Adjusting for car occupant injury liability in relation to age, speed limit, and gender-specific driver crash involvement risk

It is well established that older drivers' fragility is an important factor associated with higher levels of fatal crash involvement for older drivers. There has been less research on age-related fragility with respect to the sort of minor injuries that are more common in injury crashes. This study estimates a quantity that is related to injury fragility: the probability that a driver or a passenger of that driver will be injured in crashes involving two cars. The effects of other factors apart from drivers' fragility are included in this measure, including the fragility of the passengers, the crashworthiness of cars driven, seatbelt use by the occupants, and characteristics of crashes (including configuration and impact speed). The car occupant injury liability estimates appropriately includes these factors to adjust risk curves by age, gender, and speed limit accounting for overrepresentation in crashes associated with fragility and these other factors.     

The prevalence of seatbelt and mobile phone use among drivers in Riyadh,Saudi Arabia: An observational study

IntroductionRoad traffic injuries (RTIs) are the third leading cause of death in Saudi Arabia. Numerous factors may increase the likelihood of RTIs. The prevalence of risk factors associated with RTIs may vary due to several reasons. Because little is known about these risk factors locally, we examined the prevalence of mobile phone and seatbelt use and their association with spatial locations.MethodsThis is an observational study conducted at major highways and inner intersections throughout Riyadh, the country's capital. Two observers captured seatbelt and mobile phone use among drivers. Logistic regression models were constructed to examine the association between real estate prices and mobile phone or seatbelt use. Observations were categorized as taken place in an affluent neighborhood if the average price per square meter was above 2500 Saudi Riyal.ResultsA total of 1700 drivers were observed in 13 sites citywide. 13.8% of drivers were seen using mobile while driving and only a third of drivers (34%) were wearing seatbelts. Being at an affluent neighborhood was associated with close to three times higher odds of wearing seatbelts (OR = 2.7, 95% CI = 1.9–3.7) and also associated with 42% lower odds of mobile phone use among drivers (OR = 0.58, 95% CI = 0.36–0.92).DiscussionThis study found a high prevalence of traffic violations among drivers in Riyadh. Based on our estimate, 660,000 drivers are roaming the street during daytime while using their phones and they are less likely to wear seatbelts. Unfortunately, this estimate might contribute to increasing RTIs. Despite existing regulations, seatbelt use among drivers is significantly lower than in developed countries (i.e. USA 94%).ConclusionOur study found a high prevalence of traffic violations represented by lack of compliance with seatbelt and mobile phone use laws. These findings provide a basis for their underlying prevalence in SA. Practical applications: Public health prevention programs may use these findings to facilitate support to increasing investment in awareness campaigns and further enforcement by the traffic police to reduce RITs and improve population health.     

Rollover injury: effects of near- and far-seating position, belt use, and number of quarter rolls

PURPOSE: Vehicle and occupant responses in rollovers are complex since many factors influence both. This study analyzes the following factors: 1) belt use, 2) seated position with respect to the lead side in the rollover, 3) another front occupant in the crash, and 4) number of quarter rolls. The aim was to improve our understanding of rollover injury mechanisms. METHOD: Rollover accidents were analyzed using 1992-2004 NASS-CDS data. The sample included adult drivers and right-front passengers. All occupants were evaluated and then a subset of non-ejected occupants was analyzed. Using roll direction and seating position, the sample was divided into near- and far-seated occupants. Injury and fatality risks were determined by seatbelt use, occupancy, rollover direction, and number of quarter rolls. Risk was defined as the number of injured (e.g., MAIS 3+) divided by the number of exposed occupants (MAIS 0-6). Significance in differences was determined. A matched-pair analysis was used to determine the risk of serious injury for near- and far-seated occupants who were either belted or unbelted in the same crash. RESULTS: For all occupants, serious injury risks were highest for far-seated, unbelted occupants at 18.1% +/- 4.8%, followed by near-seated unbelted occupants at 12.0% +/- 3.5%. However, the difference was not statistically significant. Belted near- and far-seated occupants had a similar injury risk of 4.3% +/- 1.2% and 4.0% +/- 1.2%, respectively. For non-ejected occupants, serious injury risk was 9.5% +/- 3.2% for far-seated unbelted occupants and 4.9% +/- 2.1% for near-seated unbelted occupants, not a statistically significant difference. Serious injury risk was similar for belted near- and far-seated non-ejected occupants, at 3.6% +/- 1.1%. Seatbelts were 64.2%-77.9% effective in preventing serious injury for all occupants and 62.1%-26.5% for far- and near-seated, non-ejected occupants, respectively. Based on the matched pairs, seatbelts were less effective for near-seated (5.0%) compared to far-seated (2.8%) occupant MAIS 3+F risks. This was similar for non-ejected occupants. An unbelted near-seated occupant increased the risk for a belted far-seated occupant by 2.2 times, whereas an unbelted far-seated occupant increased the risk for a belted near-seated occupant by 10.2 times. For all occupants, the risk of serious injury increased with the number of quarter rolls, irrespective of seated position. For near-seated occupants, seatbelt effectiveness was higher in < or =1 roll than 1+ roll, at 72.3% compared to 28.3%. For far-seated occupants, seatbelt effectiveness was similar in < or =1 and 1+ roll samples at 78.3% and 76.8%, respectively. Near-seated occupants had the lowest serious injury risk when they were the sole occupant in the vehicle. This was also true for non-ejected occupants. However, far-seated occupants had a lower injury risk when another occupant was involved in the crash. CONCLUSIONS: The effect of carrying another occupant appears to reduce the risk of serious injury to far-seated occupants. However, near-seated occupants are better off being the sole occupant in the vehicle. Seatbelt effectiveness was lowest at 28.3% for non-ejected, near-seated occupants in 1+ rolls. This finding deserves further evaluation in an effort to improve seatbelt effectiveness in rollovers. For belted drivers alone in a rollover, fatality risks are 2.24 times higher for the far- versus near-seated position. Analysis of rollovers by quarter turns indicates that occupants are both far-side and near-side in rollovers. The extent to which this confounds the relationship between roll direction, seating position, and injury risk is unknown.     

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.     

Using naturalistic driving data to examine drivers' seatbelt use behavior: Comparison between teens and adults

ProblemTeens and young drivers are often reported as one driver group that has significantly lower seatbelt use rates than other age groups.ObjectiveThis study was designed to address the questions of whether and how seatbelt-use behavior of novice teen drivers is different from young adult drivers and other adult drivers when driving on real roads.MethodDriving data from 148 drivers who participated in two previous naturalistic driving studies were further analyzed. The combined dataset represents 313,500 miles, 37,695 valid trips, and about 9500 h of driving. Drivers did not wear their seatbelts at all during 1284 trips. Two dependent variables were calculated, whether and when drivers used seatbelts during a trip, and analyzed using logistic regression models.ResultsResults of this study found significant differences in the likelihood of seatbelt use between novice teen drivers and each of the three adult groups. Novice teen drivers who recently received their driver's licenses were the most likely to use a seatbelt, followed by older drivers, middle-aged drivers, and young drivers. Young drivers were the least likely to use a seatbelt. Older drivers were also more likely to use seatbelts than the other two adult groups. The results also showed that novice teen drivers were more likely to fasten their seatbelts at the beginning of a trip when compared to the other three adult groups.SummaryNovice teen drivers who were still in the first year after obtaining their driver's license were the most conservative seatbelt users, when compared to adult drivers.Practical applicationFindings from this study have practical application insights in both developing training programs for novice teen drivers and designing seatbelt reminder and interlock systems to promote seatbelt use in certain driver groups.     

Crash risk by driver age,gender, and time of day using a new exposure methodology

Introduction: Concerns have been raised that the nonlinear relation between crashes and travel exposure invalidates the conventional use of crash rates to control for exposure. A new metric of exposure that bears a linear association to crashes was used as basis for calculating unbiased crash risks. This study compared the two methods – conventional crash rates and new adjusted crash risk – for assessing the effect of driver age, gender, and time of day on the risk of crash involvement and crash fatality. Method: We used police reports of single-car and multi-car crashes with fatal and nonfatal driver injuries that occurred during 2002–2012 in Great Britain. Results: Conventional crash rates were highest in the youngest age group and declined steeply until age 60–69 years. The adjusted crash risk instead peaked at age 21–29 years and reduced gradually with age. The risk of nighttime driving, especially among teenage drivers, was much smaller when based on adjusted crash risks. Finally, the adjusted fatality risk incurred by elderly drivers remained constant across time of day, suggesting that their risk of sustaining a fatal injury due to a crash is more attributable to excess fragility than to crash seriousness. Conclusions: Our findings demonstrate a biasing effect of low travel exposure on conventional crash rates. This implies that conventional methods do not yield meaningful comparisons of crash risk between driver groups and driving conditions of varying exposure to risk. The excess crash rates typically associated with teenage and elderly drivers as well as nighttime driving are attributed in part to overestimation of risk at low travel exposure. Practical Applications: Greater attention should be directed toward crash involvement among drivers in their 20s and 30s as well as younger drivers. Countermeasures should focus on the role of physical vulnerability in fatality risk of elderly 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.     

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.     

Association between older driver characteristics, on-road driving test performance, and crash liability

From May 1999, a new system for licensing older drivers was introduced in New Zealand. It included a practical on-road driving test with expanded scope, to be completed every two years from the time the driver turns 80. The relationship between crashes and test performance needed to be studied to inform the debate regarding the testing system. The population studied was all drivers who entered this licensing system during its first three years of operation. They were defined as crash involved if they were involved in an injury crash during the two years following their first licensure under the new system. Logistic regression was used to describe the risk of crash involvement in terms of driving test performance and other driver characteristics. Each driving test failure was associated with a 33% increase in the odds of crash involvement (95% CI 14% to 55%), controlling for age, gender, minor traffic violations, and whether the older driver lived with another licensed driver or not. Minor traffic violations in the two years following the driving test were associated with twice the odds of crash involvement. These results suggest that the new on-road driving test does identify older driver behaviors or limitations that are related to crash liability. It is anticipated that the results presented here will provide essential information for discussing older driver licensing systems, whose impact will grow in importance as the population of drivers ages.     

Distractions and the risk of car crash injury: the effect of drivers' age

PROBLEM: Motor-vehicle accidents are one of the major causes of injury in most motorized countries. Driver distractions have been suggested as a contributor to traffic accidents. Moreover, age of the driver seems to have a role in the relationship between distractions and car crashes. But very few studies have investigated the effect of driver's age on this relationship. This exploratory study investigated the association between distractions, both inside and outside the vehicle, and the increased risk of car crash injury among drivers across different ages. METHOD: This study used a case series design to analyze data routinely collected by the NSW police in Australia. A special focus of this study was on how drivers' age affects the risk of car crash injury, which was determined by using a well-documented risk estimation methodology. RESULTS: The results obtained indicated that drivers of all ages, on the whole, are more susceptible to distractions inside the vehicle than distractions coming from outside. Age was shown to affect the relationship between in-vehicle distraction and the risk of car crash injury. A separate analysis was also conducted on hand-held phone usage while driving with results supplementing previous findings reported in the literature. IMPACT TO INDUSTRY: Safety strategies to countermeasure in-vehicle distractions have been suggested and discussed.     

Graduated driver licensing in the United States: evaluation results from the early programs

BACKGROUND: Seventeen states enacted graduated driver licensing (GDL) programs that were implemented from 1996 through 1999 and for which evaluations are of interest. METHODS: We received evaluation results reported for six states for which data were available. Summarizing results is difficult in other than the most global terms because of differences in pre-GDL programs, differences in GDL programs, and differences in evaluation methodology. RESULTS: All states identified some crash reduction among teen drivers following GDL implementation. This positive effect was observed across different geographic regions, and with different GDL programs. Simple counts are down-fewer teens are experiencing crashes and becoming injured. After calculating crash rates to adjust for changes over time in populations or licensed drivers, reductions generally were still found. Population-adjusted risks of injury/fatal crash involvement of 16-year-old drivers in Florida and Michigan were reduced by 11% and 24%, respectively. Population-adjusted risks of any crash involvement of 16-year-old drivers in Michigan and North Carolina were reduced by 25% and 27%, respectively. Reductions in night (restricted hours) crash risk were impressive in Florida, Michigan, and North Carolina. A comparison state design was only possible in the Florida evaluation, and results showed greater crash reductions under GDL. Change-point analyses of Michigan's crash data trends over time provided additional support of GDL's effectiveness in reducing crashes. DISCUSSION: Taken as a whole, and including the preliminary findings from California, Ohio, and Pennsylvania, these reports demonstrate the early effectiveness of GDL in reducing the crash risk of teen drivers. The impact of these studies and others to come will guide future research, practice, and policy.     

Comparison of mid-block and intersection-related left turn collisions

OBJECTIVES: To evaluate the factors that might influence an occupant's injury severity during a left turn movement. METHODS: We used the National Automotive Sampling System Crashworthiness Data System (1995-2005) to compare crash characteristics and injury outcome between intersection and midblock left turn collisions. RESULTS: A total of 7,396 collisions were evaluated. Traffic control devices were present in 82% of intersection and 10% of mid-block collisions. After adjustment for potential confounding variables, drivers' injury severity was not significantly associated with the crash location. However, front seat passengers in mid-block collisions had 72% higher odds of experiencing an injury with injury severity score > or =9 (odds ratio: 1.72, 95% confidence interval: 1.09-2.69). Our analysis did not show that drivers or passengers in larger vehicles, e.g., sport utility vehicles and mini-vans, were at lower risk of more severe injuries in comparison to the car occupants in sedans. CONCLUSION: We found that in comparison to intersection-related left turn collisions, mid-block crashes are associated with more severe injuries for front seat passengers. Furthermore, size of the turning vehicle was not significantly associated with injury severity for drivers or front seat passengers.     

Crash risk of ESC-fitted passenger cars

Objective: We examined both fatal and injury at-fault crashes of a population of passenger cars fitted with electronic stability control (ESC). Crash rates were calculated in relation to both registration years and mileage. Crash rates were also calculated for a non-ESC car population and crash rate ratios were calculated to compare the crash risk between ESC-fitted and non-ESC-fitted passenger cars.

Methods: Passenger car models with and without ESC were identified (ESC-equipped cars: 3,352,813 registration years; non-ESC-equipped: 5,839,946 registration years) and their vehicle information for the period 2009–2013, including mileage (ESC-equipped vehicles: 89.3 billion kilometers; non-ESC-equipped: 72.4 billion kilometers), was drawn from the national Vehicular and Driver Data Register.

The registry of Finnish road accident investigation teams was accessed and all fatal at-fault crashes among the cars in the study populations (ESC 97; non-ESC 377) for the period 2009–2013 were analyzed. The motor insurance database includes at-fault crashes leading to injuries and was utilized for analyses (ESC: N?=?8,827, non-ESC: N?=?21,437).

Crash rates and crash rate ratios were calculated to evaluate crash risk of both ESC-equipped and non-ESC-equipped passenger cars. Poisson regression was used to model crash involvement rate ratios both per registration year and per mileage for vehicles with ESC and without ESC, controlling for age and gender of the vehicle owner and vehicle mass.

Results: Passenger cars fitted with ESC showed lower crash rates than non-ESC-equipped cars in all crash types studied. In general, the difference in crash rates between ESC-equipped and non-ESC-equipped vehicles was greater when the crashes were compared to the mileage rather than registration years. The mileage-proportional crash rate of ESC-equipped cars was 64% (95% confidence interval, 61%; 67%) lower in run-off-road crashes resulting in injury and as much as 82% (65%; 91%) lower in fatal run-off-road crashes when suicides and disease attacks were not taken into account.

Conclusions: Our results show that modern passenger cars provide a significant crash risk reduction, which depends on both ESC and passive safety features introduced. Results also show that exposure evaluation in terms of registration years (or vehicle population) instead of true mileage can provide an overly pessimistic view of the crash risk.     

Modelling the relationship of driver license and offense history with fatal and serious injury (FSI) crash involvement

Introduction: Previous research has indicated that increases in traffic offenses are linked to increased crash involvement rates, making reductions in offending an appropriate measure for evaluating road safety interventions in the short-term. However, the extent to which traffic offending predicts fatal and serious injury (FSI) crash involvement risk is not well established, prompting this new Victorian (Australia) study. Method: A preliminary cluster analysis was performed to describe the offense data and assess FSI crash involvement risk for each cluster. While controlling demographic and licensing variables, the key traffic offenses that predict future FSI crash involvement were then identified. The large sample size allowed the use of machine learning methods such as random forests, gradient boosting, and Least Absolute Shrinkage and Selection Operator (LASSO) regression. This was done for the ‘all driver’ sample and five sometimes overlapping groups of drivers; the young, the elderly, and those with a motorcycle license, a heavy vehicle license endorsement and/or a history of license bans. Results: With the exception of the group of drivers who had a history of bans, offense history significantly improved the accuracy of models predicting future FSI crash involvement using demographic and licensing data, suggesting that traffic offenses may be an important factor to consider when analyzing FSI crash involvement risk and the effects of road safety countermeasures. Conclusions: The results are helpful for identifying driver groups to target with further road safety countermeasures, and for showing that machine learning methods have an important role to play in research of this nature. Practical Application: This research indicates with whom road safety interventions should particularly be applied. Changes to driver demerit policies to better target offenses related to FSI crash involvement and repeat traffic offenders, who are at greater risk of FSI crash involvement, are recommended.     

Alcohol-impaired motorcyclists versus car drivers: A comparison of crash involvement and legal consequence from adjudication data

Introduction: Driving under the influence (DUI) increases the probability of motor-vehicle collisions, especially for motorcycles with less protections. This study aimed to identify commonalities and differences between criminally DUI offenses (i.e., with a blood alcohol concentration (BAC) of 80 mg/dL or higher) committed by motorcyclists and car drivers. Methods: A total of 10,457 motorcycle DUIs and 8,402 car DUIs were compared using a series of logistic regression models, using data extracted from the documents of adjudication decisions by the courts of Jiangsu, China. Results: The results revealed that offenders from the high-BAC group (i.e., 200 mg/dL or higher) accounted for more than 20% of the total DUI offenses, and were more likely to be involved in a crash and punished with a longer detention. Motorcyclists had a higher likelihood of crash involvement, and were also more likely to be responsible for single-vehicle crashes associated with higher odds of injury sustained, compared to alcohol-impaired car drivers. In the verdict, motorcycle offenders were more likely to receive a less severe penalty. Conclusions: Interventions are clearly required to focus on reducing in the high-BAC group of offenders. For alcohol-impaired motorcyclists, their risks of crash and injury against BAC climb more steeply than the risks for car drivers. The factors including frequent occurrences, uncertainty of detection, and short-term sentences may weaken the deterrence effect of the criminalization of motorcycle DUI. Practical Applications: The traffic-related adjudication data support traffic safety analysis. Strategies such as combating motorcycle violations (e.g., unlicensed operators or driving unsafe vehicles), undertaking education and awareness campaigns, are expected for DUI prevention.     

First year as a licensed car driver: Gender differences in crash experience

Objective: To explore the crash experience and crash consequences of newly licensed male and female drivers aged 18–29 years.Methodology: A national register-based population cohort of persons born between 1970 and 1972 was followed for the period 1988–2000 on the basis of crash data in Swedish police records. The analyses focused on two crash categories regardless of consequences: single car (SC) and car-to-motor vehicle (CMV).Results: Crash incidence for men was nearly double that of women in all age groups in both crash categories. Age had a protective effect for both sexes, especially for SC crashes. Males, but not females, showed a lag in time from driving license issue date to first crash for SC crashes, which increased with age of obtaining a license. Men’s crash fatality rate was five times higher than that of women for SC crashes (32.2 and 6.1 per 1000, respectively), but the rate was comparable for CMV crashes (16.1 and 15.7, respectively). The crash morbidity rate was 25–30% higher for male drivers in both crash categories.Conclusions: Both young age and male sex emerge as important determinants of crash risk and crash consequences among young Swedish drivers.     

Older driver crash rates in relation to type and quantity of travel

It is a well-established phenomenon that, notwithstanding their overall good crash record, older drivers have a higher than average rate of involvement in injury crashes when the rate is calculated by dividing crash numbers by distance driven. It has been hypothesised that at least some of this higher crash rate is an artefact of the different nature of driving undertaken by many older drivers. For example, driving in congested urban environments provides more opportunities for collisions than driving the same distance on a motorway. However, there have been few opportunities to investigate this theory, as relevant data are difficult to acquire. High-quality data from the New Zealand Travel Survey (1997/1998) were combined with crash data to enable a statistical model to estimate the risk of driver groups under various driving conditions characterised by the type of road used, time of day, day of week, and season of year. Despite elevated crash risks per distance driven compared with middle-aged drivers for most road types, older drivers were as safe as any other age group when driving on motorways. Accounting for the fragility of older drivers and their passengers in the risk estimates for other road types, older drivers appeared to have daytime risks comparable to 25-year-olds and night-time risks as low as any other age group. The driving patterns of older drivers (in terms of when and where they drive) were estimated to minimize their risks in comparison with the driving patterns of other age groups. These results are of interest to both policy makers and transportation planners working against the background of inevitable increases in the number of older drivers as the population ages.     

Motor vehicle restraint system use and risk of spine injury

OBJECTIVE: Motor vehicle collision (MVC)-related spinal injury is a severe and often permanently disabling injury. In addition, strain injuries have been reported as a common outcome of MVCs. Although advances in automobile crashworthiness have reduced both fatalities and severe injuries, the impact of varying occupant restraint systems (seatbelts and airbags) on thoracolumbar spine injuries is unknown. This study examined the relationship between the occurrence of mild to severe cervical and thoracolumbar spine injury and occupant restraint systems among front seat occupants involved in frontal MVCs. METHODS: A retrospective cohort study was conducted among subjects obtained from the 1995-2004 National Automotive Sampling System. Cases were identified based on having sustained a spine injury of >/=1 on the Abbreviated Injury Scale (AIS), 1990 Revision. Risk risks (RRs) and 95% confidence intervals (CIs) were computed comparing occupant restraint systems with unrestrained occupants. RESULTS: We found an overall incidence of AIS1 cervical (11.8%) and thoracolumbar (3.7%) spinal injury. Seatbelt only restraints were associated with increased cervical AIS1 injury (RR = 1.40, 95% CI 1.04-1.88). However, seatbelt only restraints showed the greatest risk reduction for AIS2 spinal injuries. Airbag only restraints reduced thoracolumbar AIS1 injuries (RR = 0.29, 95% CI 0.08-1.04). Seatbelt combined with airbag use was protective for cervical AIS3+ injury overall (RR = 0.29, 95% CI 0.14-0.58), cervical neurological injury (RR = 0.19, 95% CI 0.05-0.81), and thoracolumbar AIS3+ injury overall (RR = 0.20, 95% CI 0.05-0.70). CONCLUSIONS: The results of this study suggest that seatbelts alone or in combination with an airbag increased the incidence of AIS1 spinal injuries, but provide protection against more severe injury to all regions of the spine. Airbag deployment without seatbelt use did not show increased protection relative to unrestrained occupants.     

Socioeconomic background and road traffic injuries: a study of young car drivers in Sweden

The aim of this study is to explore the manner in which different measures of original socioeconomic position (SEP) influence road traffic injuries (RTIs) among young car drivers in Sweden. The study consists of young people age 16-23. Subjects were taken from the Swedish Population and Housing Census of 1990 (n=727,995), and followed up by a search for cases of injury to car drivers in Sweden's National Hospital Discharge Register over the years 1991-96 (n=1,599). Household SEP was measured using social class, education, and disposable income. Relative risks were estimated by Poisson regression and population attributable risks were computed for each measure of SEP. Children of unskilled workers, of the self-employed, and of farmers, as well as children of parents with compulsory education only showed an increased risk of injury as car drivers compared to children in the highest socioeconomic group and children of highly educated parents. By contrast, level of household disposable income was found not to vary with RTI among young drivers. Twenty-five percent of the injuries could be avoided if all young people had the injury rate of the highest socioeconomic group, and 29% if all young people had the injury rate of those with highly educated parents. The reduction of risk differences based on household SEP calls for consideration of factors related to both differential exposure and differential susceptibility, which may be addressed in driver education.