Impact of an educational program on the safety of high-risk, visually impaired, older drivers

BACKGROUND: Older drivers (licensed drivers aged 60 years and older) have among the highest rates of motor vehicle collision involvement per mile driven of all age groups. Educational programs that promote safe driving strategies among seniors are a popular approach for addressing this problem, but their safety benefit has yet to be demonstrated. The objective of this study was to determine whether an individualized educational program that promoted strategies to enhance driver safety reduces the crash rate of high-risk older drivers. DESIGN/ SETTING: Randomized, controlled, single-masked intervention evaluation at an ophthalmology clinic. PARTICIPANTS: A total of 403 older drivers with visual acuity deficit or slowed visual processing speed or both who were crash-involved in the previous year, drove at least 5 days or 100 miles per week or both, and were at least 60 years old. INTERVENTION: Patients were randomly assigned to usual care (comprehensive eye examination) or usual care plus an individually tailored and administered educational intervention promoting safe-driving strategies. MAIN OUTCOME MEASURE: Police-reported vehicle collision rate, expressed both in terms of person-years of follow-up and person-miles of travel for 2 years postintervention. RESULTS: The intervention group did not differ significantly from the usual care only group in crash rate per 100 person-years of driving (relative risk [RR], 1.08; 95% confidence interval [CI], 0.71-1.64) and per 1 million person-miles of travel (RR, 1.40; 95% CI, 0.92-2.12). The intervention group reported more avoidance of challenging driving maneuvers and self-regulatory behaviors during follow-up than did the usual care only group (p<0.0001). CONCLUSIONS: An educational intervention that promoted safe-driving strategies among visually impaired, high-risk older drivers did not enhance driver safety, although it was associated with increased self-regulation and avoidance of challenging driving situations and decreased driving exposure by self-report.     

Driving in search of analyses

Although transportation safety has greatly improved over the past 2 decades, motor vehicle crash injuries remain a leading cause of morbidity and mortality, particularly among young drivers. Driver errors and behaviors such as speeding and distraction contribute disproportionately to crashes among inexperienced novices, who develop safe driving judgment only with substantial driving experience, commonly described as the “young driver problem.” Research on young drivers has applied a range of research methods, including analyses of national archival data (mainly from police reports), crash analyses, observation of driver behavior, surveys of driver behavior and dispositions, and experimental research on driver behavior and vehicle crash worthiness. Prominent research questions regarding young driver safety include what and how do novices learn to drive safely, what are the predictors of young driver crashes, what is the variability and overtime trajectories of young driver performance and outcomes, and to what extent is the young driver problem due mainly to average population risk or high‐risk groups? Current research on young drivers is complicated by small sample sizes, relatively rare events, high within and between group variability, missing data, the need to estimate exposure, and the lack of longitudinal and experimental designs, problems that require complex analytic methods. In this paper, we provide an overview of driving research methods, examples of research addressing the young driver problem, and examples of statistical collaboration on young driver research, focusing particularly on estimating prediction of crash risk and estimating variability in young driver performance and outcomes.     

Fatal Passenger Vehicle Crashes With At Least 1 Driver Younger Than 15 Years: A Fatality Analysis Reporting System Study

CONTEXT: A small number of fatalities continue to occur due to motor vehicle crashes on highways in which at least 1 passenger vehicle (automobile, van, or small truck) is driven by a child younger than 15 years. PURPOSE: The purpose of this study was to extend previous work suggesting that such crashes occur frequently in the Southern states and have relatively high rates in rural areas in the South and Great Plains. METHODS: This study utilizes data for the 5-year period 1999-2003 from the National Highway Transportation Safety Administration's online Fatality Analysis Reporting System. All cases were identified in which at least 1 conventional passenger vehicle in a fatal crash was being driven by a child younger than 15 years. FINDINGS: During the 5-year period, 350 fatal crashes occurred with at least 1 driver younger than 15 years involved. Twenty-one of these drivers were licensed (11) or driving with a learner's permit (10). A total of 987 individuals in 419 vehicles were involved in these crashes, and 402 deaths resulted (1.16 deaths/crash). These crashes occurred primarily in Texas, Florida, Arkansas, and Arizona, but the highest rates per 100,000 children were found in North and South Dakota and predominantly in a band of Intermountain and Plains states. There was a strong correlation between crash rates and several measures of rurality. CONCLUSIONS: Crashes involving young, largely unlicensed, drivers account for about 70 deaths yearly.     

Characteristics of Crashes With Farm Equipment That Increase Potential for Injury

CONTEXT: Crash fatality and injury rates are higher on rural roadways than other roadway types. Although slow-moving farm vehicles and equipment are risk factors on rural roads, little is known about the characteristics of crashes with farm vehicles/equipment. PURPOSE: To describe crashes and injuries for the drivers of farm vehicles/equipment and non-farm vehicles involved in an injury crash. Passengers are not included in this analysis. METHODS: Injury crashes were included that involved a farm vehicle/equipment and at least one non-farm vehicle reported in Iowa Department of Transportation crash data from 1995 to 2004. Odds ratios were calculated through logistic regression to identify increased odds for injury among drivers of non-farm vehicles and farm vehicles/equipment. We examined frequently occurring crash characteristics to identify crash scenarios leading to the highest odds for injury. FINDINGS: Non-farm vehicle drivers were 5.23 times more likely to be injured than farm vehicle/equipment drivers (95% CI = 4.12-6.46). The absence of restraint use was a significant predictor of injury for both farm vehicle/equipment drivers (OR = 2.85; 95% CI = 1.14-7.13) and non-farm vehicle drivers (OR = 2.53; 95% CI = 1.54-4.15). Crash characteristics increasing the odds of injury for non-farm vehicle drivers included speeding, passing the farm vehicle/equipment, driving on a county road, having a frontal impact collision, and crashing in darkness. Ejection was the strongest predictor of injury for the farm vehicle/equipment driver. CONCLUSION: Non-farm vehicle drivers were much more likely to be injured than farm vehicle/equipment drivers, suggesting that farm vehicle/equipment crash prevention should be a priority for all rural road users. Prevention strategies that reduce motor vehicle speed, assist in safe passing, increase seat belt use, and increase conspicuousness of the farm vehicle/equipment are suggested.     

Driver education and fatal crash involvement of teenaged drivers.

Fatal crash involvement of teenagers per licensed driver and per population in 27 states was related to the proportions of teenagers who received high school driver education. Among 16--17 year olds, driver education was associated with a great increase in the number of licensed drivers, without a decrease in the fatal crash involvement per 10,000 licensed drivers- About 80 per cent of the 16--17 year olds who took high school driver education obtained licenses that they would not otherwise have obtained until age 18 or thereafter. The net effect is much higher death involvement rates per 10,000 population, on average, in states with greater proportions of 16-17 year olds receiving high school driver education. The data suggest that most teenagers would obtain licenses when they are 18--19 years old, irrespective of high school driver education, and indicate that differences among the states in fatal crash involvement rates per 10,000 licensed 18--19 year old drivers were not significantly related to either high school driver education or delayed licensure.     

2008年蓬莱市机动车驾驶员道路交通安全知识与违章驾驶行为调查

[目的]了解蓬莱市机动车驾驶员对道路交通安全的知识与违章（不良）驾驶行为,从而有针对性地采取干预措施,降低道路交通伤害的发生。[方法]2008年,在蓬莱市城区和农村抽取部分机动车驾驶员进行问卷调查。[结果]调查机动车驾驶员1083人,其中城区646人。农村437人。道路交通安全知识知晓率,城区驾驶员为80．18％,农村驾驶员为76．20％（P〉0．05）;最近1个月内无违章（不良）驾驶行为者所占比例,城区驾驶员为25．08％,农村驾驶员为28．15％（P〉0．05）;最近1个月内违章（不良）行为次数,全部调查对象为（1．67±1．57）次,其中城区驾驶员为（1．65±1．52）,农村驾驶员为（1.71±1．64）次（P〉0．05）。违章（不良）驾驶行为率最高的城区驾驶员是驾驶时使用手机（61．92％）、酒后驾驶（28．92％）,农村驾驶员是不戴头盔（42．33％）、在非机动车道上行驶（33．64％）。[结论]蓬莱市城乡机动车驾驶员道路交通安全知识知晓率较高,但违章（不良）驾驶行为率也较高。     

A comparison of driver- and passenger-based estimates of alcohol-impaired driving

INTRODUCTION: Persons who drive after drinking or ride with drinking drivers are at increased risk of motor vehicle crash. Although alcohol is involved in 40% of fatal motor vehicle crashes yearly, there exist few systems to monitor alcohol-impaired driving. In this study we compare driver- and passenger-based estimates of the prevalence of alcohol-impaired driving. DESIGN: A random-digit-dialing telephone survey of the United States. Participants were adults aged 18 or older who were English- or Spanish-speaking from 5238 households (response rate = 56.1%). RESULTS: From the 4603 respondents who reported driving in the preceding 30 days, we estimate that there were 126 million drinking-driving episodes in the United States in 1994. From the 4380 passengers in the preceding 30 days, we estimate 191 million episodes. Three percent of respondents self-reported as drinking drivers (4.8% of males and 1.3% of females) and 4.9% as passengers of drinking drivers. Drinking drivers were more likely to be passengers of drinking drivers (44% versus 4% of nondrinking drivers). Drinking drivers were also more than twice as likely to report drinking daily, and only one half as likely to report always wearing their safety belts. CONCLUSION: Passengers who report riding with a drinking driver may provide an important estimate of the prevalence of drinking driving. Passengers of drinking drivers represent a high-risk group that is not considered in most prevention efforts. Because being a passenger of a drinking driver is not illegal, it may be an easier topic for clinicians to broach than drinking and driving.     

Vulnerability of female drivers involved in motor vehicle crashes: an analysis of US population at risk

Objectives. Motor vehicle trauma has been effectively reduced over the past decades; however, it is unclear whether the benefits are equally realized by the vehicle users of either sex. With increases in the number of female drivers involved in fatal crashes and similarity in driving patterns and risk behavior, we sought to evaluate if advances in occupant safety technology provide equal injury protection for drivers of either sex involved in a serious or fatal crash.Methods. We performed a retrospective cohort study with national crash data between 1998 and 2008 to determine the role of driver sex as a predictor of injury outcome when involved in a crash.Results. The odds for a belt-restrained female driver to sustain severe injuries were 47% (95% confidence interval = 28%, 70%) higher than those for a belt-restrained male driver involved in a comparable crash.Conclusions. To address the sex-specific disparity demonstrated in this study, health policies and vehicle regulations must focus on effective safety designs specifically tailored toward the female population for equity in injury reduction.Motor vehicle–related trauma is the leading cause of unintentional injuries resulting in the highest number of fatalities among those aged 5 to 34 years in the United States.¹ The overall consequence of motor vehicle trauma on the health of the US population, as measured by the disability-adjusted life-years metric, indicates that approximately 449 healthy life-years per 100 000 population were lost as a result of premature mortality and disability attributable to the health condition.² To address this public health concern, the Healthy People 2020 project initiated by US Department of Health and Human Services targets reducing motor vehicle–related mortality and injury rates by 10% in the current decade (compared with figures estimated in 2007).³ Specifically among the injuries, the project focuses on reducing fatal and nonfatal traumatic brain injuries and spinal cord injuries. To realize these objectives, the framework of the Healthy People 2020 project prioritizes certain vision-based goals, one of which specifically aims at eliminating health disparities among demographic segments including differences that occur by gender or sex. To identify steps targeted toward reducing motor vehicle–related injuries within this framework, it is of interest to evaluate whether sex-specific disparity plays a role in the effectiveness of prevalent motor vehicle safety systems.Traffic data over the past decades have consistently demonstrated that female drivers are underrepresented in fatal or serious injury motor vehicle crashes; female drivers exhibit approximately one third the rate of fatal crash involvement per driver compared with male drivers (Figure 1).⁴ Subsequently, the burden on health caused by motor vehicle trauma is 2-fold higher for males (age-adjusted disability-adjusted life-years for male and female road traffic victims were 600 and 296 life-years per 100 000 population, respectively).² The trends in the fatality rates between the 2 sexes is better understood by analyzing the related individual factors: crash fatality rate (proportion of fatal crashes among all crashes), crash incidence density (number of crashes per annual vehicle miles traveled), and driving exposure (annual vehicle miles traveled per licensed driver).Open in a separate windowFIGURE 1Fatal crash involvement rate and crash involvement rate in the US population by sex.Data indicate that although the driving exposure among male drivers has been consistently higher (33% more annual vehicle miles traveled per driver in 2009),⁵ the crash incidence density is in fact higher for female drivers (1.52 vs 1.26 injurious crashes per million vehicle miles traveled for female and male drivers, respectively, in 2009).^4,5 As studies confirm, the trend for the decreasing difference in the crash involvement rate (per licensed driver) for the 2 sexes is indicative of increasing exposure—both licensing and travel miles—and socioeconomic changes in driving behavior among female drivers.^6–8 Therefore, despite a higher fatality involvement rate for male drivers, traffic trends indicate that future female drivers may be equally as likely to be involved in a crash.Becauses male and female drivers are expected to have comparable exposure to traffic crashes, it is necessary that motor vehicle safety systems provide equitable injury protection to occupants of either sex involved in moderate to serious crashes. Owing to the relatively high exposure and fatal crash involvement rate, standard adult occupant safety systems (seatbelt, airbags, and other passive safety devices) have been designed and evaluated with a focus on the occupant characteristics typically representing the male population. It should be noted that the effectiveness and the performance of such safety devices is, however, sensitive to biological and biomechanical considerations including occupant age, anthropometric size, injury tolerance, and the mechanical response of the affected body region. Because sex is expected to be highly correlated with these variables (except age), it is hypothesized that current advances in safety technology optimized for male characteristics may not be equally effective in protecting female occupants.Our objective was to evaluate whether a female driver restrained by the safety belt sustains a similar risk of moderate to serious injuries compared with a belt-restrained male driver when involved in a comparable crash. The results would highlight the importance of future advances in occupant safety technology to specifically focus on reducing the sex-specific disparity, if any, as an important step toward the mitigation of overall traffic injury–related health burden.     

Romance with the automobile in the 20th century: implications for adolescents in a new millennium

Nearly three-fourths of deaths among American adolescents and young adults result from only four causes: motor vehicle accidents, other unintentional injuries, homicide, and suicide. Thirty percent of those deaths result from motor vehicle accidents, the number one cause of death among adolescents. A number of factors that influence the morbidity and mortality are associated with driving. Compared to other countries, it is easier for American adolescent to obtain a relatively inexpensive license and gain access to a car. For the young driver, adolescent development and increased risk taking, inexperience, dangerous driving behavior, and alcohol-related factors are of special significance. In this article, we review recent crash statistics as well as effectiveness of various preventive measures, including driver education, graduated licensing, alcohol-related measures, and vehicle-related factors. Graduated licensing and alcohol-related measures have been the most effective measures so far.     

The driver's role in fatal two-car crashes: a paired "case-control" study.

This population-based study examines drivers' characteristics associated with driving errors that resulted in fatal motor vehicle crashes. Routinely collected data from the Fatal Accident Reporting System were used to assess whether a driver initiated the crash (case) or was passively involved (control) in 6,506 two-car collisions (81% of 7,993 eligible events). A paired comparison of cases and controls avoided confounding by environmental factors, exposure to traffic, and differences in case fatality. The strongest predictor of crash initiation is alcohol (odds ratio (OR) = 11.5; 95% confidence interval (CI) 9.57-13.9). Odds ratios are elevated even at the lowest blood alcohol concentration levels and increase dramatically as alcohol levels rise. Drivers aged 40-49 years are least likely to initiate crashes; odds ratios rise in a U-shaped manner to 3.35 in teenagers (95% CI 2.72-4.13) and to 22.1 in drivers over 80 years (95% CI 14.2-34.5). Other risk factors for initiating a fatal crash are the following: not wearing a seat belt (OR = 1.54; 95% CI 1.35-1.75), driving without a valid driver's license (OR = 2.16; 95% CI 1.72-2.73), and having had a crash within the last year (OR = 1.21; 95% CI 1.07-1.38). Driving errors leading to fatal crashes do not occur at random, but are associated with specific driver characteristics. The risk factors for crash initiation among crash-involved drivers are similar to risk factors for crash involvement found in other studies. These findings suggest that driving errors often explain high rates of crash involvement, invite further use of crash initiation in traffic injury research, and underscore the value of population-based registries for analytic epidemiology.     

Factors associated with adolescents' propensity to drive with multiple passengers and to engage in risky driving behaviors

PurposeResearch shows that parenting factors and individual difference variables, such as sensation seeking (SS) and risk perceptions (RPs), are associated with increased motor vehicle crash risk for young drivers. The presence of peer passengers is also known to be associated with increased crash risk. However, as previous studies did not study these factors concurrently, less is known about the factors that are associated with driving with peer passengers and if peer passengers may mediate the effect of parenting and individual difference variables on adolescents' engagement in risky driving behavior.MethodsWe examined predictors of driving with multiple passengers (DWMPs) and explored it as a potential mediator of pathways from three factors: (1) SS, (2) RPs, and (3) Parental monitoring and rule-setting to risky driving behaviors in a convenience sample of 198 adolescent drivers using a cross-sectional Web-based survey.ResultsFindings indicate that both stronger RPs and perceiving parents as strong monitors and rule setters were associated with less engagement in risky driving, whereas greater SS was associated with more engagement in risky driving; RPs, monitoring, and SS were also significantly associated with DWMPs in these same directions. DWMPs partially mediated the effect of these risk factors on risky driving behavior.ConclusionsResults inform theory and policy by examining factors associated with risk taking in the context of adolescent driving. Interventions can be developed to complement graduated driver licensing laws by targeting individual difference variables and decreasing opportunities for peer passenger carriage.     

Obesity and risk for death due to motor vehicle crashes

OBJECTIVES: We examined the role of body mass index (BMI) and other factors in driver deaths within 30 days after motor vehicle crashes. METHODS: We collected data for 22 107 drivers aged 16 years and older who were involved in motor vehicle crashes from the Crashworthiness Data System of the National Automotive Sampling System (1997-2001). We used logistic regression and adjusted for confounding factors to analyze associations between BMI and driver fatality and the associations between BMI and gender, age, seatbelt use, type of collision, airbag deployment, and change in velocity during a crash. RESULTS: The fatality rate was 0.87% (95% confidence interval [CI]=0.50, 1.24) among men and 0.43% (95% CI=0.31, 0.56) among women involved as drivers in motor vehicle crashes. Risk for death increased significantly at both ends of the BMI continuum among men but not among women (P<.05). The association between BMI and male fatality increased significantly with a change in velocity and was modified by the type of collision, but it did not differ by age, seatbelt use, or airbag deployment. CONCLUSIONS: The increased risk for death due to motor vehicle crashes among obese men may have important implications for traffic safety and motor vehicle design.     

Young driver restrictions: Does the evidence support them?

Objective: To assess the suitability of Queensland's graduated licensing system in the context of rural and remote Queensland. Design: Age‐based comparison of crash data collected by the Rural and Remote Road Safety Study (RRRSS). Setting: Rural and remote North Queensland. Participants: A total of 367 vehicle controllers aged 16 years or over hospitalised at Townsville, Cairns or Mount Isa for at least 24 hours, or killed, as a result of a vehicle crash. Measurements: Specific RRRSS variables are assessed in relation to Queensland's graduated licensing program, including rates of unlicensed driving/riding, late night crashes, crashes with multiple passengers, contributing factors in crashes and vehicle types involved. Results: While people between 16 and 24 years of age comprise 16% of the target population, 25% of crashes meeting RRRSS criteria involved a vehicle controller in that age group. 12.8% of all cases involved an unlicensed driver/rider, within which 66% were below 25 years of age. Young drivers/riders were represented in 50% of crashes occurring between 11:00 p.m. and 5:00 a.m., and 33% of crashes in vehicles with multiple passengers. Motorcyclists represented about 40% of cases in both age groups. There were no significant differences between age groups in vehicle types used, or circumstances that contributed to crashes. Conclusions: The general overrepresentation of young drivers/riders in rural and remote North Queensland supports tailored interventions, such as graduated licensing. However, while some measures in the legislation are well supported, problems surrounding unlicensed driving/riding might be exacerbated.     

A cohort study of drink-driving motor vehicle crashes and alcohol-related diseases

OBJECTIVES: To elicit whether drivers involved in alcohol-related motor vehicle crashes are more likely to have future alcohol-related hospital admissions. METHOD: A population-based cohort study of 3,286 drivers involved in a motor vehicle crash between 1988 and 1992 were followed over an eight to 13-year period. RESULTS: The findings from the study suggest a twofold increased risk associated with an alcohol-related motor vehicle crash and future alcohol-related hospital admission. The average time between an alcohol-related motor vehicle crash and future alcohol-related hospital admission was 12 years. Men and indigenous Australian drivers were more likely to have a future alcohol-related hospital admission. CONCLUSION: It is evident from this study that drink-driving resulting in a motor vehicle crash and hospitalisation could be considered an indicator of a less overt problem of alcohol dependency. IMPLICATIONS: It is important that penalties for drink-driving go beyond merely punitive action and provide rehabilitation.     

Factors in Adolescent Drinking/Driving: Binge Drinking, Cigarette Smoking, and Gender

ABSTRACT: During three consecutive years, 3,137 high school seniors from three graduating classes in one Michigan county were surveyed. The primarily White sample reported their use of alcohol and cigarettes, driving experience, and drinking/driving experience. Survey data were linked with state driver history records. Fully one-third of the high school seniors reported driving after drinking in the past six months. To identify factors associated with self-reported drinking/driving, correlation and regression analyses were conducted. Frequent binge drinking and riding with a drinking driver were consistent factors in driving after drinking frequency. Being male, smoking cigarettes, having frequent use of a motor vehicle, having a driving offense on record, and number of years licensed were important correlates, varying by year of graduation. Comprehensive interventions to moderate drinking, smoking, and driving after drinking are needed.     

道路伤害的病例对照研究

目的：探讨道路伤害危险因素。方法：采用病例对照研究方法，于2001年11月至2002年8月收集沈阳市皇姑区发生机动车交通事故的事故组驾驶员406例，并同期在皇姑区内于随机时间、随机地点调查道路上正常行驶的对照组驾驶员438名。采用统一问卷、面询方法，调查内容包括驾驶员的一般情况，连续驾驶时间，事故／调查前睡眠状况，急、慢性困倦程度(采用Stanford和Epworth困倦量表测量)，饮酒，吸烟，驾驶安全态度和行为，车速，车辆状况等。结果：处于慢性困倦状态的驾驶员发生事故的危险性是非困倦状态驾驶员的1．98倍(OR=1．98，95％CI：1．26—3．12)，事故组驾驶员的困倦程度高于对照组，但差异无显著性(OR＝2．38，95％CI：0．89—6．31)。夜班或倒班发生事故的危险是常白班的2．09倍(OR＝2．09，95％CI：1．48—2．94)，酒后驾车发生事故的危险性是非酒后驾车的3．59倍(OR＝3．59，95％CI：1．13--11．39)，无人约束时会违章的驾驶员发生事故的危险性是不违章驾驶员的1．73倍(OR＝1．73，95％CI：1．22—2．46)。结论：慢性困倦、夜班或倒班、酒后驾车、违章等是道路伤害的危险因素，急性困倦可能是道路伤害的一个潜在危险因素。     

The Heavy Vehicle Study: a case-control study investigating risk factors for crash in long distance heavy vehicle drivers in Australia

Background  

Heavy vehicle transportation continues to grow internationally; yet crash rates are high, and the risk of injury and death extends to all road users. The work environment for the heavy vehicle driver poses many challenges; conditions such as scheduling and payment are proposed risk factors for crash, yet the precise measure of these needs quantifying. Other risk factors such as sleep disorders including obstructive sleep apnoea have been shown to increase crash risk in motor vehicle drivers however the risk of heavy vehicle crash from this and related health conditions needs detailed investigation.     

Prospective study of brief neuropsychological measures to assess crash risk in older primary care patients

BACKGROUND: Practicing primary care physicians often encounter the difficult clinical situation of evaluating the older driver. We wanted to investigate the relation between self-reported driving behavior, neuropsychological measures, and crash risk to inform the development of a test battery that could predict unsafe driving behavior and was feasible for use by primary care physicians. METHODS: This study was a prospective follow-up of 107 drivers aged 65 years and older recruited from a primary care setting in 1995. Tests of attention, visual information processing, spatial orientation, and general mental status were administered at baseline. At baseline and after 2 years of follow-up, patients were asked about their driving history using the driving questionnaire. Risk for reported crashes in the follow-up period was assessed in relation to baseline driving history and measures of cognition. RESULTS: Baseline self-reports of driving habits and attitudes were associated with an increased risk of reporting a crash after 2 years of follow-up (relative risk ratio = 5.31; 95% confidence interval [CI], 0.63, 44.63). In addition, baseline tests of attention, visual information processing, and spatial orientation were associated with an increased risk of reporting motor vehicle crash at follow-up. For example, respondents with poor performance on the Trail Making Test-part A, were almost four times more likely to report a crash at follow-up (risk ratio = 3.15; 95% CI, 0.76, 13.07). CONCLUSION: Although our conclusions are tempered by small sample size, this preliminary study suggests that brief cognitive tests and simple questions about driving habits warrant further investigation as indicators of crash risk with potential utility for assessing older drivers in primary care.     

Effect of environmental factors on the risk of death for drivers of two-wheeled motorized vehicles involved in road crashes

OBJECTIVES: To assess the effect of environmental factors on the risk of death for drivers of two-wheeled motorized vehicles (TWMV) after a crash. METHODS: We studied a case series comprising all 309,626 drivers of TWMV involved in road crashes with victims compiled by the Spanish Department of Transportation from 1993 to 2002. The dependent variable was death of the driver. Environmental factors included temporal variables (year, month, day and hour of the crash) and spatial variables (area where the accident took place and light conditions, among others). Confounding variables related to the driver (age, sex, helmet use), the vehicle, and the type of crash were also recorded. Poisson regression models were constructed to obtain crude and adjusted relative risks for each environmental condition. RESULTS: In the adjusted analysis, no association was found between most time-related factors and the risk of death, with the exception of an increased risk in the early hours of the morning. The risk of death was much greater for crashes on open roads (especially highways and motorways) than in urban areas, where the risk of death increased as the size of the town decreased. CONCLUSIONS: After adjustment for several confounders, the only environmental factors related to the risk of death in TWMV drivers after a crash were the area when the crash occurred, and (more weakly) the time of day when it occurred.     

桂林市机动车驾驶员道路交通伤害影响因素分析

目的探讨机动车驾驶员道路交通伤害(RTI)的影响因素,为预防和减少RTI的发生提供科学依据。方法通过广西省公安厅交警总队收集2000—2009年桂林市区的RTI数据,对机动车驾驶员RTI影响因素进行Logistic回归分析。结果 2000—2009年桂林市发生RTI共3603起,造成506人死亡,2 911人受伤,男女死亡比例为2.54∶1;RTI的伤亡主要发生在21～45岁青年;由机动车驾驶员造成的RTI共3 208起,占总数的89.04%;疲劳驾车(P=0.000,OR=4.280,95% CI=2.055～8.916)、超速行驶(P=0.000,OR=0.269,95% CI=0.125～0.578)、纵向间距不够(P=0.001,OR=1.606,95% CI=1.815～3.164)及违反交通信号(P=0.000,OR=2.118,95% CI=1.524～2.945)等4个因素进入多因素非条件Logistic回归分析模型。结论疲劳驾车、超速行驶、纵向间距不够及违反交通信号与RTI的发生密切相关。