Trends in motor vehicle crash mortality in Europe, 1980-2007

Recent trends (1980-2007) in mortality from road traffic crashes in European countries, and, for comparative purposes, in the USA and Japan were reviewed. Data came from the World Health Organisation database. Age-standardised rates, at all ages and at 15-24, 25-64, ?65 years, were computed. Joinpoint regression analyses to evaluate significant changes in trends were performed. In the European Union as a whole rates declined from 20.2 in 1987 to 13.5/100,000 in 2007 in men, and from 6.3 to 3.7/100,000 in women; European Union rates remained lower than USA, but higher than Japanese ones. In 2007, the highest male rates were in Lithuania (36.7/100,000), the Russian Federation (35.2), Ukraine (29.8), and Latvia (28.5), and the lowest ones in the Netherlands (6.2) and Sweden (6.9); the highest female rates were in the Russian Federation (11.3), Lithuania (9.7), Belarus, Latvia, and Ukraine (around 8), and the lowest ones in Switzerland (1.7), the UK, and Nordic countries (around 2). Mortality from motor vehicle crashes declined in northern and western European countries and - though to a lesser extent - in southern European countries, too. Mortality trends were also favourable in the Czech Republic and Poland since the mid 1990’s, whereas they were still upwards in Romania and the Russian Federation. No trend was observed in Hungary and Ukraine. Trends were consistent in various age groups considered. Thus, additional urgent and integrated intervention is required to prevent avoidable deaths from motor vehicle crashes, particularly in selected central and eastern European countries.     

Responsibility of drivers, by age and gender, for motor-vehicle crash deaths

Problem: Motor-vehicle crash rate comparisons by age and gender usually are based on the extent to which drivers in a particular age/gender category are themselves injured or involved in crashes (e.g., the number of 20-year-old females in crashes). Basing comparisons instead on the extent to which drivers in various age/gender groups are responsible for deaths (including themselves) in their crashes is more revealing of their overall contribution to the problem. Methods: Data from the Fatality Analysis Reporting System (FARS, 1996–2000) were used in the analysis, which was based on crashes that involved one or two vehicles only. Drivers in fatal single-vehicle crashes were assumed to have responsibility for the crash. In fatal two-vehicle crashes, driver operator errors reported by police were used to assign crash responsibility. Results: When all crashes were considered, both the youngest and oldest drivers were most likely to be responsible for deaths in their crashes. In two-vehicle crashes, the oldest drivers were more likely than young drivers to be responsible. Young males were more likely than young females to be responsible for crash deaths, whereas females in their 50s and older were more likely than same-age males to be responsible. In terms of responsibility for deaths per licensed driver, young drivers, especially males, had the highest rates because of their high involvement rates and high responsibility rates. The majority of deaths for which young drivers were responsible occurred to people other than themselves, especially passengers in their vehicles, whereas the bulk of the deaths for which older drivers were responsible were their own. Discussion: The results highlight the contribution of young drivers to the motor-vehicle crash problem, the need for measures such as passenger restrictions in graduated licensing systems, and the need for vehicle modifications to better protect older occupants.     

Effect of vehicle and crash factors on older occupants

PROBLEM: The expected substantial increase in people aged 65 or older is important for those concerned about transportation injuries. However, much of the previous research concentrates on older drivers and overlooks the fact that vehicle and crash factors may provide significant explanations of older occupant injury rates. METHOD: Differences across age groups are explored using two nationwide travel surveys, crash involvement, fatalities, and injuries from crash databases and an ordered probit model of injury severity. RESULTS AND DISCUSSION: Two noticeable differences that help explain injury risk are that older people are more likely to travel in passenger cars than younger people who frequently use light trucks, and that seriously injured older occupants are more likely to be involved in side-impact crashes than their younger counterparts. IMPACT: Increased attention to vehicle engagement in side-impact crashes and to vehicle technologies that can help drivers avoid side collisions would be particularly helpful for older occupants.     

Driving and alternatives: older drivers in Michigan

Method: A statewide telephone survey of Michigan drivers and former drivers aged 65 and older collected information on transportation mode choices, experience with alternatives to driving, and whether drivers planned for when they could no longer drive. Results: Results showed that most older adult households owned at least one automobile, and that the automobile was the primary mode of transportation. Most former drivers obtained rides from relatives and friends. Use of public transportation was low, and some seniors were not aware of available public transportation services. Older drivers did not plan for driving cessation. Over half the drivers who perceived a likelihood of driving problems within 5 years expected to keep driving beyond 5 years. Impact on industry: Because of their lifelong reliance on the automobile, their desire to drive themselves, and their lack of experience with public transportation, efforts to enhance the mobility of older people should consider this background while alternatives to the personal automobile are developed.     

Prediction of vehicle crashes by drivers' characteristics and past traffic violations in Korea using a zero-inflated negative binomial model

Aims: Traffic safety is a significant public health challenge, and vehicle crashes account for the majority of injuries. This study aims to identify whether drivers' characteristics and past traffic violations may predict vehicle crashes in Korea.

Methods: A total of 500,000 drivers were randomly selected from the 11.6 million driver records of the Ministry of Land, Transport and Maritime Affairs in Korea. Records of traffic crashes were obtained from the archives of the Korea Insurance Development Institute. After matching the past violation history for the period 2004–2005 with the number of crashes in year 2006, a total of 488,139 observations were used for the analysis. Zero-inflated negative binomial model was used to determine the incident risk ratio (IRR) of vehicle crashes by past violations of individual drivers. The included covariates were driver's age, gender, district of residence, vehicle choice, and driving experience.

Results: Drivers violating (1) a hit-and-run or drunk driving regulation at least once and (2) a signal, central line, or speed regulation more than once had a higher risk of a vehicle crash with respective IRRs of 1.06 and 1.15. Furthermore, female gender, a younger age, fewer years of driving experience, and middle-sized vehicles were all significantly associated with a higher likelihood of vehicle crashes.

Conclusions: Drivers' demographic characteristics and past traffic violations could predict vehicle crashes in Korea. Greater resources should be assigned to the provision of traffic safety education programs for the high-risk driver groups.     

Drowsy drivers: The effect of light and circadian rhythm on crash occurrence

Drowsiness has been recognized as a pervasive problem for drivers, with effects comparable to alcohol. Alcohol, however, has a clear legal limit for impairment; there are no comparable criteria to suggest sleepiness. Drowsiness has been associated with light and circadian rhythm. To investigate the joint effects of these factors on crash occurrence, along with other factors, single vehicle crashes reported in Ontario (1999–2004) were analyzed. Crashes occurring at four times of day, when light varies and circadian rhythm is low (2–5 a.m. and 2–4 p.m.) and with similar light conditions and higher circadian rhythm (9–11 p.m. and 10 a.m.–12 noon). Logistic regression was used to see how light and other factors are associated with single vehicle crashes occurring at times of low circadian rhythm, when drowsiness is more likely.Initial results indicated many circumstances associated with occurrence at these times: the age and sex of the driver and reported driver condition as well as weather. There is, however, an interaction between light and presumed alertness. In separate analyses for daytime and night time crashes most variables were significant for nighttime crashes but not for daytime events. The effects of alcohol and youth remained. A lack of light may exacerbate the effects of other factors at times of low alertness; this should be further investigated in controlled environments such as sleep laboratories and/or driving simulators.     

Assessment of older drivers: relationships among on-road errors, medical conditions and test outcome

PROBLEM: It is essential that driver licensing authorities have a valid and reliable system for evaluating older drivers' continuing competency; road tests are usually required as part of such a system. This study sought to find information about the nature of driving errors made during license review tests, and about relationships between error type and test outcome for older drivers. METHOD: Data from licensing authority files from 533 road tests during a 12-month period were analyzed; medical and other referral information was included. Average driver age was 76 years. Performance scores were generated for intersection negotiation, lane changing, low speed manoeuvres, positioning and speed control, safety margin, and car control. RESULTS: Logistic regression analysis showed that test outcome was well predicted by a subset of driving performance scores; adding driver age to the model explained very little variance. Age alone was strongly associated with outcome. Relationships between referral information and test outcome are also reported. IMPACT: Results highlight several factors relevant to the development of more valid and reliable road tests for older drivers.     

Projections of hospitalised fall-related injury in NSW, Australia: impacts on the hospital and aged care sectors

Projections of the number, rate and cost of fall-related hospitalised injuries for individuals aged 65 years and older in New South Wales (NSW), Australia were estimated to 2051 for two scenarios: (1) demographic change only using 2008 admission rates; and (2) modelled change using negative binominal regression taking into account current trends in admission rates. Based on demographic change alone, the number and cost of fall injury hospitalisations among older people is expected to increase almost three-fold by 2051. Transfers to permanent residential aged care will also increase 3.2 fold. However, if the fall-related hospitalisation rate sustains its current trend, these increases are projected to be more than ten-fold by 2051. Even with demographic change alone, there will be a significant impact on the resources required to care for older people suffering a fall injury hospitalisation over the next forty years in NSW. The impact on the hospital and aged care sectors will be considerable unless significant improvements occur in the prevention and treatment of fall-related injury in older people.     

Health, safety, self-regulation and the older driver: It's not just a matter of age

Problem

The purpose of this research was to examine the impact of age and health on patterns of driving and self-regulation among older adults who still drive.

Method

This analysis presents the results of a nationwide survey of drivers who are 50 + (N = 3,824, 53.11% response rate), focusing on questions about the impact of their self-reported health on attitudes toward and self-regulation of driving.

Results

The data indicate that as age increases, so too does reported self-regulation of driving, increasing sharply among those ages 70 and older. The data also indicate that respondent's reported confidence in driving and their enjoyment of driving decline as they age. Health status bears a significant relationship with all three of these variables, positively related to confidence in driving skills and to enjoyment in driving, but negatively related to self-regulation reports. As self-reported health declines, respondent's report engages in greater voluntary restrictions of their driving.

Discussion

All too often, the driving decision is linked primarily to chronological age. Analysis done here indicates that age alone is not the best indicator of self-regulation and how older adults change their driving behaviors.

Summary

This research presents the results of a nationwide survey of 50+ drivers and their self-reported driving, self-regulation behaviors, and health status. Strong support was found for the argument that chronological age is not an adequate measure of self-regulating behaviors and driver safety among those 50+. In particular, it was found that a person's health status and the interaction between age and health are essential considerations in the decisions around self-regulation and driving. People tend to self-regulate more with age, but the effect becomes much more pronounced as health status declines.

Impact on industry

In the coming years, if older adults can't get to where they want to go and continue to be viable consumers in our national fabric, all industries will eventually suffer. Transportation is a key component to the nation's social contract with older individuals and their families.     

Evaluating the impact of criminalizing drunk driving on years of life lost due to road traffic deaths in one megacity,China

Objective: Road safety is an important public health issue worldwide. However, few studies have analyzed the association between criminalizing drunk driving and years of life lost (YLL) due to road traffic deaths (RTDs). Our study can provide useful information about this policy.

Methods: We used interrupted time-series analysis to find the changes in monthly YLL and RTD before and after law enforcement began using RTD data from 2008 to 2014 in Tianjin.

Results: After adjustment for seasonality, months, holidays, and the number of people in each district, criminalizing drunk driving was followed by a 11.1% (95% confidence interval [CI], 1.1–21.1%) reduction in risk of RTDs and a corresponding 778.1-year (95% CI, 200–1,355.1) reduction in monthly YLL. The reduction in YLL was especially significant among males, those aged 16–64 years old, and suburban residents.

Conclusions: This study highlights that the law can lead to a reduction in YLL due to RTDs in Tianjin, China. Large immediate public health benefits resulted from the new road traffic law in China. YLL provides a complementary measure for examining the effect of criminalization on drunk driving RTDs.     

Effects of environment, vehicle and driver characteristics on risky driving behavior at work zones

This study aims to analyze the effects of environment, vehicle and driver characteristics on the risky driving behavior at work zones. A decision tree is developed using the classification and regression tree (CART) algorithm to graphically display the relationship between the risky driving behavior and its influencing factors. This approach could avoid the inherent problems occurred in the conventional logistic regression models and further improve the model prediction accuracy. Based on the Michigan M-94/I-94/I-94BL/I-94BR highway work zone driving behavior data, the decision tree comprising 33 leaf nodes is built. Bad weather, poor road and light conditions, partial/no access control, no traffic control devices, turning left/right and driving in an old vehicle are found to be associated with the risky driving behavior at work zones. The middle-aged drivers, who are going straight ahead in their vehicles with medium service time and equipped with an airbag system, are more likely to take risky behavior at lower work zone speed limits. Further, the middle-aged male drivers engage in risky driving behavior more frequently than the middle-aged female drivers. The number of lanes exhibits opposing effects on risky behavior under different traveling conditions. More specifically, the risky driving behavior is associated with the single-lane road under bad light or weather conditions while drivers are more likely to engage in risky behavior on the multi-lane road under good light conditions.     

Child passenger injury risk in motor vehicle crashes: a comparison of nighttime and daytime driving by teenage and adult drivers

INTRODUCTION: To examine the association between child passenger injury risk, restraint use, and crash time (day vs. night) for children in crashes of vehicles driven by teenage versus adult drivers. METHODS: Cross-sectional study involving telephone interviews with insured drivers in a probability sample of 6,184 crashes involving 10,028 children. RESULTS: Child passengers in teen nighttime crashes had an increased injury risk and an increased risk of restraint nonuse compared with those in teen daytime crashes. This increased injury risk can be explained by differences in the age of child passengers, collision type, and child passenger's restraint status associated with time of day. CONCLUSIONS: In order to limit the risk of injury to child passengers driven by teens, Graduated Driver Licensing (GDL) laws should include provisions restricting nighttime driving, as well as mandates for age-appropriate restraint for child passengers. Consideration should also be given for education in child passenger safety for novice teen drivers as part of the licensing process. IMPACT ON INDUSTRY: Results of this study can be used to support advocacy efforts by the automotive industry and others to promote nighttime driving restrictions on novice drivers. In addition, given that both driver groups were more likely to be involved in a single-vehicle collision during the night, technologies such as electronic stability control may offer opportunities for protection. Further reseach on specific circumstances of teen nighttime crashes is needed to inform industry efforts to improve visibility or vehicle operation under poor lighting conditions.     

Influence of light zones on drivers' visual fixation characteristics and traffic safety in extra-long tunnels

Objective: Special light zone is a new illumination technique that promises to improve the visual environment and improve traffic safety in extra-long tunnels. The purpose of this study is to identify how light zones affect the dynamic visual characteristics and information perception of drivers as they pass through extra-long tunnels on highways.

Methods: Thirty-two subjects were recruited for this study, and fixation data were recorded using eye movement tracking devices. A back-propagation artificial neural network was employed to predict and analyze the influence of special light zones on the variations in the fixation duration and pupil area of drivers. The analytic coordinates of focus points at different light zones were clustered to obtain different visual fixation regions using dynamic cluster theory.

Results: The findings of this study indicated that the special light zones had different influences on fixation duration and pupil area compared to other sections. Drivers gradually changed their fixation points from a scattered pattern to a narrow and zonal distribution that mainly focused on the main visual area at the center, the road just ahead, and the right side of the main visual area while approaching the special light zones. The results also showed that the variation in illumination and landscape in light zones was more important than driving experience to yield changes in visual cognition and driving behavior.

Conclusions: It can be concluded that the special light zones can help relieve drivers' vision fatigue to some extent and further develop certain visual stimulus that can enhance drivers' attention. The study would provide a scientific basis for safety measurement implementation in extra-long tunnels.     

CDC's research portfolio in older adult fall prevention: a review of progress, 1985-2005, and future research directions

PROBLEM: Falls are a leading cause of mortality and morbidity among adults age 65 and older. Population models predict steep increases in the 65 and older population bands in the next 10-15 years and in turn, public health is bracing for increased fall rates and the strain they place on health care systems and society. To assess progress in fall prevention, the Centers for Disease Control and Prevention conducted a research portfolio review to examine the quality, relevance, outcomes and successes of the CDC fall prevention program and its impact on public health. METHODS: A peer review panel was charged with reviewing 20 years of funded research and conducting a SWOT (strengths, weaknesses, opportunities, and threats) analysis for extramural and intramural research activities. Information was collected from grantees (via a survey instrument), staff were interviewed, and progress reports and products were reviewed and analyzed. RESULTS: CDC has invested over $24,900,000 in fall-related research and programs over 20 years. The portfolio has had positive impacts on research, policies and programs, increasing the public health injury prevention workforce, and delivering effective fall prevention programs. DISCUSSION: Public health agencies, practitioners, and policy makers recognize that while there are some evidence-based older adult fall prevention interventions available, many remain unused or are infeasible to implement. Specific recommendations across the public health model, include: additional research in gathering robust epidemiologic data on trends and patterns of fall-related injuries at all levels; researching risk factors by setting or sub-population; developing and testing innovative interventions; and engaging in translation and dissemination research on best practices to increase uptake and adoption of fall prevention strategies. CDC has responded to a number of suggestions from the portfolio review including: funding translation research of a proven Tai Chi fall intervention; beginning to address gaps in gender, ethnic, and racial differences in falls; and collaborating with partner organizations who share in CDC's mission to improve public health by preventing falls and reducing fall-related injuries. IMPACT ON INDUSTRY: Industry has an opportunity to develop more accessible and usable devices to reduce injury from falls (for example, hip protectors and force reducing flooring). By implementing effective, evidence-based interventions to prevent falls and reduce injuries from falls, significant decreases in health care costs can be expected.     

A study on chest injury mechanism and the effectiveness of a headform impact test for pedestrian chest protection from vehicle collisions

This study was aimed at investigating the injury mechanism of pedestrian chests in collisions with passenger vehicles of various frontal shapes and examining the influence of the local structural stiffness on the chest injury risk by using the headform impact test at the chest contact area of the vehicle. Three simulations of vehicle to pedestrian collisions were conducted using three validated pedestrian finite element (FE) models of three pedestrian heights of 177 (AM50th), 165 and 150 cm and three FE vehicles models representing a one-box vehicle, a minicar and a medium car. The validity of the vehicle models was evaluated by comparing the headform acceleration against the measured responses from headform impact tests. The chest impact kinematics and the injury mechanisms were analyzed in terms of the distribution of the von Mises stress of the ribcage and in terms of the chest deflections. The chest contact locations on the front panel and the bonnet top were identified in connection to the causation of rib fractures. The risk of rib fractures was predicted by using the von Mises stress distribution. The headform impact tests were carried out at the chest contact area on the front panel and bonnet to examine the safety performance with respect to pedestrian chest protection. In simulations of the one-box vehicle to pedestrian collisions, the chest was struck directly by the frontal structure at a high velocity and deformed substantially, since a shear force was generated by the stiff windshield frame. The acceleration of the headform was related to the rib deflections. The injury threshold of the ribcage deflection (42 mm) corresponded to the headform average acceleration of 68 G. In the minicar collision, the chest was struck with the bonnet top and cowl area at a low velocity, and the deformation was small due to the distributed contact force between the chest and the bonnet top. Besides, the ribcage deformation was too small for bridging a relation between the headform accelerations and rib deflections. In the medium car collision, the deformation mode of the chest was similar to that in the minicar collision. The chest collided with the bonnet top at a low velocity and deformed uniformly. The deflection of the ribs had an observable correlation with the headform accelerations measured in the headform impact tests. The frontal shape of a vehicle has a large influence on a pedestrian’s chest loadings, and the chest deformation depends on the size of the pedestrian and the stiffness of the vehicle. The one-box passenger vehicle causes a high chest injury risk. The headform impactor test can be utilized for the evaluation of the local stiffness of a vehicle’s frontal structure. The reduction of the headform acceleration is an effective measure for pedestrian chest protection for specific shapes of vehicles by efficacy in modifying the local structural stiffness.