LAUSR

Background This study aims to examine potential road crash disparities across relative wealth and location of residence in Kenya by analyzing population-representative Demographic and Health Survey data. Methods Relative wealth was measured by household assets, converted into an index by polychoric principal components analysis. Location and sex-stratified associations between wealth quantiles and crashes were flexibly estimated using fractional polynomial models. Structural equation models were fit to examine whether observed differences may operate through previously identified determinants. Results In rural areas, crashes were least common for both the poorest men (-5.2 percentage points, 95% CI: -7.3 to -3.2) and women (-1.6 percentage points, 95% CI: -2.9 to -0.4). In urban areas, male crashes were lowest (-3.0 percentage points, 95% CI: -5.2 to -0.8) among the wealthiest, while they peaked in the middle of the female wealth distribution (2.0 percentage points, 95% CI: 0.3-3.8). Male differences operate partially though occupational driving and vehicle ownership. Urban female differences operate partially through household vehicle ownership, but differences for rural women were not explained by modeled determinants. Conclusions Relative wealth and road crash have opposite associations in rural and urban areas. Especially in rural areas, it is important to mitigate potential unintended effects of economic development.