Traumatic brain injury mortality among U.S. children and adolescents ages 0–19 years, 1999–2017

IntroductionTo examine recent traumatic brain injury (TBI) mortality changes among Americans aged 0–19 years by sex, age, urbanicity, state, and intent/causes of injury. Method: TBI mortality per 100,000 population and average annual percent changes (AAPCs), plus 95% confidence intervals (CIs) based on Joinpoint regression models. Results: Age-adjusted TBI mortality among Americans aged 0–19 years declined consistently, though at varying rates between 1999 and 2013 (AAPC = −4.8%, 95%CI: −6.3%, −3.2%), and then significantly increased from 4.42 per 100,000 population in 2013 to 5.17 per 100,000 population in 2017 (AAPC = 3.4%, 95% CI: 1.7%, 5.1%). During the study time period, boys, rural children, and youth aged 15–19 years had higher TBI mortality rates than girls, urban children, and younger children, respectively. TBI mortality from unintentional transport crashes decreased substantially in all age groups between 1999 and 2017, and especially from 1999 to 2010. TBI mortality from suicide increased significantly from 2008 to 2017 in the 10–14-year age group (AAPC = 14.6%, 95% CI: 12.6%, 16.6%) and from 2007 to 2017 in the 15–19-year age group (AAPC = 6.3%, 95% CI: 3.8%, 8.7%). Unintentional transport crashes were the leading cause of TBI-related mortality in 46 states in 1999, but by 2017, suicide became the first leading cause in 14 states. Conclusions: Pediatric TBI mortality declined consistently between 1999 and 2013 and increased significantly from 2013 to 2017, driven primarily by the mortality decrease from unintentional transport crashes and increase in suicide mortality. The spectrum of leading causes of pediatric TBI mortality changed across age groups and over time from 1999 to 2017. Practical Applications: TBI mortality increases in the United States since 2013 are driven primarily by increasing suicide rates, a trend that merits the attention of policy-makers and injury researchers. Action should be taken to curb growing TBI mortality rates among adolescents aged 10–19 years.     

Probationary and non-probationary drivers' nighttime crashes in Western Australia, 1996-2000

INTRODUCTION: This study was designed to explore the temporal aspects of crashes for probationary and non-probationary drivers. METHODS: Data from the West Australian Road Injury Database from 1996-2000 were used to calculate age-sex-specific crash rates per 100,000 person-days and to plot proportions of fatal and hospital crashes by time for probationary and non-probationary drivers. The population attributable risk was used to estimate the potential number of lives saved by nighttime driving restriction in the probationary period. RESULTS: Probationary drivers were seven times more likely to crash than non-probationary drivers. While the highest number of crashes was in the daytime, probationary drivers had a higher proportion of fatal or hospitalization crashes at night than non-probationary drivers. CONCLUSION: Restrictions on driving at night could form part of graduated driver training. Even if some probationary drivers disobeyed the restriction, a substantial reduction in car occupant fatalities and hospitalizations could result.     

Continued trends in older driver crash involvement rates in the United States: Data through 2017–2018

Introduction: With the growing older adult population due to the aging baby-boom cohort, there was concern that increases in fatal motor-vehicle crashes would follow. Yet, previous analyses showed this to be untrue. The purpose of this study was to examine current trends to determine if previous declines have persisted or risen with the recent increase in fatalities nationwide. Methods: Trends among drivers ages 70 and older were compared with drivers 35–54 for U.S. passenger vehicle fatal crash involvements per 100,000 licensed drivers from 1997 to 2018, fatal and all police-reported crash involvements per vehicle miles traveled using the 1995, 2001, 2009, and 2017 National Household Travel Surveys, and driver deaths per 1,000 crashes. Results: Since the mid-1990s, fatal crashes per licensed driver trended downward, with greater declines for drivers ages 70 and older than for middle-aged drivers (43% vs. 21%). Fatal crash rates per 100,000 licensed drivers and police-reported crash rates per mile traveled for drivers ages 70–79 are now less than those for drivers ages 35–54, but their fatal crash rates per mile traveled and risk of dying in a crash remain higher as they drive fewer miles. As the economy improved over the past decade, fatal crash rates increased substantially for middle-aged drivers but decreased or remained stable among older driver age groups. Conclusions: Fatal crash involvements for adults ages 70 and older has recently increased, but they remain down from their 1997 peak, even as the number of licensed older drivers and the miles they drive have increased. Health improvements likely contributed to long-term reductions in fatal crash rates. As older drivers adopt vehicles with improved crashworthiness and safety features, crash survivability will improve. Practical Application: Older adults should feel confident that their independent mobility needs pose less risk than previously expected.     

Road safety performance indicators and their explanatory value: A critical view based on the experience of Central European countries

Counts of road crashes and their victims represent essential information for road safety practitioners allowing them to analyse their spatial and temporal aspects. However, they cannot provide details on the factors causing road crashes. As a result, various road safety performance indicators (RSPIs) were introduced, making it possible to gather information on the effectiveness of interventions on road safety in given areas. However, analysis of the trends in road casualties in several Central European countries based on safety performance (measured by RSPIs) suggest that not even these indicators can provide full understanding of road safety trends, and, if they are applied generally without the required background information, this could even lead to serious misinterpretation of the trends in road casualties. Sudden breaks in long-term trends seem to be linked to the transition process and to certain legislative reforms. The exposure and socio-economic climate appear to have had a major impact on road crash outcomes. Various additional indicators describing organisational and structural aspects may be helpful, therefore, in better understanding and predicting the development in road safety for individual countries.     

Underage drinking: frequency, consequences, and interventions

OBJECTIVES: To examine the frequency of underage drinking, driving after drinking and alcohol-related crashes, trends in these behaviors, and promising interventions. METHODS: We examined drinking and drinking- and-driving behaviors reported in the United States in the 2001 U.S. National Household Survey of Drug Abuse, the Centers for Disease Control and Prevention 2001 Youth Risk Behavior Survey, the 1992 National Longitudinal Alcohol Epidemiologic Study, and the 1999 National Survey of Drinking and Driving conducted for the National Highway Traffic Administration. We also examined the 1999 European School Survey Project on Alcohol and Other Drugs. Alcohol-related fatal crashes were examined from the U.S. Fatality Analysis Reporting System. Evaluation of interventions to reduce teenage drinking and driving after drinking were reviewed. RESULTS: In the United States, 19% of youth ages 12-20 consumed five or more drinks on an occasion in the past 30 days. Although European nations have lower legal drinking ages (16-18) than in the United States (21), similar proportions engage in underage drinking. In two-thirds of European countries, a greater percentage of 15-16 year-olds drank five or more drinks on an occasion in the past month than in the United States. In both the United States and Europe, the earlier people begin to drink, the greater the likelihood of developing alcohol dependence and other alcohol-related problems, including alcohol-related crash involvement, during adolescence and adult years. During the past 20 years alcohol-related traffic deaths among people younger than 21 have been cut in half in the United States, but progress has halted since 1995 and the problem is still large. Interventions shown by research to reduce alcohol-related crashes among youth include raising the legal drinking age to 21, zero tolerance laws, and some interventions that are family, school, or community based. CONCLUSIONS: Despite research showing that a variety of interventions can reduce underage drinking and alcohol-related crash fatalities, the frequency of these behaviors remains high and the average age of drinking initiation is declining in the United States. Efforts are needed to enhance publicized enforcement of underage drinking laws. Comprehensive community interventions that include enforcement of these laws also are needed.     

The role of sales of new motorcycles in a recent increase in motorcycle mortality rates

INTRODUCTION: The National Highway Traffic Safety Administration (NHTSA) has reported that mortality rates from crashes among motorcycle riders in the United States increased from 21.0 per 100 million motorcycle miles traveled in 1997 to 38.4 per 100 million motorcycle miles traveled in 2003. At the same time, annual domestic sales of new, on-road motorcycles increased from 247,000 in 1997 to 648,000 in 2003. METHOD: This study used data from the NHTSA Fatality Analysis Reporting System and annual sales figures for on-road motorcycles to determine if newer motorcycles were more likely to be involved in fatal crashes and if fatal crashes involving newer motorcycles could account for the mortality increase after 1997. RESULTS: Mortality rates were 7.9, 8.1, 5.4, and 2.9 per 10,000 motorcycles sold for motorcycles <1, 1-3, 4-6, and 7-11 years old, respectively, from 1994 to 2003. Assuming complete registration, the number of motorcycles sold during the 2000-2003 time period accounted for 42.4% of the total number of motorcycles registered in 2003. Motorcycles sold during 2000-2003 were associated with 52.5% of all motorcycle deaths in 2003. The increase in the number of deaths associated with motorcycles less than four years old between 1997 and 2003 accounted for 78.1% of the total increase in motorcyclist deaths over this time period. CONCLUSIONS: Two possible explanations for the association between high sales volumes and mortality rates are: (a) increased exposure from more extensive use of motorcycles when they are new; and (b) inexperience with motorcycle riding or with specific motorcycles. IMPACT ON INDUSTRY: This study suggests that the deaths of growing numbers of motorcyclists are a consequence of the financial success of the motorcycle industry.     

Field data: distributions and costs of road-traffic fatalities in South Africa

BACKGROUND: Road-traffic crashes and fatalities constitute major social and economic issues in South Africa. They are a major cause of morbidity and mortality comparable to HIV/AIDS, homicides, and some chronic diseases. METHODS: Road-traffic accident data for the year 2003 obtained from the Department of Transport, Pretoria, South Africa were used for this study. The valuation of the costs of road-traffic crashes and fatalities in South Africa is based on the gross output or human capital approach. RESULTS: 10,197 fatal road crashes and 12,353 fatalities were reported during the study period. More than 50% of the fatal road crashes and fatalities occurred in only three out of 11 provinces. The Northern Cape, which is the least populated province, had the highest fatal road crashes per 100,000 population and fatalities per 100,000 population. The number of road-traffic fatalities in the rural areas was 2.7 times that in the urban areas. The total costs of the road-traffic fatalities which was about R 8 billion (>US$ 1 billion) is about 0.6% of the country's nominal GDP for 2003. 60% of the cases and costs of road-traffic fatalities involved persons aged 20-39 years, although this age group is only 27% of the country's population. The rural areas accounted for 73% and the urban areas 27% of the total costs of fatal road-traffic crashes. CONCLUSION: Those living in the rural areas of the South African society and those aged 20-49 years constitute high-risk groups of road-traffic crashes and fatalities. They are also responsible for most of the attendant costs of fatal crashes and fatalities in the country.     

Road traffic deaths in Brazil: rising trends in pedestrian and motorcycle occupant deaths

Objective: According to the World Health Organization, the global burden of road traffic mortality exceeds 1.27 million people annually; over 90 percent occur in low- and middle-income countries. Brazil's road traffic mortality rate of ～20 per 100,000 is significantly higher than nearby Chile or Argentina. To date, there has been very little information published on road traffic fatalities among vulnerable road users (VRUs) in Brazil. Methods: Road traffic fatality data from 2000 to 2008 were extracted from Brazil's Mortality Information System (SIM). Road traffic deaths were extracted using the International Classification of Diseases (ICD-10) V-codes (V01-V89) and then subcategorized by VRU categories. Information was then disaggregated by gender, age, and region. Results: In 2008, 39,211 deaths due to road traffic injuries were recorded in Brazil, resulting in a crude mortality rate of 20.7 per 100,000 inhabitants. Pedestrian mortality averaged 5.46 deaths per 100,000 between 2000 and 2008. The mortality rate for elderly pedestrians (80+ years) is 20.1 per 100,000, over 10 times that of 0- to 9-year-olds. In the past decade, motorcycle occupant mortality has dramatically increased by over 300 percent from 1.5 per 100,000 in 2000 to 4.7 per 100,000 in 2008. The 20- to 29-year age group remains most affected by motorcycle deaths, with a peak fatality rate of 10.76 per 100,000 in 2008. The north and northeast regions, with the lower per capita gross domestic product (GDP), have higher proportions of VRU deaths compared with other regions. Conclusions: Vulnerable road users are contributing an increasing proportion of the road traffic fatalities in Brazil. Nationally, elderly pedestrians are at particularly high risk and motorcycle fatalities are increasing at a rapid rate. Less prosperous regions have higher proportions of VRU deaths. Understanding the epidemiology of road traffic mortality in vulnerable road user categories will better allow for targeted interventions to reduce these preventable deaths.     

Job control and occupational health: the moderating role of national R&D activity

Workers (n = 17 275) from 14 European Union (EU) member states provided data on job control, job dissatisfaction, perceived risk of occupational stress, and absence. For each state, level of research and development (R&D) activity was assessed. Associations between individual levels of control and occupational health were stronger where national R&D activity was higher. The moderation occurred for individuals' levels of control in relation to job dissatisfaction, perceived risk of occupational stress, and absence. The findings with job dissatisfaction and absence were replicated in a sample of workers from 10 Eastern European former Communist countries (n = 7926). Copyright © 2007 John Wiley & Sons, Ltd.     

The legal minimum drinking age in texas: Effects of an increase from 18 to 19

Effects on motor vehicle crash involvement of raising the legal drinking age in Texas from 18 to 19 were examined, using an interrupted time-series design. Rates of single-vehicle-nighttime (SVN) and non-SVN crashes per 100,000 licensed drivers from 1978 through 1984 were examined for three levels of crash severity (serious injury, minor injury, property damage only) and four age groups (16–17, 18, 19–20, 21 and over). Results revealed significant reductions in SVN crashes for the 18-year-old target population across all levels of crash severity: serious injury, down 10.8% ; minor injury, down 14.3% ; and property damage only, down 12.8%. In comparison, no significant changes in SVN crashes among drivers age 21 and over were found. When the effects of macroeconomic conditions on crash rates were controlled statistically, no change in the estimated effect of the legal age law was seen. It is clear that the 1-year increase in legal age in Texas had a significant effect on youth crash involvement.     

Surrogate measures of alcohol involvement in fatal crashes: Are conventional indicators adequate?

The problem of alcohol-related highway fatalities has led a majority of states to enact new legislative countermeasures. Because few states consistently collect information on alcohol involvement in fatal crashes, the evaluation of the effectiveness of these countermeasures has relied on surrogate measures of alcohol involvement. Using data from the U.S. Department of Transportation's Fatal Accident Reporting System (FARS), this study addresses the following questions: (a) Which of the several surrogate measures used are most likely to reflect alcohol involvement in fatal crashes? and (b) Do the trends in these surrogate measures provide an accurate appraisal of the true trends in alcohol-involved fatal crashes? The authors conclude that nighttime fatal crashes are the best surrogate measure of alcohol-involved crashes, but that surrogate measures may not accurately mirror trends in alcohol-involved fatal crashes over time, particularly in small states or over short durations. All drivers in fatal crashes should be given blood alcohol level (BAL) tests to most accurately assess the effects of drunk driving countermeasures.     

Investigating the influence on safety of retrofitting Italian motorways with barriers meeting a new EU standard

Objective: A new European Union (EU) regulation for safety barriers, which is based on performance, has encouraged road agencies to perform an upgrade of old barriers, with the expectation that there will be safety benefits at the retrofitted sites. The new class of barriers was designed and installed in compliance with the 1998 (European Norm) EN 1317 standards for road restraint systems, which lays down common requirements for the testing and certification of road restraint systems in all countries of the European Committee for Standardization (CEN). Both the older and new barriers are made of steel and are installed in such a way as to avoid vehicle intrusion, but the older ones are thought to be only effective at low speeds and large angles of impact. The new standard seeks to remedy this by providing better protection at higher speeds. This article seeks to quantify the effect on the frequency of fatal and injury crashes of retrofitting motorways with barriers meeting the new standards.

Methods: The estimation of the crash modification was carried out by performing an empirical Bayes before–after analysis based on data from the A18 Messina–Catania motorway in Italy. The methodology has the great advantage to account for the regression to the mean effects. Besides, to account for time trend effects and dispersion of crash data, a modified calibration methodology of safety performance was used.

Results: This study, based on data collected on 76 km of motorway in the period 2000–2012, derived Crash Modification Factor point estimates that indicate reductions of 72% for run-off-road fatal and injury crashes and 38% in total fatal and injury crashes that could be expected by upgrading an old safety barrier by complying with new EU 1317 standards. The estimated benefit-cost ratio of 5.57 for total crashes indicates that the treatment is cost effective.

Conclusions: The magnitude of this benefit indicates that the retrofits are cost-effective even for total crashes and should continue in any European country inasmuch as the estimated Crash Modification Factors are based on treatment sites that are reasonably representative of all European motorways.     

The Iowa Graduated Driver Licensing program: effectiveness in reducing crashes of teenage drivers

PROBLEM: Graduated Driver Licensing (GDL) programs vary in the United States in terms of implementation and restrictions. The State of Iowa's GDL program is assessed for its effectiveness in reducing crashes among teenage drivers. METHOD: Time series analysis was used to evaluate police documented crashes involving 16-, 17-, and 18-year-old drivers over a 10 year period, with an intervention identified at the point of GDL implementation. RESULTS: After controlling for seasonal trends and auto-correlative effects, a significant reduction in the crash rate of and 16- and 17-year-old drivers was observed due to the GDL implementation. However, there were no significant reductions in crash rates for 18-year-old drivers. DISCUSSION: The analyses suggest that the Iowa GDL program is effective in reducing the crash rates of 16- and 17-year-old drivers but the effects do not sustain for 18-year-old drivers. IMPACT ON INDUSTRY: The results suggest that the program appears to be working, however further analysis is needed to determine what factors are preventing lasting effects for these teenage drivers.     

Motor vehicle fatalities among Gulf War era veterans: characteristics, mechanisms, and circumstances

OBJECTIVES: Our objective was to describe fatal motor vehicle crashes (MVC) among veterans of the 1991 Gulf War era and to compare the distribution of crash and individual characteristics between those deployed to the Gulf War (GWV) and those not deployed (NDV). METHODS: We compared individual characteristics, crash mechanisms, and crash circumstances between 765 GWV and 553 NDV who died from MVC within the first five years of the war, between May 1991 and December 1995. RESULTS: Overall, GWV and NDV who died from a MVC were more likely to be enlisted males (97%), 21-30 years old (72%), have a high school education or less (91%), drive a passenger car (52%), and not use restraints (60%). The overall annual rate of motor vehicle fatalities for GWV (23.6 per 100,000; 95% confidence interval: 21.9-25.3) was significantly greater than the rate for NDV (15.9, 95% CI: 14.6-17.3). GWV with the highest motor vehicle fatality rates include males (24.8, 95% CI: 23.0-26.6), 17-20 year olds (105.0, 95% CI: 78.2-138.1), and those not married (27.3, 95% CI: 25.1-30.1). Adjusting for differences in age distribution across GWV and NDV did not account for the difference in rates. Characteristics of MVC fatalities that were over-represented among GWV include serving as regular active duty (p = 0.001), having a high school education or less (p = 0.01), being involved in a single-vehicle crash (p = 0.008), and dying within the first hour following the crash (p = 0.004). Also, we identified a greater proportion of alcohol-related crashes among GWV during the late night and early morning hours. CONCLUSIONS: The highest rates of motor vehicle fatality among young, single males in the military mirror the experience of the general population. Further research is necessary to determine modifiable risk factors that can be targeted for specific interventions and whether the elevated late night alcohol-related crash rate among GWV is an effect of deployment or an inherent population bias among those selected for operational deployments.     

Effects of turning on and off red light cameras on fatal crashes in large U.S. cities

IntroductionThis study updates estimates of effects of activating red light cameras and offers a first look at effects of turning them off.MethodAmong 117 large U.S. cities with more than 200,000 residents in 2014, trends in citywide per capita rates of fatal red light running crashes and of all fatal crashes at signalized intersections were compared between 57 cities that initiated camera programs during 1992–2014 and 33 cities without cameras to examine effects of activating camera programs. Trends also were compared between 19 cities that removed cameras and 31 regionally matched cities with continuous camera programs to evaluate effects of terminating camera programs. Because several cities removed cameras during 2005–2008 and estimated effects might have been confounded by the subsequent economic downturn, primary analyses were limited to the 14 cities that removed cameras during 2010–2014 and 29 regionally matched cities with continuous camera programs. Poisson regression examined the relationship of activating and deactivating cameras with fatal crash rates.ResultsAfter controlling for temporal trends in annual fatal crash rates, population density, and unemployment rates, rates of fatal red light running crashes and of all fatal crashes at signalized intersections were 21% and 14% lower, respectively, in cities with cameras after cameras were turned on than would have been expected without cameras; 30% and 16% higher, respectively, in 14 cities that terminated cameras during 2010–2014 after cameras were terminated than expected had cameras remained; and 18% and 8% higher, respectively, in all 19 cities that removed cameras, but not significantly.ConclusionsThis study adds to the body of evidence that red light cameras can reduce the most serious crashes at signalized intersections, and is the first to demonstrate that removing cameras increases fatal crashes.Practical applicationsCommunities thinking about removing cameras should consider impacts to safety.     

Characteristics of crashes and injuries among 14 and 15 year old drivers,by rurality

Purpose: Motor-vehicle crashes continue to be the leading cause of death for teenagers in the United States. The United States has some of the youngest legal driving ages worldwide. The objective of this study was to determine rates and factors associated with injury crashes among 14- and 15-year-old drivers and how these varied by rurality. Methods: Data for this cross-sectional study of 14- and 15-year-old drivers were obtained from the Iowa Department of Transportation from 2001 to 2013. Crash and injury crash rates were calculated by rurality. The relationship between crash and driver factors and injury was assessed using logistic regression. Findings: Teen drivers, aged 14 and 15 years, had a statewide crash rate of 8 per 1,000 drivers from 2001 to 2013. The majority of crashes occurred in urban areas (51%), followed by in town (29%), remote rural areas (13%), and suburban areas (7%). Crash and injury crash rates increased as level of rurality increased. The odds of an injury crash increased more than 10-fold with the presence of multiple other teens as passengers, compared to no passengers (OR = 10.7, 95% CI: 7.1–16.2). Conclusions: Although 14- and 15-year-old drivers in Iowa have either limited unsupervised (school permits) or supervised only driving restrictions, they are overrepresented in terms of crashes and injury crashes. Rural roads and multiple teen passengers are particularly problematic in terms of injury outcomes. Practical applications: Results from this study support passenger restrictions and teen driving interventions designed with a rural focus.     

Road safety in China: Analysis of current challenges

Introduction

China has the world's largest population, and is the second largest automobile market. China's economy is booming, resulting in a rapid increase in both the road infrastructure and access to private vehicles. Along with economic growth, the ownership of motorized vehicles has almost quadrupled in the past 10 years, from 42.2 million in 1997 to 159.7 million in 2007. However, at the same time, China also has a very high number of road fatalities compared to other countries, with about 100,000 reported fatalities each year.

Method

This study analyzes the Chinese road-fatality situation to identify areas in which the total harm caused by crashes can be substantially and readily reduced. It provides a comprehensive analysis of the current road-fatality situation in China using conventional indices and the likely future trends.

Results

Four areas were identified in which countermeasures have the most potential to substantially reduce fatalities in China: pedestrians and other non-motorists, nighttime driving, vehicle passengers, and motorcycles.

Conclusion

While China faces unprecedented road safety issues, this report identifies major areas in which there are opportunities to greatly reduce total harm.     

The effects of daylight saving time on vehicle crashes in Minnesota

Introduction: Daylight saving time (DST), implemented as an energy saving policy, impacts many other aspects of life; one is road safety. Based on vehicle crash data in Minnesota from 2001 to 2007, this paper evaluates long- and short-term effects of DST on daily vehicle crashes. Method: To provide evidence to explain the causes of more/fewer crashes in DST, we examine the impact of DST on crashes in four periods of a day: 3 a.m.-9 a.m., 9 a.m.-3 p.m., 3 p.m.-9 p.m., 9 p.m.-midnight. The effects of risk and exposure to traffic are also separated. Our statistical models not only include weather conditions and dummy variables for days in DST as independent variables, but also consider traffic volumes on major roads in different periods of a day. Our major finding is that the short-term effect of DST on crashes on the morning of the first DST is not statistically significant. Moreover, it is interesting to notice that while DST per se is associated with fewer crashes during dusk, this is in part offset because it is also associated with more traffic on roads (and hence more crashes). Our path analysis shows that overall DST reduces crashes. Impact on industry: Daylight saving time can lead to fewer crashes on roads by providing better visibility for drivers.     

Does the Maryland graduated driver licensing law affect both 16-year-old drivers and those who share the road with them?

PROBLEM: To assess effects of the 1999 Maryland graduated driver licensing (GDL) law on both 16-year-old drivers and other road users. METHOD: Calculation and comparison of crash involvement rates and non-fatal injury rates pre-GDL (1996-1998) and post-GDL (2001-2003) by type of road user, per population, and per licensed driver, with adjustment for trends among 30-59-year-old drivers. RESULTS: Post-GDL, prevalence of licensure decreased 24% among 16-year-olds, and rates of 16-year-old drivers involved in crashes significantly decreased per 16-year-old population (corrected rate ratio (RRc) 0.82; 95% CI (0.71, 0.96)). A significant decrease also was observed for non-fatal injuries per 16-year-old population among 16-year-old drivers involved in crashes (RRc 0.63; 95% CI (0.41, 0.98)). Similarly, decreases, albeit not statistically significant, were observed among their passengers and other vehicle occupants. Per 16-year-old licensed driver, a slight non-significant increase was observed in crash involvement rates; non-fatal injury rates per 16-year-old licensed driver suggest decreased risk (non-significant) among 16-year-old drivers, their passengers, and other vehicle occupants. SUMMARY: Maryland's GDL delayed licensure and reduced crashes and non-fatal injuries among 16-year-old drivers per population. Trends in injuries among other road users involved in crashes with 16-year-old drivers were suggestive of a benefit from GDL, although observed decreases were not significant. Per licensed driver, findings were not significant, but suggested little change in crash involvement and decreased non-fatal injuries. Because one-third fewer 16-year-olds were licensed post-GDL, these results may suggest a selection effect in licensure. IMPACT ON INDUSTRY: Because Maryland had nighttime restrictions for new drivers before 1999, this study suggests other components of GDL are beneficial for drivers and possibly for other road users. States with weak GDL laws should strongly consider revising them.     

Older drivers’ involvement in fatal RTCs. Do crashes fatal to them differ from crashes involving them but fatal to others?

In several countries, older drivers are disproportionately involved in fatal road traffic crashes (RTCs) for various reasons. This study maps the circumstances of occurrence of crashes involving older drivers that are fatal to either them or other road users and highlights differences between them. Sweden’s national in-depth studies of fatal RTCs archive was used and focus was placed on crashes in which a driver aged 65 years or older was involved between 2002 and 2004 (n = 197). Thirteen driver and crash characteristics were analyzed simultaneously and typical crash patterns (classes) were highlighted. For each pattern, the proportions of crashes fatal to the older driver vs. to someone else were compared. Four patterns were identified: (1) crashes on low-speed stretches, involving left turn and intersections; (2) crashes involving very old drivers and older vehicles, (3) rear-end collisions on high-speed stretches; and (4) head-on and single-vehicle crashes in rural areas. Older drivers dying in the crash were over-represented in classes 2 and 4. The study shows that when older drivers are involved in fatal RTCs, they are often the ones who die (60%). Typical circumstances surrounding their involvement include manoeuvring difficulties, fast-moving traffic, and colliding in an old vehicle. Preventing fatal RTCs involving older drivers requires not only age-specific but also general measures.