Trends in the burden of road traffic injuries among children and adolescents aged 0-19 years in low- and middle-income countries, 1990-2023.

Background: Road traffic injuries remain a leading cause of death and disability among children and adolescents worldwide, particularly in low- and middle-income countries (LMICs), where rapid motorisation and limited trauma care capacity increase vulnerability. In this study, we aimed to characterise long-term patterns and potential future trajectories of the burden of road traffic injuries among children and adolescents aged 0-19 years in LMICs, using estimates from the Global Burden of Disease (GBD) 2023 study. Methods: From the GBD 2023 database, we extracted incidence, prevalence, mortality, and disability-adjusted life years (DALYs) for road traffic injuries across 129 LMICs and stratified them by age, sex, and gross national income. We assessed temporal patterns using estimated annual percentage change and joinpoint regression. Further, we used decomposition analysis to illustrate the relative contributions of population growth, age structure, and epidemiological change to the disease burden. We used autoregressive integrated moving average (ARIMA) models for exploratory and scenario-based projections of future trends. Results: Between 1990 and 2023, the overall burden of road traffic injuries among children and adolescents in LMICs declined across DALYs, mortality, incidence, and prevalence. Declines were most pronounced in upper-middle-income and more modest in low-income countries. Motor vehicle-related injuries accounted for the largest share of DALYs across income groups. Males and older adolescents showed higher estimated rates and slower declines. Decomposition analysis indicated that population growth was the primary driver of the increasing burden in low-income countries, whereas epidemiological improvements were primarily observed in upper-middle-income countries. Exploratory extrapolations of ARIMA suggested that DALYs and mortality might continue to decline, while incidence and prevalence might stabilise or increase modestly under unchanged historical trends. Conclusions: Based on estimates from GBD 2023, the burden of road traffic injuries among children and adolescents in LMICs has declined over the past three decades, despite substantial differences across different income, age, and sex groups. These findings should be interpreted as estimated patterns rather than directly observed epidemiological changes. Strengthening road safety, trauma care, and prevention strategies, particularly in low-income settings, is essential to reduce inequality and mitigate the burden of road traffic injuries in children and adolescents.