001
0.003
0.003
0.003
0.003
0.003
0.003
0.003
0.003
NH3
0.28
0.54
0.31
0.31
0.31
0.31
0.31
0.31
1.02
1.02
1.02
1.02
1.02
1.02
1.55
1.55
1.55
1.55
1.55
1.55
1.55
5.44
5.44
5.44
13.69
13.69
13.69
59.03
59.03
RSD
(Continued)
0.14
1.91
0.17
2.01
0.41
0.17
2.01
0.41
0.21
1.81
0.08
0.21
1.81
0.08
0.21
1.81
0.08
0.41
0.21
1.81
0.08
1.30
0.97
0.64
1.30
0.97
0.91
1.30
0.65
VOC
Table 3. Vehicle stock MR 2005 disaggregated by category, emission abatement technology and fuel type, and pollutant emission in g/km.

1127
15.728
7.936
Motorcycle
Urban public
transportation
bus
Interurban bus
2.261
Private bus
Heavy diesel truck Type 2

Conventional two-stroke motorcycle
Conventional four-stroke motorcycle
Diesel urban bus Type 3
Conventional diesel interurban bus
Diesel interurban bus Type 1
Conventional diesel rural bus
Diesel rural bus Type 1
Private bus
Subcategory
23
35
65
44
25
31
32
15
51
2
25
17
27
31
100
Composition
(%)
Source: Elaboration based on TRP, INE, Lepeley and Cifuentes (1999), Caserini et al. (2008).
a
Values obtained from Caserini et al. (2008), Lepeley and Cifuentes (1999), and others.
b
PM2.5 from exhaust emissions.
c
Type 1: EURO I; Type 2: EURO II; Type 3: EURO III, or higher.
d
Not applicable.
4.394
Rural public
transportation
bus
4.303
Number of
vehicles
Category
Table 3. (Continued).
86,000
4500
4500
80,000
80,000
80,000
40,000
40,000
40,000
40,000
35,000
35,000
35,000
35,000
25,000
Annual
kma
0.16
NA
NA
0.21
0.48
0.30
0.61
0.25
0.16
0.11
0.77
0.32
0.20
0.14
0.32
PM2.5b
NOx
4.70
0.03
0.15
6.14
12.28
8.77
8.49
4.67
3.40
2.38
11.19
6.15
4.47
3.13
6.15
0.03
0.002
0.002
0.04
0.03
0.04
0.02
0.02
0.02
0.02
0.02
0.02
0.02
0.02
0.02
SOx
0.003
0.002
0.002
0.003
0.003
0.003
0.003
0.003
0.003
0.003
0.003
0.003
0.003
0.003
0.003
NH3
0.58
8.78
1.17
0.85
1.30
1.21
1.26
0.63
0.57
0.40
1.68
0.84
0.75
0.53
0.84
VOC
59.03
0.01
0.01
33.76
33.76
33.76
29.41
29.41
29.41
29.41
21.43
21.43
21.43
21.43
21.88
RSD
1128
1129
subcategories are the greatest contributors to the emissions of this pollutant, followed by the remaining buses and trucks. Estimations obtained for diesel pickups,
jeeps, and vans are comparable with medium-sized trucks and buses EURO I or
higher. Additionally, these categories emission levels of NH3 and VOC are comparable to those of natural gas vehicles.
In general, motorcycles show the lowest emission rates for all the pollutants per
kilometer traveled, except for VOC, as mentioned earlier.
3.2.2. Changes in PM2.5 and O3 environmental concentration
Table 4 shows the marginal increase in the environmental concentration of secondary pollutants PM2.5 and O3, estimated per vehicle, lifetime, category, and kilometer
traveled for each vehicle category.
Motorized vehicles circulating in the MR contributed a total of 25.5 ppb of O3
and 13.8 g/m3 of secondary PM2.5 to the ambient levels of these two pollutants in
2005. The heavy truck category is the greatest contributor of these two pollutants to
the environmental concentration per traveled kilometer, followed by Urban Public
Transportation Buses, and by buses and trucks in general. Inversely, the motorcycle
category presents the lowest PM2.5 rates per traveled kilometer, while the O3 rates
per kilometer traveled obtained for motorcycles are comparable with the light truck
category rates. The greatest contribution per category is made by private passenger
cars and heavy trucks.
3.2.3. Mortality attributable to exposure to PM2.5 and O3
Indicators of mortality attributable to exposure to O3 and PM2.5 were obtained for
each category as a function of different parameters: traveled kilometers, vehicle,
Table 4. Contributions to O3 and PM2.5 ambient concentration, in ppb and g/m3,
respectively, per traveled kilometer, annual contribution per vehicle and per category.
Category
Heavy truck
Urban public
transportation bus
Rural public
transportation bus
Interurban bus
Private bus
Medium-sized truck
Light trucks
School bus
Minibus, van
Pickup
Jeep
Private passenger car
Taxi
Collective taxi
Motorcycle
a
ppb
O3/km
ppb
O3/veh
ppb
O3
g/m3
PM2.5/km
g/m3
PM2.5/veh
g/m3
PM2.5
5.10E09
5.20E09
4.40E04
4.20E04
3.62
3.3
4.90E09
3.30E09
2.30E04
2.60E04
3.45
2.09
3.20E09
1.30E04
0.57
2.80E09
1.10E04
0.49
3.70E09
3.80E09
2.50E09
1.20E09
6.40E10
7.30E10
6.10E10
4.80E10
8.10E10
3.50E10
3.40E10
1.10E09
1.30E04
9.50E05
1.20E04
6.80E05
1.90E05
2.20E05
1.80E05
1.40E05
1.10E05
2.10E05
2.00E05
4.90E06
0.56
0.21
1.9
2.45
0.14
1.43
2.77
0.45
7.26
0.55
0.29
0.02
2.60E09
2.60E09
2.10E09
8.90E10
7.60E10
4.60E10
2.30E10
1.70E10
1.40E10
7.70E11
7.40E11
1.20E11
9.10E05
6.40E05
1.20E04
2.70E05
2.30E05
2.10E06
6.90E06
5.00E06
2.50E06
4.60E06
4.40E06
1.00E06
0.39
0.15
1.62
1.78
0.17
0.91
1.03
0.16
1.37
0.12
0.06
0.0002
Categories sorted in descending order of emissions of g/m3 PM2.5/km.
1130
and lifetime. The highest magnitudes of indicators of premature mortality from

exposure to both pollutants were from the buses and trucks categories. Results for
all categories are shown in Table 5, in descending order of the number of premature
deaths per traveled kilometer.
Our results indicate that motor vehicle circulation was responsible for at least
2590 premature deaths that occurred in the MR during 2005, as a consequence of
Table 5. Indicators of premature mortality from exposure to O3 (acute) and PM2.5 (chronic)
per traveled kilometer, annual deaths per vehicle, and per lifetime.
Category
Heavy truck
Urban public transportation bus
Interurban bus
Rural public transportation bus
Private bus
Medium-sized truck
Light truck
School bus
Minibus, van
Pickup
Jeep
Taxi
Collective taxi
Motorcycle
Deaths/
km
Annual deaths/
vehicle
Expected deaths
during lifetimea
8.92E07
6.09E07
5.11E07
4.81E07
4.74E07
3.90E07
1.64E07
1.37E07
8.59E08
4.40E08
3.24E08
3.02E08
1.56E08
1.51E08
8.78E09
4.23E02
4.87E02
2.05E02
1.68E02
1.19E02
2.13E02
5.12E03
4.10E03
5.01E04
1.32E03
9.73E04
5.07E04
9.36E04
9.04E04
2.13E04
7.35E01
1.41E+00
5.91E01
4.86E01
3.43E01
3.71E01
7.84E02
6.28E02
7.68E03
2.02E02
1.49E02
9.35E03
1.72E02
1.67E02
5.23E03
Lifetime values for car (18.4 years), motorcycle (24.5 years), bus (28.9 years), commercial vehicle
(15.3 years), and heavy truck (17.4 years) were taken from Samaras and Ntziachristos (2008).
Table 6. Number of cases attributable to exposure to O3 (Acute) and PM2.5 (Chronic) per
category.
Categorya
Heavy truck
Light truck
Medium-sized truck
Pickup
Minibus, van
Interurban bus
Jeep
School bus
Private bus
Taxi
Collective taxi
Motorcycle
Total
a
Acute O3
Chronic PM2.5
Total
22
20
15
12
45
17
9
4
3
3
1
1
3
2
0.09
157
612
369
314
285
241
182
161
86
69
27
29
26
21
11
0.03
2433
634
389
329
297
286
199
170
90
72
30
30
27
24
13
0.12
2590
Categories sorted in descending order of total attributable cases.
1131
exposure to trafc-related O3 and secondary PM2.5. This gure is equivalent to

8.1% of the total deaths registered in this period, representing a rate of 405 premature deaths per million habitants. The number of premature deaths per category for
the year 2005 is shown in Table 6. Most of the attributable cases (94%) were
caused by chronic exposure to secondary PM2.5, of which 50% is attributable to
trucks. Similarly, 31 and 28% of premature mortality caused by exposure to O3 can
be attributed to trucks and private passenger cars, respectively. As observed, 13, 11,
and 24% of the total mortality from exposure to trafc-related pollution can be
attributed to light, medium, and heavy trucks, respectively. Motorcycles do not signicantly contribute to annual mortality caused by exposure to these pollutants.
Table 7. Annual deaths caused by different types of road accidents.

Annual deaths
Category
Private
passenger car
Taxi
Collective taxi
Pickup
Jeep
Minibus, van
School bus
Light truck
Medium-sized
truck
Heavy truck
Motorcycle
Urban public
transportation
bus
Rural public
transportation
bus
Interurban bus
Private bus
Total
a
Total
Category
(Ministry
Total
of
Simple
category
Double Multiple
Involvement
Health)e
accidentsa accidentsb accidentsc (CONASET)d
(%)
102
48
12
162
29.9
218
4
3
49
5
8
2
24
2
3
1
39
5
0
13
35
5
0
0
6
0
3
0
8
3
7
4
94
10
11
15
67
10
1.2
0.7
17.3
1.9
2.1
2.7
12.3
1.9
9
5
126
14
15
20
90
14
1
10
66
0
14
43
1
1
3
2
25
112
0.3
4.7
20.6
2
34
150
0.4
9
1
288
4
1
211
2
5
44
15
7
543f
2.7
1.2
100
20
9
729
Simple accidents deaths include run overs, overturns, and crashes that do not involve other categories.
Double accident deaths include crashes between two categories or between one category and a bicycle.
c
Multiple accident deaths include crashes of more than two categories, considering bicycles.
d
Total deaths registered by CONASET. This database contains disaggregated information about each
vehicle categorys involvement in fatal accidents, but does not consider deaths caused by the accident
that occurred posterior to it.
e
Total deaths according to Ministry of Health. This database contains information of the total number
of deaths caused by road accidents, but does not contain information regarding vehicles involvement
in accidents causing those deaths.
f
This number does not match the total number of annual deaths registered by CONASET (465 deaths).
The reason for the difference is that the responsibility for deaths in double accidents (126 deaths) and
multiple accidents (23 deaths) was attributed to each participating vehicle category, resulting in a double count of the number of fatalities.
b
1132
3.3. Mortality from road accidents

Road accidents that occurred in the MR during 2005 were classied according to
the number of vehicle categories involved: simple (one category), double (two categories), and multiple (three or more categories) accidents. Table 7 shows the distribution of fatalities resulting from trafc accidents according to the number of
vehicle categories involved, the percentage of each categorys involvement in the
total deaths, and the total number of deaths attributable to each vehicle category.
Out of all the accidents registered by CONASET, 432 resulted in one or more fatalities: 68% occurred as a consequence of a simple accident, 27% from double accidents, and 5% from multiple accidents (see columns 2, 3 and 4 of Table 7).
The fth column of Table 7 shows that private passenger cars generate the
greatest number of deaths followed by the urban public transportation buses, and
pickups and medium-sized truck categories. On the other hand, the heavy truck category shows the lowest number of road accident fatalities, followed by the rural
public transportation buses and collective taxi categories.
Analyses of death certicate-based information indicate that 729 deaths had a
road accident-related secondary cause of death in the MR during 2005. This is
equivalent to 2.3% of all deaths and a rate of 114 premature deaths per million
habitants, considering the total population of the MR in 2005.
Table 8 shows indicators of mortality per kilometer traveled, vehicle, and lifetime of each category, in descending order of magnitude of deaths/km. Motorcycles
show the highest rate of deaths per kilometer traveled, followed by urban public
transportation buses, private buses, interurban buses, and school buses. Mortality
indicators per traveled kilometer for school buses were 5 times, 15 times, and 24
times higher than those for private cars, taxis, and heavy trucks, respectively.
3.4. Premature deaths associated with motor vehicle circulation
Our results indicate that at least 3319 premature deaths occurred in the MR during
2005 as a consequence of motor vehicles external impacts on health, of which
Table 8. Indicators of mortality caused by road accidents, per traveled kilometer, annual
deaths per vehicle, and per lifetime.
Categorya
Deaths/km
Annual deaths/vehicle
Deaths/lifetime
Motorcycle
Private bus
Interurban bus
School bus
Light truck
Pickup
Medium-sized truck
Jeep
Minibus, van
Collective taxi
Taxi
Heavy truck
4.80E07
2.36E07
1.59E07
1.33E07
9.09E08
4.51E08
2.79E08
1.87E08
1.85E08
1.71E08
1.52E08
7.62E09
5.84E09
5.65E09
2.84E09
2.16E03
1.89E02
3.98E03
4.55E03
2.73E03
2.48E03
8.37E04
3.22E04
8.51E04
6.97E04
4.55E04
2.29E04
3.51E04
3.39E04
2.44E04
5.31E02
5.46E01
1.15E01
1.32E01
4.18E02
3.81E02
1.28E02
5.93E03
1.30E02
2.01E02
6.97E03
3.50E03
6.46E03
6.25E03
4.25E03
Categories sorted in descending order of deaths/km indicators.
1133
Table 9. Indicators of premature mortality for MR 2005 associated to motor vehicle

circulation, per traveled kilometer, annual deaths per vehicle, per lifetime, and per category.
Categorya
Premature Annual premature Deaths/ Annual premature

deaths/km
deaths/vehicle
lifetime
deaths
Heavy trucks
Private bus
Interurban bus
Motorcycle
Medium-sized truck
School bus
Light truck
Minibus, van
Pickup
Jeep
Taxi
Collective taxi
8.94E07
8.45E07
6.34E07
6.14E07
5.28E07
4.89E07
4.09E07
2.27E07
2.09E07
9.36E08
7.19E08
4.89E08
4.76E08
2.12E08
2.09E08
4.25E02
6.76E02
1.58E02
2.14E02
2.12E02
2.37E03
2.22E02
6.82E03
7.60E03
7.29E04
2.16E03
8.29E04
1.43E03
1.27E03
1.25E03
0.74
1.95
0.46
0.62
0.61
0.06
0.39
0.10
0.12
0.01
0.03
0.02
0.02
0.02
0.02
636
539
36
92
93
34
311
50
419
185
325
503
44
34
18
Categories sorted in descending order of premature deaths/km indicators.
22% is due to road accidents and 78% to the exposure to pollutants generated by
motor vehicle circulation. This corresponds to 10.4% of all mortality registered in
the MR in this period, and a rate of 520 premature deaths per million habitants.
Table 9 shows global indicators of premature mortality and the total fatalities
estimated for all categories. The heavy truck, urban public transportation bus, and
private passenger car categories are responsible for 19, 16, and 15% of the estimated total mortality that can be attributed to motor vehicle trafc, respectively.
Heavy trucks and urban public transportation buses present the highest indicators per kilometer traveled. The impact magnitudes of these two categories are congured quite differently: urban transportation buses indicator of total mortality is
formed almost evenly between road accidents and pollutant exposure, while mortality attributed to heavy trucks is dominated by pollutant exposure. The opposite
occurs with motorcycles: 98% of the global indicator of premature deaths per kilometer traveled is determined by road accidents, and only 2% to pollutant exposure.
The motorcycle category presents high indicators of premature deaths per kilometer traveled in comparison to other categories, even compared to indicators
obtained for rural public transportation buses and medium-sized trucks. For this category, the estimated premature deaths indicator per traveled kilometer is 7, 10, and
23 times higher than the estimation for pickups, private passenger cars and taxis,
respectively.
The results obtained for taxi and collective taxi categories were the lowest. For
these categories, the indicators per traveled kilometer are 11, 10, and 4 times lower
than the estimated indicators for school buses, pickups and private passenger cars,
respectively.
4. Discussion
This study presents two main results. First, a set of comprehensive indicators of
trafc-related impacts on public health was developed, in order to yield complete
1134
information about the total impact on premature mortality resulting from motorized
trafc. Second, estimates of total impact on premature mortality were obtained for
each vehicle category, as a function of different parameters (premature deaths per
driven kilometer, year, and lifetime).
Traditionally, trafc-related mortality is associated only to direct mortality, i.e.
death as a consequence of trafc accidents, where the relationship between cause
and effect is clearly evident and straightforward. However, the extent to which
motor vehicles inuence premature mortality is much greater than their involvement in trafc accidents, and when additional impacts from this activity are
considered, the real impact of road trafc on mortality is signicantly larger.
One of the major implications of this common misinterpretation is that both
community and regulators base their decisions on incomplete information, and
therefore, it would be expected that results from such decision-making processes
be biased.
For example, in Chiles MR, trafc accidents were responsible for a mortality
rate of 114 annual deaths per million inhabitants during 2005, equivalent to 2.3%
of all-cause mortality registered in this period. According to our results, when the
two main factors that inuence trafc-related mortality are considered simultaneously, the rate of annual deaths per million inhabitants increases to 520, and the
equivalent percentage of the total deaths registered in the same area and time period
increases to 10.4%.
The results of this study indicate that the public transportation buses generate
the greatest health impact on MRs population in terms of annual premature deaths
per vehicle and premature deaths during a vehicles lifetime. However, the number
of transported passengers was not considered within this study. If this variable were
integrated in the analysis, the numbers would show that public transportation buses
are signicantly safer and less pollutant, which makes them the most efcient
means for transporting passengers. While it is essential that authorities with competence in the transport sector strengthen the participation of public transport in the
MRs transportation matrix and encourage the public to use this means of transportation, equally important is the need to adopt measures to reduce this activitys negative impacts on society.
The MR health and environment authorities have assessed the implementation
of different measures in the transport sector, with the aim of decreasing its contribution to the alarming pollution levels observed in the region and reducing their
impact on public health. Also, various governmental organisms make constant
efforts to reinforce road safety plans and control vehicles in circulation, in order
to reduce the risks of accidents. However, the adoption of these measures alone
and separately is not enough to deal with the expected impacts of the regions
accelerated growth of vehicles in circulation: coordinated and integrated multisector action is essential, including public participation throughout the decisionmaking process.
The comprehensive indicators developed in this study are a useful tool which
can support the complex process of deciding between transportation modes by
delivering complete disaggregated information of premature mortality attributable to
different types of vehicle.
Multiple impacts and benets of each means of transportation must be considered when making such decisions, because of the multiple trade-offs existing
between road safety, a clean environment, comfort, and the satisfaction of personal
1135
needs. For example, the change from gas vehicles into hybrid electric vehicles is a
cost-effective measure for the society, in terms of emission reduction. On the other
hand, these vehicles are generally smaller and lighter, and therefore in disadvantage
when facing bigger and heavier vehicles in an accident, given that death and serious
injury risks are higher for passengers in the lighter vehicle involved in the accident.
Another example is the case of motorcycles: using this type of vehicle has several
benets for the user, mainly linked to low operational cost and avoidance of trafc
congestion. Yet, motorcycles present the highest death risk due to accidents. Our
indicators allow the inclusion of public health requirements when such decisions
are being made.
4.1. Implications for risk communication

The question of how best to compare and communicate information regarding
health impacts from motor trafc, once quantied, is a complicated issue inherent
to health impact assessments. Moreover, peoples perceptions, worries, and interests
regarding transportation risk management and the need for regulation must be taken
into account if successful communication strategies are to be implemented.
The objective of risks communication is to provide relevant information with
which the public can make responsible decisions concerning the risks that they face
as individuals, and as society as a whole. Adequate communication of the magnitude of the impact that vehicle circulation imposes on certain dimensions of public
health is essential. In this sense, the indicators designed and quantied in this study
represent an important contribution to the mixture of stakeholders participating in
the transport sector, by providing adequate understanding of the global social
impact that the circulation of different vehicle categories have on public health.
Moreover, indicators based on local information provide more useful results, by
reecting the current situation and tendencies of vehicle trafc in Chiles MR, and
by reducing the bias from transferring results obtained elsewhere.
At an individual level, this information is especially useful for heightening
awareness of the importance of individual actions contributing to these impacts,
encouraging informed, efcient, and effective civic participation in the process of
public policy development and responsible decision-making regarding changes in
lifestyle or motor vehicle purchase options.
From the regulators perspective, the results of this study are a useful tool with
which to more efciently confront the complex transportation-related decisionmaking process. This will allow for the optimization of resources invested in
implementing public policies, minimization of the potential conicts caused by differing interests, and recognition of the multiple trade-offs between economic
development and health.
Our main indicators were structured in such a way to quantify the total impact
of trafc on mortality as annual deaths per million habitants. By expressing the
impact of transportation using this common measure of risk, comparisons are established between risks associated with different technologies and industrial sectors,
such as forestry, manufacturing, chemical, agriculture, mining, and energy generation, among others. This will facilitate the publics understanding of the impact of
their personal preferences and actions.
1136
4.2. Further considerations

As discussed previously, negative health impacts from exposure to air pollution and
trafc accidents differ signicantly. Nevertheless, exposure to both environmental
risk factors has been consistently associated with mortality, so we quantied the
potential impact on health from motorized vehicles as a whole, in terms of total premature mortality by using this specic outcome as a common metric. This logic
assumption relies on the fact that a death is a death regardless of its cause, and
therefore can be considered equal in terms of its health and social consequences.
From a different perspective, the methodology used to quantify the number of
deaths caused by road accidents is very different from that used for estimating the
number of premature deaths caused by exposure to air pollution. Road accidentrelated deaths are caused directly by the accidents impact on the person and are
considered a specic event (count data), while pollutant exposure acts indirectly
by increasing the risk of illness or pathological conditions that may lead to premature death, i.e. death is the delimiter of survival time or life expectancy (Knzli
2002).
Age structure of victims affected by these two causes is an important issue in
the comparability of risk from exposure to air pollution and trafc accidents. In
general, associations between exposure to air pollution and premature mortality are
more consistent for children (Kim et al. 2004; Loomis et al. 1999) and the elderly
(Pope III, Ezzati, and Dockery 2009), while road accidents are a major global cause
of death for young people between 15 and 44 years old (WHO 2009). The implications of this are especially signicant when calculating the economic valuation of
these deaths based on per capita income, according to life expectancy reduction and
its subsequent loss in national productivity. This is explained by the fact that the
attribution of similar economic benets to society as a whole derived from the
avoidance of air pollution deaths, with a life expectancy reduction in the order of
months, as opposed to a death by trafc accident, where the life expectancy reduction is in the order of decades, is not reasonable.
Individuals willingness to pay for reductions in a given risk or to prevent a
fatality caused by it is a different approach widely used to estimate the economic
value of a fatality, which is also affected by differences in the at-risk context of
deaths from exposure to air pollution and trafc accidents. This method relies on
the fact that members of the public not only stand to benet from, say, improved
public health, but also ultimately pay for it either direct or indirectly, and therefore
social decisions are to reect the rate at which members of the society are willing
to trade health benets for other desirable benets (Sommer et al. 1999). Public perception of risks from air pollution and trafc accidents have a strong inuence on
the monetary value they are willing to pay in order to prevent undesirable effects
from these causes. More specically, WTP to reduce air pollution risk is inuenced
by low degrees of dread, severity, controllability, and personal exposure, while
WTP to reduce trafc accident risk is inuenced by perceived immediacy of its
occurrence (Vassanadumrongdee and Matsuoka 2005).
Beyond the real impact derived from air pollution and trafc accidents, peoples
perceptions of the risks they face from these hazards are determined by attributes
such as the degree of voluntariness of exposure, controllability, familiarity, dreadfulness, and immediacy of the consequences, among other attributes of risks. In
contrast to environmental hazards (i.e. air pollution), hazards directly related to
1137
transportation (i.e. trafc accidents) are perceived by the Chilean population as relatively not dreadful, known, and with a small personal effect. Motor vehicles and
public transportation are signicantly associated with high personal and social benets, according to Bronfman and Cifuentes (2003).
Another important difference lies in the levels of uncertainty inherent to the
assessment process of deaths by these two causes. An important part of the uncertainty concerning the assessment of air pollution-related deaths is determined by the
uncertainty in the estimation of C-R functions, the differences in exposure at individual levels, variability in the population, and the various assumptions used in the
calculations, among others (Knzli 2002). On the contrary, the number of accident
related-deaths is obtained based on historical records and death certicates, so
uncertainty associated to this process comes from databases, errors, and biased
information.
4.3. Limitations of the study

During the development of this study, serious problems were detected concerning
the details and quality of the information on vehicles in circulation and road accident characteristics. A signicant difculty emerged from the lack of a methodology
to attribute the responsibility of the accident victims to each of the participating
vehicles that would integrate both the effects of the vehicles attributes and the drivers attitude on accident risk and death risk. The use of ECF when estimating the
increase in environmental concentration (especially that of O3) instead of emission
and dispersion models, is also a limitation that detracts from the precision of the
obtained results.
In order to tackle these difculties, various assumptions were adopted, which
along with the uncertainty inherent to the different models used in this study, add
uncertainty to the assessments made in this work. However, the objective in performing this kind of modeling is to develop tools to aid the decision-making process, and therefore aims at identifying relations and tendencies or an order of
magnitude of the problem, rather than exact gures.
Acknowledgments
The authors would like to acknowledge the nancial support of Chiles CONICYT through
the National Fund for Scientic and Technological Research (FONDECYT) for having
partially funded this work through Regular Fund N 1090577.
Notes
1. The information source is the National Committee of Transit Security (CONASET) of
the Transport and Telecommunications Ministry.
2. Computer program to calculate emissions from road transport, 3rd version.
3. Available at http://www.epa.gov/ttn/chief/ap42/ch13/nal/c13s0201.pdf.
4. Information from the Ministry of Health.
5. Average speeds are obtained from the starting pointdestination survey of traveling in
Great Santiago 2006, performed by the Ministry of Transportation and Telecommunication (2008).
6. This is due to the assumption that emission abatement systems would maintain their efciency during the rst years of use.
1138
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