The association between exposure to a rear-end collision and future neck or shoulder pain: a cohort study

Neck pain is the most frequently reported feature in connection with whiplash injury, but it is also a common complaint in the general population. Therefore it is crucial to include an unexposed comparison group when evaluating the association between neck pain and a previous motor vehicle crash (MVC). To determine whether exposure to a rear-end collision, without or with whiplash injury, is associated with future neck or shoulder pain, a cohort study was conducted. The study population consisted of persons covered by traffic insurance at one of the largest insurance companies in Sweden. Claim reports were collected from the period November 1987 to April 1988. Drivers exposed to a rear-end collision were divided into two subgroups, without reported whiplash injury (n = 204) and with reported whiplash injury (n = 232). Two comparison groups, unexposed to MVCs, consisting of 1599 and 2089 persons, were selected with consideration taken to the age and gender distribution in the exposed subgroups. A questionnaire concerning neck or shoulder pain and other subjective health complaints was mailed to all the study subjects at follow-up in 1994, 7 years after the rear-end collision. The relative risk of neck or shoulder pain at follow-up was 1.3 (95% CI 0.8-2.0) in the exposed subjects without whiplash injury compared with the unexposed. The corresponding relative risk in subjects with whiplash injury was 2.7 (95% CI 2.1-3. 5). We conclude that there is no increased risk of future neck or shoulder pain in drivers who did not report whiplash injury in connection with a rear-end collision 7 years earlier. In drivers with reported whiplash injury, the risk of neck or shoulder pain 7 years after the collision was increased nearly three-fold compared with that in unexposed subjects.     

The association between exposure to a rear-end collision and future health complaints

Different symptoms, together with neck pain, have been attributed to persons with persistent complaints after a previous motor vehicle crash (MVC) and are sometimes referred to as the "late whiplash syndrome." A cohort study was conducted to determine whether exposure to a rear-end collision, with or without whiplash injury, is associated with future health complaints. The results regarding future neck or shoulder pain have previously been described, and the objective of the present report was to focus on outcomes other than neck pain. Included in the study were persons 18 to 65 years of age and covered by traffic insurance at one of the largest insurance companies in Sweden. Claim reports were collected from the period November 1987 to April 1988. Drivers exposed to a rear-end collision were divided into two subgroups: those with reported whiplash injury (n = 232) and those without reported whiplash injury (n = 204). For comparison, 3688 subjects who were unexposed to MVCs were selected, with consideration taken to the age and gender distribution in the exposed subgroups. The prevalence of different health complaints among the study subjects was estimated according to a mailed questionnaire at follow-up in 1994, 7 years after the rear-end collision. When exposed subjects with whiplash injury were compared to unexposed subjects, increased relative risks in the range of 1.6-3.7 were seen for headache, thoracic and low back pain, as well as for fatigue, sleep disturbances and ill health. No corresponding increased risks were found among the exposed subjects without reported whiplash injury. We conclude that rear-end collisions resulting in reported whiplash injuries seem to have a substantial impact on health complaints, even a long time after the collision. There is a need to identify factors that predict a non-favorable outcome in order to improve clinical management.     

Does periodic vehicle inspection reduce car crash injury? Evidence from the Auckland Car Crash Injury Study

OBJECTIVES: This paper examines the association between periodic motor vehicle inspection and frequent tire pressure checks, and the risk of car crash injury. METHODS: Data were analysed from the Auckland Car Crash Injury Study, a population-based case-control study in Auckland, NZ, where vehicles are required to undergo six-monthly safety inspections. Cases were all cars involved in crashes in which at least one occupant was hospitalised or killed, which represented 571 drivers. Controls were randomly selected cars on Auckland roads (588 drivers). Participants completed a structured interview. RESULTS: Vehicles that did not have a current certificate of inspection had significantly greater odds of being involved in a crash where someone was injured or killed compared with cars that had a current certificate, after adjustment for age, sex, marijuana use, ethnicity and licence type (OR 3.08, 95% CI 1.87-5.05). Vehicles that had not had their tire pressure checked within the past three months also had significantly greater odds of being involved in a crash compared with those that had a tire pressure check, after adjustment for age, sex, ethnicity, seatbelt use, licence type, self-reported speed and hours per week of driving exposure (OR 1.89, 95% CI 1.16-3.08). CONCLUSIONS: This study provides new evidence, using rigorous epidemiological methods and controlling for multiple confounding variables, of an association between periodic vehicle inspections and three-monthly tire pressure checks and reduced risk of car crash injury. DISCUSSION: This research suggests that vehicle inspection programs should be continued where they already exist and contributes evidence in support of introducing such programs to other areas.     

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.     

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。     

Restraint use among northwest American Indian children traveling in motor vehicles

OBJECTIVES: We sought to estimate motor vehicle passenger restraint use among Northwest American Indian children 8 years old or younger and to determine factors associated with using proper (i.e., age and weight appropriate) passenger restraint systems. METHODS: We surveyed vehicles driven by members of 6 tribes in Idaho, Oregon, and Washington. Associations between proper restraint and child, driver, and vehicle characteristics were analyzed using logistic regression for clustered data. RESULTS: We observed 775 children traveling in 574 vehicles; 41% were unrestrained. Proper restraint ranged from 63% among infant seat-eligible children to 11% among booster seat-eligible children and was associated with younger child's age (odds ratio (OR) per year = 0.60; 95% confidence interval (CI) = 0.48, 0.75), seating location (OR front vs rear=0.27; 95% CI=0.16, 0.44), driver seat belt use (OR=2.39; 95% CI=1.51, 3.80), and relationship (OR for nonparent vs parent=0.28; 95% CI=0.14, 0.58). More than half of drivers felt children could use an adult seat belt earlier than recommended guidelines, and 63% did not correctly identify whether their tribe had child safety seat laws. CONCLUSIONS: Children in these communities are inadequately restrained. Restraint use was exceedingly low among booster-eligible children and children riding with unrestrained adults. Interventions emphasizing appropriate restraint use and enforcement of passenger safety laws could reduce the risk of injury or death in motor vehicle accidents.     

Seating position in cars and fatality risk.

Fatality risk in passenger cars according to seating position (front versus rear; left versus center or right) was examined using Fatal Accident Reporting System (FARS) data for 1975 through 1985. Comparing the fatality risk of unrestrained occupants matched in sex and age (within three years) revealed effects attributable to seating position, and not to occupant characteristics correlated with use of different seats. Fatality risk to drivers was the same as fatality risk to right front passengers to within 1 per cent; this was so for crashes in all directions and for frontal crashes. Fatality risk in rear seats was (26 +/- 2) per cent lower than in front seats, and lower in center compared to outboard seats by (22 +/- 4) per cent for front seats and (15 +/- 4) per cent for rear seats. The center rear seat was associated with the lowest fatality risk.     

Long-term labour-market performance of whiplash claimants

A whiplash is a sudden acceleration–deceleration of the neck and head, typically associated with a rear-end car collision that may produce injuries in the soft tissue. Often there are no objective signs or symptoms of injury, and diagnosing lasting whiplash-associated disorders (WAD) is difficult, in particular for individuals with mild or moderate injuries. This leaves a scope for compensation-seeking behaviour. The medical literature disagrees on the importance of this explanation. In this paper we trace the long-term earnings of a group of Danish individuals with mild to moderate injuries claiming compensation for having permanently lost earnings capacity and investigate if they return to their full pre-whiplash earnings when the insurance claim has been assessed. We find that about half of the claimants, those not granted compensation, return to an earnings level comparable with their pre-whiplash earnings suggesting that these individuals do not have chronic WAD in the sense that their earnings capacity is reduced. The other half, those granted compensation, experience persistent reductions in earnings relative to the case where they had not been exposed to a whiplash, even when they have a strong financial incentive to not reduce earnings. This suggests that moderate injuries tend to be chronic, and that compensation-seeking behaviour is not the main explanation for this group. We find that claimants with chronic WADs used more health care in the year prior to the whiplash than claimants with non-chronic cases. This suggests that lower initial health capital increases the risk that a whiplash causes persistent WAD.     

机动车驾驶员道路交通伤害危险因素的病例对照研究

目的：探讨道路伤害中机动车驾驶员的危险因素，为进一步开展交通道路伤害预防提供科学依据。方法：采用病例对照研究方法，通过面询方法收集事故驾驶员和非事故驾驶员的一般情况、睡眠状况、急性困倦、吸烟、饮酒、违章驾驶行为等情况。以SPSS11．5软件进行统计分析。结果：调查了150名事故驾驶员和174名非事故驾驶员。在控制了其他影响因素情况下，驾驶时因感觉/判断错误、疏忽大意、遇紧急情况措施不当和违章操作的OR值（95％CI）分别是137．51（15．773-1198．876）、72．82（18．980-279．344）、25．16（3．097-204．398）和13．27（1．976-89．146）；初中及以下教育程度的驾驶员发生事故的危险性是高中及以上教育程度驾驶员的2．76倍（95％CI：1．082-7．021）；实际驾龄〈5年的驾驶员发生事故的危险性是实际驾龄≥5年的驾驶员的3．04倍（95％CI：1．235-7．457）；驾驶时感觉/判断失误与每周驾驶时间存在交互作用，每周驾驶时间≥40h的驾驶员，因感觉秽4断错误而发生交通事故的危险性低于每周驾驶时间〈40h的驾驶员（OR=0．022，95％CI：0．001-0．371）。结论：驾驶时疏忽大意、感觉/判断错误、遇紧急事故措施不当、违章操作、初中及以下教育程度、实际驾龄短是道路交通伤害中机动车驾驶员的危险因素。     

Psychoactive drugs and the risk of injurious motor vehicle crashes in elderly drivers.

To determine whether commonly used psychoactive drugs increase the risk of involvement in motor vehicle crashes for drivers > or = 65 years of age, the authors conducted a retrospective cohort study. Data were obtained from computerized files from the Tennessee Medicaid program, driver's license files, and police reports of injurious crashes. Cohort members were Medicaid enrollees 65-84 years of age who had a valid driver's license during the study period 1984-1988 and who met other criteria designed to exclude persons unlikely to be drivers and to ensure availability of necessary study data. There were 16,262 persons in the study cohort with 38,701 person-years of follow-up and involvement in 495 injurious crashes. For four groups of psychoactive drugs (benzodiazepines, cyclic antidepressants, oral opioid analgesics, and antihistamines), the risk of crash involvement was calculated with Poisson regression models that controlled for demographic characteristics and use of medical care as an indicator of health status. The relative risk of injurious crash involvement for current users of any psychoactive drug was 1.5 (95% confidence interval (CI) 1.2-1.9). This increased risk was confined to benzodiazepines (relative risk = 1.5; 95% CI 1.2-1.9) and cyclic antidepressants (relative risk = 2.2; 95% CI 1.3-3.5). For these drugs, the relative risk increased with dose and was substantial for high doses: 2.4 (95% CI 1.3-4.4) for > or = 20 mg of diazepam and 5.5 (95% CI 2.6-11.6) for > or = 125 mg of amitriptyline. Analysis of data for the crash-involved drivers suggested that these findings were not due to confounding by alcohol use or driving frequency.     

Incidence and outcome of first syncope in primary care: A retrospective cohort study

ABSTRACT: BACKGROUND: Assessment of risk for serious cardiovascular outcome after syncope is difficult. OBJECTIVES: To determine the incidence of first syncope in primary care. To investigate the relation between syncope and serious cardiovascular (CV) outcome and serious injury. METHODS: Retrospective cohort study using data from the Intego general practice-based registration network, collecting data from 55 general practices (90 GP's). All patients with a first syncope from 1994 to 2008 were included; five participants without syncope were matched for age and gender for every patient with syncope. The main outcome measures were incidence of first syncope by age and gender and one year risk of serious CV outcome or injury after syncope. RESULTS: 2785 patients with syncope and 13909 matched patients without syncope were included. The overall incidence of a first syncope was 1.91 per 1000 person-years (95% CI 1.83-1.98). The incidence was higher in females (2.42 (95% CI 2.32-2.55) per 1000 person-years) compared to males (1.4 (95% CI 1.32-1.49) per 1000 person-years) and follows a biphasic pattern according to age: a first peak at the age of 15-24 years is followed by a sharp rise above the age of 45. One year serious outcome after syncope was recorded in 12.3% of patients. Increasing age (HR 1.04 (1.03-1.04)), CV comorbidity (HR 3.48 (95% CI 2.48-4.90) and CV risk factors (HR 1.65 (95% CI 1.24-2.18) are associated with serious outcome. Cox regression, adjusting for age, gender, CV comorbidity and risk factors, showed that syncope was an independent risk factor for serious CV outcome or injury (HR 3.99 (95% CI 3.44-4.63)). The other independent risk factors were CV comorbidity (HR 1.81 (95% CI 1.51-2.17)) and age (HR 1.03 (95% CI 1.03-1.04)). CONCLUSIONS: Incidence rate of first syncope in primary care was 1.91 per 1000 person-years. One year risk of serious outcome after syncope was 12.3%. Increasing age, CV comorbidity and risk factors are associated with serious outcome. Compared to a control group, syncope on itself is an independent risk factor for serious outcome (adjusted for age, gender, CV comorbidity and risk factors).     

The influence of motor vehicle legislation on injury claim incidence

BACKGROUND: Although there have been numerous strategies to prevent motor vehicle collisions and their subsequent injuries, few have been effective in preventing motor vehicle injury claims. In this paper, we examine the role of legislation and compensation system in altering injury claim incidence. METHODS: The population base for our natural experiment was all Saskatchewan, Manitoba, British Columbia and Quebec residents who submitted personal injury claims to their respective motor vehicle insurance provider from 1990 to 1999. The provinces of Saskatchewan and Manitoba switched from Tort to pure No-Fault insurance on January 1, 1995 and on March 1, 1994 respectively. British Columbia maintained tort insurance and Quebec maintained pure no-fault insurance throughout the entire 10-year period. RESULTS: The conversion from tort insurance to pure no-fault motor vehicle insurance resulted in a five-year 31% (RR = 0.69; 95% CI 0.68-0.70) reduction in total injury claims per 100,000 residents in Saskatchewan and a five-year 43% (RR = 0.57; 95% CI 0.56-0.58) reduction in Manitoba. At the same time, the province of British Columbia retained tort insurance and had a five-year 5% reduction (RR = 0.95; 95% CI 0.94-0.99). Quebec, which retained pure no-fault throughout the entire 10-year period, had less than one third of the injury claims per 100,000 residents than the tort province of British Columbia. INTERPRETATION: The conversion from tort to pure no-fault legislation has a large influence in reducing motor vehicle injury claim incidence in Canada. Legislative system and injury compensation scheme have an observable impact on injury claim incidence and can therefore have significant impact on the health care system.     

Association between body mass index and recovery from whiplash injuries: a cohort study

It is hypothesized that excess weight is a risk factor for delayed recovery from neck pain, such as from whiplash injuries. However, the association between obesity and recovery from whiplash injury has not been studied. The authors examined the association between body mass index and time to recovery from whiplash injuries in a population-based cohort study of traffic injuries in Saskatchewan, Canada. The cohort included 4,395 individuals who made an insurance claim to Saskatchewan Government Insurance and were treated for whiplash injury between July 1, 1994, and December 31, 1995. Of those, 87.7% had recovered by November 1, 1997. No association was found between baseline body mass index and time to recovery. Compared with individuals with normal weight, those who were underweight (hazard rate ratio = 0.88, 95% confidence interval: 0.73, 1.06), overweight (hazard rate ratio = 1.01, 95% confidence interval: 0.94, 1.09), and obese (hazard rate ratio = 0.99, 95% confidence interval: 0.90, 1.08) had similar rates of recovery, even after adjustment for other factors. The results do not support the hypothesis that individuals who are overweight or obese have a worse prognosis for whiplash.     

Road injuries and relaxed licensing requirements for driving light motorcycles in Spain: a time-series analysis

Objective

To assess differences between the risk of injury for motorcycle riders before and after the passing of a law allowing licenced car drivers to drive light motorcycles without having to take a special motorcycle driving test.

Methods

We carried out a quasi-experimental study involving comparison groups, and a time-series analysis from 1 January 2002 to 30 April 2008. The study group was composed of people injured while driving or riding a light motorcycle (engine capacity 51–125 cubic centimetres), while the comparison groups consisted of riders of heavy motorcycles (engine capacity > 125 cc), mopeds (engine capacity ≤ 50 cc) or cars who were injured in a collision within the city limits. The “intervention” was a law passed in October 2004 allowing car drivers to drive light motorcycles without taking a special driving test. To detect and quantify changes over time we used Poisson regression, with adjustments for trend and seasonality in road injuries and the existence of a driver’s licence penalty point system.

Findings

The risk of injury among light motorcycle riders was greater after the law than before (relative risk, RR = 1.46; 95% confidence interval, CI: 1.34–1.60). Although less markedly, after the law the risk of injury also increased among heavy motorcycle drivers (RR = 1.15; 95% CI: 1.02–1.29) but remained unchanged among riders of mopeds (RR = 0.92; 95% CI: 0.83–1.01) and cars (RR = 1.06; 95% CI: 0.97–1.16).

Conclusion

Allowing car drivers to drive motorcycles without passing a special test increases the number of road injuries from motorcycle accidents.     

2010年我国成人道路交通伤害行为危险因素流行特点

目的了解我国不同成年人群道路交通伤害主要行为危险因素的流行特点。方法2010年在我国162个监测点,采用多阶段分层整群随机抽样,调查了98658名18岁及以上居民,通过面对面问卷调查收集道路交通伤害相关行为危险因素信息。对样本进行复杂加权后,分析不同成年人群头盔佩戴、安全带佩戴、酒后驾驶、疲劳驾驶和无证驾驶情况。结果2010年我国成人摩托车驾乘人员中,头盔经常佩戴率为20．03％（95％CI：16．98％～23．08％）,不佩戴率为59．52％（95％CI：55．80％～63．25％）,男性佩戴情况好于女性（P〈0．001）。机动车驾驶员安全带经常佩戴率为36．74％（95％CI：33．04％～40．45％）,不佩戴率为37．22％（95％CI：33．81％～40．62％）,女性佩戴情况好于男性（P=0．028）。机动车驾驶员酒后驾驶率为10．89％（95％CI：9．65％～12．13％）,45～54岁组驾驶员酒后驾驶率最高（P=0．010）。机动车驾驶员疲劳驾驶率为19．71％（95％CI：18．06％～21．37％）,35～44岁年龄组驾驶员疲劳驾驶率最高（P=0．003）。机动车驾驶员无证驾驶率为24．68％（95％CI：22．13％～27．23％）,65岁及以上年龄组驾驶员无证驾驶率最高（P〈0．001）。结论中国成年人道路交通危险行为问题较为严重。     

Mortality reduction with air bag and seat belt use in head-on passenger car collisions

To assess the efficacy of occupant protection systems, the authors measured the mortality reduction associated with air bag deployment and seat belt use for drivers involved in head-on passenger car collisions in the United States. They used a matched case-control design of all head-on collisions involving two passenger cars reported to the Fatality Analysis Reporting System in 1992-1997, and driver mortality differences between the paired crash vehicles for air bag deployment and seat belt use were measured with matched-pair odds ratios. Conditional logistic regression was used to adjust for multiple effects. There were 9,859 head-on collisions involving 19,718 passenger cars and drivers. Air bag deployment reduced mortality 63% (crude odds ratio (OR) = 0.37, 95% confidence interval (CI): 0.32, 0.42), while lap-shoulder belt use reduced mortality 72% (OR = 0.28, 95% CI: 0.25, 0.31). In a conditional logistic model that adjusted for vehicle (rollover, weight, age) and driver (age, sex) factors, air bags (OR = 0.71, 95% CI: 0.58, 0.87) and any combination of seat belts (OR = 0.25, 95% CI: 0.22, 0.29) were both associated with reduced mortality. Combined air bag and seat belt use reduced mortality by more than 80% (OR = 0.18, 95% CI: 0.13, 0.25). Thus, this study confirms the independent effect of air bags and seat belts in reducing mortality.     

Maternal age, exposure to siblings, and risk of amyotrophic lateral sclerosis

Between 1987 and 2005, the authors conducted a nested case-control study based on the Swedish Multi-Generation Register to investigate whether early life exposures, namely, maternal age at delivery and exposure to siblings, are associated with an increased risk of amyotrophic lateral sclerosis (ALS). The study comprised 768 ALS cases and five controls per case matched by birth year and gender. Odds ratios and their corresponding 95% confidence intervals for ALS were estimated by conditional logistic regression modeling. Low maternal age (< or =20 years) and high maternal age (> or =41 years) were both associated with higher risk of ALS (odds ratio (OR) = 1.5, 95% confidence interval (CI): 1.1, 2.0 and OR = 1.7, 95% CI: 1.1, 2.4, respectively). The relative risk of ALS increased slightly with increasing number of younger siblings (OR = 1.1, 95% CI: 1.0, 1.1; p = 0.02). Children whose first younger sibling was born after the age of 6 years had the greatest relative risk (OR = 1.8, 95% CI: 1.2, 2.7). Exposure to older siblings was not associated with the risk of ALS. Although the strength of the observed associations was modest, these results provided further support for the theory that early life exposures might contribute to the disease pathogenesis.     

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.     

A Comparison of Nonfatal Unintentional Injuries in the United States Among U.S.-Born and Foreign-Born Persons

The objective of this research was to compare the risk of nonfatal unintentional injuries between foreign-born and U.S.-born persons. Cross-sectional, nationally representative data were used from the 2000–2003 National Health Interview Survey to compare the risk of injury between 62,267 foreign-born and 322,200 U.S.-born persons. Nonfatal unintentional injuries occurring during the three months prior to the interview were compared by age, gender, education, poverty status, region of residence, family size, and health insurance coverage status. There were a total of 7,654 injured persons with U.S.-born persons having a weighted injury prevalence of 2.3% (95% confidence interval [CI]: 2.2, 2.4) and foreign-born persons having a weighted injury prevalence of 1.2% (95% CI: 1.0, 1.3). With the U.S.-born population as the reference and while controlling for sociodemographic characteristics, the odds ratio of injury risk was 0.54 (95% CI: 0.48, 0.62) for the foreign-born population. Transportation-related injuries occurred more frequently among foreign-born persons than among U.S.-born persons (23.7%, 95% CI: 19.7, 28.3 vs. 15.0%, 95% CI: 14.0, 16.2, respectively). This research is the first step in determining the morbidity from unintentional injuries among the foreign-born population in the U.S.     

Sleep, sleepiness and motor vehicle accidents: a national survey

OBJECTIVE: To assess the role of sleep-related factors, ethnicity and socioeconomic deprivation in self-reported motor vehicle accidents while driving, after controlling for gender, age and driving exposure. METHODS: Mail survey to a random electoral roll sample of 10,000 people aged 30-60 years, stratified by age decades and ethnicity (71% response rate). The analytical sample included 5,534 current drivers (21.6% Maori men, 21.2% Maori women, 30% non-Maori men, 27.2% non-Maori women). RESULTS: Multiple logistic regression analyses revealed the following independent risk factors for accident involvement while driving (last three years): being younger; higher average weekly driving hours; never/rarely getting enough sleep (OR=1.26, 95% CI 1.06-1.49); reporting any chance of dozing in a car while stopped in traffic (Epworth Sleepiness Scale question 8, OR=1.52, 95% CI 1.15-2.02); and among women, being non-Maori. Total Epworth score was not significantly related to reported accident involvement. CONCLUSIONS: Chronic sleep restriction, and any likelihood of dozing off at the wheel of a motor vehicle, were significant independent predictors of self-reported involvement in all types of motor vehicle accidents, not only those identified as fatigue-related. The Epworth Sleepiness Scale alone is not a reliable clinical tool for identifying individuals at higher risk of crashes. IMPLICATIONS: Factors relating to chronic sleepiness were as important as established demographic risk factors for self-reported motor vehicle accident involvement among 30-60 year-old drivers. The findings reinforce the need for multi-faceted campaigns to reduce sleepy driving.