Road safety policies and motor vehicle fatalities in Ecuador: a geographical and temporal analysis from 1990 to 2022.

Introduction: Ecuador has implemented several road safety policies (RSPs), which may have differentially impacted motor vehicle fatalities (MVFs) across time, geography and population groups. This study aimed to analyse temporal and geographical trends in MVF in Ecuador from 1990 to 2022 and to explore how RSPs are related to these changes. Methods: An ecological time-series study was conducted using data from death certificates that listed MVF. Crude and age-standardised mortality rates were estimated for the entire population and crude rates for sex, age, geographical region and province. RSPs in Ecuador from 1990 to 2022 were documented, and Joinpoint analyses were used to relate the dates of these policies to changes in temporal and geographical trends. Results: MVF remained unchanged from 20.17 deaths per 100 000 population in 1990 to 20.31 in 2022. Four significant trends were identified: MVF decreased on average by 3.1% (95% CI -4.5% to 1.9%) per year between 1990 and 2002, increased by 5.6% (95% CI 3.4% to 9.5%) between 2002 and 2010, decreased by 2.8% (95% CI -5.8% to -1.6%) between 2010 and 2020 and increased by 11.3% (95% CI 0.3% to 17.5%) between 2020 and 2022. Between 1990 and 2022, MVF declined by 1.4% (95% CI -2% to -1%) per year for females, 3.6% (95% CI -4.9% to -3.1%) for those aged ≤14 and 2.5% (95% CI -3.1% to -2%) for those aged ≥65. Geographical analyses showed a declining annual trend of 1.8% (95% CI -2.2% to -1.4%) in the Andean region and 0.7% (95% CI -1.3% to -0.3%) in urban areas. Trends of decreasing MVF were seen in only 4 of the 24 provinces. Conclusions: Over the last 30 years, the implementation of multiple policies to improve road safety in Ecuador has been accompanied by fluctuating trends in MVF but no overall decrease. A possible explanation is the impact of economic crises on increasing MVF, which has attenuated the beneficial effects of RSPs.