Motorcycle helmet use and injury outcome and hospitalization costs from crashes in Washington State.

OBJECTIVES. The incidence, type, severity, and costs of crash-related injuries requiring hospitalization or resulting in death were compared for helmeted and unhelmeted motorcyclists. METHODS. This was a retrospective cohort study of injured motorcyclists in Washington State in 1989. Motorcycle crash data were linked to statewide hospitalization and death data. RESULTS. The 2090 crashes included in this study resulted in 409 hospitalizations (20%) and 59 fatalities (28%). Although unhelmeted motorcyclists were only slightly more likely to be hospitalized overall, they were more severely injured, nearly three times more likely to have been head injured, and nearly four times more likely to have been severely or critically head injured than helmeted riders. Unhelmeted riders were also more likely to be readmitted to a hospital for follow-up treatment and to die from their injuries. The average hospital stay for unhelmeted motorcyclists was longer, and cost more per case; the cost of hospitalization for unhelmeted motorcyclists was 60% more overall ($3.5 vs $2.2 million). CONCLUSIONS. Helmet use is strongly associated with reduced probability and severity of injury, reduced economic impact, and a reduction in motorcyclist deaths.     

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.     

Death and injury from motor vehicle crashes in Colombia.

We report data on the distribution and determinants of road deaths and injuries for all victims in Colombia, with the aim of defining targets and priorities for highway death prevention in that country and other rapidly urbanizing nations. Using information from Colombia's Fund for the Prevention of Road Injury and the national death registry, we studied data on deaths and injuries from 1991 to 1995 for the nation as a whole and for the country's two largest cities, Santa Fe de Bogotá and Medellín. Deaths and injuries are rising in the nation as a whole. Of the deaths, 75% occur in urban areas, and 80% are in males. Pedestrians aged 15-34 are a peak subgroup. Thirty-four percent of deaths are attributable to speeding and/or alcohol consumption. Death tolls are highest at night and on weekends. Specific priority targets for intervention are indicated by the fact that 75% of road deaths in Colombia occur in urban areas and that 80% of all victims are males.     

Assessing technologies for preventing injuries in motor vehicle crashes

Motor vehicle crashes are a leading cause of morbidity and mortality. In the Haddon matrix, crashes are divided into three phases and factors affecting each phase. In the context of this matrix, the effectiveness, use, and legislation of safety belts and airbags are discussed, using process, injury, and economic outcome measures.     

Potential-years-life-lost from motor vehicle crashes in Israel: an epidemiologic analysis

Motor Vehicle Crashes (MVC) were the 7th ranking specific cause of mortality (Israel 1975) after ischaemic heart disease (ISHD), cerebrovascular disease, respiratory disease, various types of cancer, and accidents other than MVC, but were the top ranking single cause (in males, next to accidents of all kinds) of Potential-Years-Life-Lost (PYLL) ages 1-65 among men and women and men 1-70 and 2nd ranking cause of PYLL age 1-75 among men. Many young male deaths from MVC and few from non-traumatic causes below age 40 account for these high PYLL rankings for MVC. Israeli age-specific death rates from MVC below age 40 were lower than those of USA, but higher among the elderly (reason: pedestrian deaths). Both Israel's PYLL rate (PYLL per 100 000 persons) from MVC and crude mortality rates are only slightly lower than those of USA. Trends in Israel point to a growing number of drivers among young and poorer groupings, who have been shown elsewhere to be at high-risk for MVC mortality. PYLL from MVC in Israel can be expected to increase, even if crude death rates remain stable or decline. Swift low-cost preventive measures could arrest or reverse these predicted trends.     

Variations in minimum licensing age and fatal motor vehicle crashes

The effect of differences in the legal minimum licensing age on fatal motor vehicle crashes was studied in New Jersey (age 17), Massachusetts (age 16 1/2), and Connecticut (age 16). New Jersey's 17-year-old licensing law was associated with greatly reduced fatal crash involvement. It is estimated that 65 to 85 per cent reductions in 16 year-old-driver fatal crash involvement can be expected if the licensing age is increased from 16 to 17 without increasing fatal crash rates at older ages.     

Death and injury from motor vehicle crashes: a tale of two countries

OBJECTIVE: To determine why road deaths dropped by 33.9% in the United Kingdom, compared to 6.5% in the United States, between 1990 and 1999. METHODS: Deaths per billion vehicle kilometers traveled (D/BVKM), and case fatality rates (CFR) in the United States and the United Kingdom were tracked. Time trends in CFR can be used to track the direct effects of speed of impact. CFR is a crash-phase outcome that is independent of exposure, and varies approximately to the fourth power of the speed of crash impact. Joinpoint regression analysis was used to analyze changes in time trends of CFR. RESULTS: In the 1990s, the decrease in deaths in the United Kingdom was attributable mostly to the 29.6% drop in the CFR. In the United States, the CFR dropped by only 6.6%. The United Kingdom introduced speed cameras and an array of speed-calming measures. By contrast, in the United States, use of speed cameras was extremely rare, and speed limits and speeds increased in 32 of the 50 states, mostly in 1995 and 1996, after which CFR actually rose (p<.0001). Intercountry differences in time trends in seat belt use, trauma care, vehicle kilometers traveled, congestion, and driving under the influence of alcohol (DUI), along with massive increase in use of higher-risk sports utility vehicles in the United States, did not account for the contrasting trends in deaths through the 1990s. But increases in DUI in the United States after 1997 may have contributed to increases in speed-related crashes. CONCLUSIONS: The reductions in CFR, probably from small drops in speed of impact account for the disproportionately greater drop in death tolls in the United Kingdom compared to the United States. The temporal fit between drops in CFR and deaths following the introduction of speed cameras in the United Kingdom and increases in speed (speed creep), CFR, and deaths in the United States following raised speed limits suggests that diverging changes in speeds of impact accounted mainly for these changes. Use of D/BVKM to correct for exposure concealed the lack of progress after 1990 in the United States, since falling time trends in D/BVKM reflect increases in congestion. If the United States had implemented United Kingdom-type speed control policies and not raised speed limits, there would have been an estimated 6500 to 10,000 (approximately 16% to 25%) fewer road deaths per year during the period following speed-limit increases (1996 to 1999), including many DUI-related deaths. Reductions of up to 50% are now achievable based on newer population-wide strategies for speed control.     

The role of motor vehicle crashes in causing certain injuries.

Hospital discharge data from Rhode Island were used to assess the role of motor vehicle crashes in causing several types of serious injuries. Motor vehicle crashes were the cause of injury for approximately two-thirds of patients hospitalized with injuries to the chest organs, liver, and spleen, and approximately one-third of those with traumatic pneumothorax or hemothorax, and injuries to the head, kidney, intestine, distal femur, pelvis, and patella.     

Risk indicators for talipes equinovarus in Washington State, 1987-1989

To identify risk indicators for talipes equinovarus, we compared 175 case children with talipes equinovarus of unknown etiology identified through the Washington State Birth Defect Registry with 1,470 control children sampled from resident live births. Infant gender, maternal smoking, death of a preterm sibling, and marital status were independently related to talipes equinovarus in an analysis based on information from birth certificate records. The findings differed by infant gender. The prevalence odds ratio for maternal smoking was 2.6 (95% confidence interval: 1.6-4.0) in males and 1.4 (95% confidence interval:0.6-3.2) in females.     

Factors associated with front row seating of children in motor vehicle crashes

BACKGROUND: Current safety guidelines recommend that children age 12 or younger sit in the rear seat of passenger vehicles. However, front row seating among these children remains common. To develop future educational and other interventions to decrease front row seating of young children, it is important to examine factors associated with this behavior. METHODS: We identified factors associated with front row seating of children 12 years of age or younger using data from a cross-sectional study of children who were the single passenger in crashes of insured vehicles in 15 U.S. states. Data were collected by insurance claims records and a telephone interview. A probability sample of 3775 crashes representing 27678 crashes with child occupants was collected between 1 December 1998, and 30 November 2002. Multivariate Poisson regression was used to identify specific child, driver, and vehicle characteristics associated with front row seating. RESULTS: When children were the sole occupants in the vehicle, approximately 1 in 3 (31%) sat in the front seat. The child's age and restraint use, the driver's age and relationship to the child passenger, the type of vehicle, and the presence of a passenger airbag were all associated with front row seating. CONCLUSIONS: Educational interventions can be tailored to address the specific needs of subgroups of drivers and children to reduce front row seating. In addition, these data could be used to support legislative interventions to limit front row seating of younger children when a teenager is driving.     

Pregnancy Outcomes in Women with Rheumatoid Arthritis in Washington State

Objective: To determine whether rheumatoid arthritis (RA) is associated with increased adverse obstetric or neonatal outcomes. Study design and setting: Washington State birth records and hospital discharge data between 1987 and 2001 identified a cohort of women with rheumatoid arthritis and a comparison group of women without rheumatoid arthritis. Pregnancy and neonatal outcomes were compared using general linear models for common outcomes, calculating approximate relative risks and 95% confidence intervals. Results: There were 243 women with rheumatoid arthritis and 2559 controls. Infants of women with rheumatoid arthritis had increased risk of cesarean delivery (adjusted approximate relative risk, aRR=1.66, 95% CI (1.22, 2.26)), prematurity (aRR=1.78, 95% CI (1.21, 2.60)), and longer birth hospitalization (aRR=1.86, 95% CI (1.32, 2.60)) compared to those born to women without rheumatoid arthritis. Conclusions: We speculate that the increased risks for cesarean delivery, prematurity, and longer hospitalization at birth among infants born to women with rheumatoid arthritis may be due to the pathophysiologic changes associated with rheumatoid arthritis or medications used to treat the disease.     

Pregnancy risk factors and birth outcomes in Washington State: a comparison of Ethiopian-born and US-born women.

This study compared birth outcomes of three cohorts of women with singleton live births in Washington State between 1980 and 1991: all Black Ethiopian-born women (n = 264) and samples of US-born Black (n = 526) and White (n = 546) women. Ethiopians were older, more likely to be married, and less likely to smoke than were US-born women, and they were less likely to have anemia than US-born Blacks. The adjusted low-birthweight risk among Ethiopians was similar to that of US-born Blacks (relative risk [RR] = 0.9) and Whites (RR = 1.1). Ethiopians were more likely to have high-birthweight infants than were US-born Blacks (RR = 4.0). Cultural and behavioral etiologies may explain these favorable birth outcomes.     

Daylight saving time and motor vehicle crashes: the reduction in pedestrian and vehicle occupant fatalities.

Fatal crashes were tabulated for 6-hour periods around sunrise and sunset, from 13 weeks before the fall change to standard time until 9 weeks after the spring change to daylight saving time. Fatal-crash occurrence was related to changes in daylight, whether these changes occurred abruptly with the fall and spring time changes or gradually with the changing seasons of the year. During daylight saving time, which shifts an hour of daylight to the busier evening traffic hours, there were fewer fatal crashes. An estimated 901 fewer fatal crashes (727 involving pedestrians, 174 involving vehicle occupants) might have occurred if daylight saving time had been retained year-round from 1987 through 1991.     

Multidisciplinary pain center outcomes in Washington State Workers' Compensation

We conducted this study to evaluate the clinical and disability status of injured workers 4.6 years after undergoing multidisciplinary pain center evaluation, comparing subjects who received treatment to subjects who were evaluated only. Three hundred injured workers were selected for a telephone survey; 150 had received pain center treatment and 150 had been evaluated but not treated. The survey included the SF-12, and questions about subjects' pain intensity and current work status. A workers' compensation database indicated the disability status of subjects. The response rate was 50%. In multivariate analyses, treated and evaluated-only subjects did not differ significantly in disability status, pain intensity, SF-12 scores, or current work status. At 4.6 years follow up, there was no evidence that pain center treatment affects either disability status or clinical status of injured workers.     

Occupational injuries among minors doing farm work in Washington State: 1986 to 1989.

BACKGROUND. There is growing evidence that many children are injured while engaged in agricultural work. However, little specific information on farm work-related injuries among minors is available, probably because employment or workers' compensation data for children are hard to obtain. METHODS. Workers' compensation data were used to evaluate occupational injuries among children in Washington State from 1986 through 1989. The frequency and severity of injuries among minors doing farm work were compared with the distributions of injuries among minors working in food service and all other occupations by year of injury, age of injury, and month and hour of injury. RESULTS. A total of 16,481 claims filed by children under age 18 were evaluated. Although farm workers accounted for only 7% of all claims, they made up 36% of claims filed by children under age 14, and 17% of claims filed by children aged 14 or 15. Injuries classified as serious accounted for 26% of farm worker claims compared with only 16% of all claims filed by children. CONCLUSIONS. Although injury rates could not be developed owing to the lack of denominator data, this study demonstrates that farm work is dangerous for young children.     

The sexual assault of women at work in Washington State, 1980 to 1989.

Sexual assault in the workplace and the related factors have not been well studied. Workers' compensation claims data were used to describe work-related sexual assaults in Washington State between 1980 and 1989. Sixty-three cases of work-related rape were identified during this study period. The occupations of the rape victims were similar to occupations identified as high risk for other intentional injuries, and the rape incidents were characterized by isolation from the public and from coworkers. Estimates of industry-specific rates are presented. The identification, evaluation, and prevention of sexual assault and other workplace violence are discussed.