The Association Between Distance from Major Highways to Hospitals and Road Traffic Injury Mortality in Thailand

Abstract

Background: Road traffic injuries (RTIs) remain a leading cause of morbidity and mortality globally, especially in low- and middle-income countries like Thailand. Timely access to trauma care is critical to improve survival, yet the influence of hospital proximity to main roads on RTI outcomes in Thailand is not well understood.

Methods: We conducted a retrospective observational study analyzing data from 35 hospitals across Thailand during 2024. Hospital distances from main highways were calculated using geographic information systems. Outcome measures included the number of RTI-related injuries, deaths, and the fatality-to-injury ratio (FIR). Statistical analyses comprised Pearson’s correlation, multiple linear regression, and logistic regression to examine associations between distance, injury burden, and mortality. Spatial heatmaps identified geographic clusters of high fatality.

Results: The mean hospital distance to the nearest main road was 14.7 km (SD 8.3). A total of 12,450 RTI cases and 312 deaths (fatality rate 2.5%) were recorded. Distance from main roads showed no significant correlation with injury counts (r=0.09, p=0.71), but a moderate positive correlation with mortality counts (r=0.38, p=0.19). Multiple regression indicated injury and disability counts were strong predictors of death (p<0.001), while distance exhibited a borderline negative association with mortality. Logistic regression classified hospitals by FIR strata with 85.7% accuracy; disability burden strongly predicted higher FIR. Heatmaps revealed clusters of elevated FIR in remote provinces.

Conclusion: Proximity to main roads alone does not predict RTI incidence or mortality in a straightforward manner; instead, injury severity and disability burden predominantly influence fatality outcomes. Geographic remoteness may contribute to delayed access to care, impacting survival. These findings emphasize the need for integrated trauma care strategies addressing timely access and functional recovery, and for targeted EMS resource allocation to high-risk regions in Thailand.