LAUSR

Background In the past decades, extremely serious road accidents with a death toll over ten in each have become a severe public health problem in China. This study investigates risk factors contributing to extremely serious road accidents, which will be crucial for accident prevention. Methods Collecting data from The Road Accident Statistical Annual Report openly issued by China’s Traffic Management Bureau of the Public Security Ministry for the time period 2004–2015, we used the monthly case number of extreme serious road accidents as the dependent variable. We then selected ten risk factors as primary independent variables: professional driver, driving under influence (alcohol or drug), fatigue, vehicle type, overload, brake problem, weather, road classification, terrain, and region. The method of negative binominal regression was implemented to investigate the association between these risk factors and extremely serious road accidents. Results A total of 346 extremely serious road accidents were included in our analysis. On a national scale, we found that professional driver [incidence rate ratio (IRR): 1.10, 95% CI: 1.02–1.19], fatigue (IRR: 1.15, 95% CI: 1.03–1.29), large vehicle type (IRR: 1.11, 95% CI: 1.03–1.21), overload (IRR: 1.09, 95% CI: 1.03–1.16), and terrain (IRR: 1.09, 95% CI: 1.01–1.18) were significantly associated with extremely serious road accidents. Besides, separate analyses on western and non-western region indicated that both regions had shared risk factors as well as distinct factors. Conclusions Our study identifies professional driver, fatigue, large vehicle type, overload, and terrain as significant risk factors of extremely serious road accidents in China, and targeted and preventative measures could be taken based on our findings.