A bibliometric analysis of the published road traffic injuries research in India, post-1990

In 1990, injuries in general ranked as the 12th contributor in global disease burden in terms of disability adjusted life years (DALY), rising to 7th rank in 2010 and projected to reach 5th by the year 2030 [1, 2]. Road traffic injuries (RTIs) account for approximately 30% of injury-related deaths worldwide, and are the most common cause of death among people aged 15–29 years [3]. In India, approximately 28% of total DALYs lost due to injuries are attributed to RTIs alone [4]. In 2016, there were 150,785 deaths occurring in 480,652 road crashes. Further, RTI-related deaths have increased by 43% over the last 10 years [5]. Unless new initiatives and intense efforts are made, the total number of road traffic deaths in India is likely to surpass 250,000 by 2025 [6].

In India, RTIs, particularly those involving pedestrians, cyclists and motorised 2- or 3-wheelers, are a significant cause of preventable death, predominantly in men of productive age [7]. Research in RTIs has not received much attention from the scientific community due to a lack of focus in national policies and funding opportunities, especially in low- and middle-income countries (LMIC). In India, such as in most LMICs, the research output on key public health issues, including RTIs, remains poor. Indeed, only 4.4% of the total health research studies published in India during 2002 were related to public health sciences [8] and the contribution of injury research (2001–2008) was only 0.7% (RTI research, 0.1%), which is grossly inadequate to address the current disease burden [9].

National Crime Record Bureau data shows a clearly rising burden of RTI-related morbidity and mortality in India [9]. Realising the urgency, the Government of India initiated a drive to address the increasing RTI burden in the 11th Five Year Plan (2007–2012) by developing a pan-India network of trauma care facilities to provide immediate treatment for accident victims along the Golden Quadrilateral Corridor as well as the North-South and East-West Corridors. The objective of this scheme was to reduce the number of preventable deaths because of road accidents to 10% [10]. Nevertheless, there is no published research of appropriate quality on the assessment of RTI burden or on the effectiveness of interventions [8]. Responding to these issues, the Indian Council of Medical Research (ICMR) has recently invited countrywide research proposals on RTIs specifically focusing on surveillance, health system preparedness, and barriers and facilitators during the golden hour, as well as to develop interventions to address the problem of RTIs [11]. In addition, systematic reviews and bibliometric analyses may be valuable tools to fill this research gap. Bibliometric analyses may aid policy planners and researchers in identifying critical research areas for evidence-based decision-making and policy formulation in LMICs [12].

Therefore, the present bibliometric analysis aims to map RTI research output, assessing the quality of the research ecosystem in India, and identifying the focus areas and actors involved. This analysis will help inform researchers, academicians and the scientific community on the need and importance of research in this emerging public health issue.

This study is a bibliometric analysis of research published in the field of RTIs in India. Bibliometrics, a widely used technique, involves the quantitative analysis of citations of published journal articles [12]. The bibliometric analysis methodology used herein followed that used in previous studies [8, 13, 14]. This study included the RTI research performed in India from 1990 to date.

The Scopus® search retrieved 260 documents, all of which were manually reviewed and 18 documents were excluded. Of the 18 excluded documents, 9 were not relevant to RTIs and 9 were from countries other than India. Finally, we retrieved 242 documents for bibliometric analysis (Fig. 1). Of the 242 articles retrieved, the majority were original articles (n = 208, 85.95%), reviews (n = 16, 6.61%), editorials (n = 6, 2.48%), letters (n = 5, 2.07%), and others such as conference papers, short surveys and notes (n = 7, 2.89%). The retrieved documents were published in 108 peer-reviewed journals. The total number of citations for the 242 documents, at the time of data analysis (23 March 2017), was 1302 excluding self-citations by the authors. The average number of citations per article was 5.38. All the publications were available in English. The h-index of total retrieved articles was 18 (at least 18 documents were cited at least 18 times in peer-reviewed scientific publications).

In this study, we presented a bibliometric review of publications on RTIs in India. The analysis showed a steady quantitative increase in publications on RTI, especially after the year 2010, which reflected that this issue is receiving the attention of policy planners and researchers. This rise in publications might be due to a growth in the number of research journals, especially online journals, as well as the increased attention of the scientific community, networking and collaboration, and an increasing focus from agencies such as WHO, Bloomberg Philanthropies and the Government of India [3, 33‐36].

We analysed the value of the h-index of retrieved articles, revealing an inadequate contribution and quality of research publications. We analysed the top 10 institutions, journals, authors and highly cited articles to identify the leading actors. This analysis provided insights on the quality of RTI research in India. The h-index of institutions based on RTI research in India also revealed low research productivity. None of the top 10 institutions achieved an h-index beyond single digits. Further, the study revealed that clinical research is being performed in isolation. Contribution to highly cited articles was no more than five articles by any institution, despite using a much lower cut off at 15 citations. Except for the Administrative Staff College, no institution in the top 10 had a total number of citations surpassing three digits.

Evaluation of the top 10 cited articles on RTI revealed that only five published articles were original articles with no more than 50 citations. Of the top 10 cited articles, none was multi-centric or multi-country or had an interventional design. No nationally representative study was included in the top 10 articles. This study reported that the top four journals did not have an IF; none of the top 10 journals had an h-index value of more than 4, and the SJR of the top 10 journals remained less than 1. Only one of the top 10 journals, Accident Prevention and Analysis, had an IF greater than 1. This finding is also in coherence with the analysis of the top 10 institutions in terms of quality. Thus, the study findings indicate an inadequate quality and amount of RTI research conducted in India, in agreement with previous analyses performed on the evaluation of public health research [8, 9, 37].

In India, the growth of the motor vehicle industry, liberalised economic policies of successive governments, aggressive media promotion for cars and bikes, increasing purchasing power, easy availability of loans and poor public transport facilities have possibly contributed in increasing motorisation and a changing transport scenario. Cyclist and motorcyclist transport is a major mode of travel in towns, rural areas and even most cities in India [7, 24, 38‐40]. In such a scenario, there is an urgency of research and innovations in the field of RTIs, especially with regards to vulnerable road users, legislation and road behaviour, disability, etc. [3]. Herein, this lag is evident in the density visualisation map of all relevant keywords. Networking between the scientific community is quintessential to address this problem.

The Road Traffic Injuries Research Network, evolved at the Global Forum for Health Research in Geneva (1999), has raised significant interest among research collaborators and institutions in LMICs [35]. There is a need for creating such networks to promote research at the national and sub-national levels in India. Nevertheless, there has been increased attention in RTIs nationally and internationally, as evident from the launching of the pan-India trauma care network scheme [10], ICMR’s recent research initiative [11], the formation of Road Traffic Injuries Research Network and Road Safety collaboration [35], the declaration of “Road Safety decade (2011–2020)” [41], and the heavy fines for traffic rules violation in the recently amended Motor Vehicle (Amendment) Bill 2016 [42]. However, a comprehensive evidence base is needed to take informed actions on road safety, and prevention and management of RTI in India. This is a window of opportunity for India to break the downfall in the inverted U shaped loop (Kuznets phenomenon) RTI mortality pattern [32], as experienced in developed countries. Realising the need, the National Health Policy 2017 has highlighted the need for preventing RTIs and resulting deaths by developing appropriate intervention strategies. Our study findings will help inform the focus areas in developing a national research agenda to substantially reduce RTI burden and improve road safety.

This bibliometric analysis may be a significant guide for tracking the growth and quality of research in RTIs. To the best of our knowledge, there are few publications on bibliometric analysis in India to evaluate the research productivity of institutions, journals and key research and policy areas. Our study would open new opportunities to identify research areas in RTI and networking opportunities in India.

RTI research output in India has increased significantly although the amount and quality of publications does not match the increasing burden of RTIs. Our study concluded that there are marked research inequities in relation to the RTI burden and geographic distribution, a lack of collaborative research between disciplines and networking among researchers, a lack of studies in risk factors and risk groups, and that clinical research is performed in isolation. Systematic priority setting, adequate funding and institutional capacity-building will be required to address the alarming situation of RTIs.