Crossing county lines: the impact of crash location and driver's residence on motor vehicle crash fatality

Injury severity analysis of familiar drivers and unfamiliar drivers in single-vehicle crashes on the mountainous highways

Mountainous highways suffer from high crash rates and fatality rates in many countries, and single-vehicle crashes are overrepresented along mountainous highways. Route familiarity has been found greatly associated with driver behaviour and traffic safety. This study aimed to investigate and compare the contributory factors that significantly influence the injury severities of the familiar drivers and unfamiliar drivers involved in mountainous highway single-vehicle crashes. Based on 3037 cases of mountainous highway single-vehicle crashes from 2015 to 2017, the characteristics related to crash, environment, vehicle and driver are included. Random-effects generalized ordered probit (REGOP) models were applied to model injury severities of familiar drivers and unfamiliar drivers that are involved in the single-vehicle crashes on the mountainous highways, given that the single-vehicle crashes had occurred. The results of REGOP models showed that 8 of the studied factors are found to be significantly associated with the injury severities of the familiar drivers, and 10 of the studied factors are found to significantly influence the injury severities of unfamiliar drivers. These research results suggest that there is a large difference of significant factors contributing to the injury severities between familiar drivers and unfamiliar drivers. The results shed light on both the similar and different causes of high injury severities for familiar and unfamiliar drivers involved in mountainous highway single-vehicle crashes. These research results can help develop effective countermeasures and proper policies for familiar drivers and unfamiliar drivers targetedly on the mountainous highways and alleviate injury severities of mountainous highway single-vehicle crashes to some extent. Based on the results of this study, some potential countermeasures can be proposed to minimize the risk of single-vehicle crashes on different mountainous highways, including tourism highways with a large number of unfamiliar drivers and other normal mountainous highways with more familiar drivers.

The relationship between geographic location and outcomes following injury: A scoping review

INTRODUCTION

Globally, injury incidence and injury-fatality rates are higher in regional and remote areas. Recovery following serious injury is complex and requires a multi-disciplinary approach to management and community re-integration to optimise outcomes. A significant knowledge gap exists in understanding the regional variations in hospital and post-discharge outcomes following serious injury. The aim of this study was to review the evidence exploring the association between the geographic location, including both location of the event and place of residence, and outcomes following injury.

MATERIALS AND METHODS

A scoping review was used to investigate this topic and provide insight into geographic variation in outcomes following traumatic injury. Seven electronic databases and reference lists of relevant articles were searched from inception to October 2018. Studies were included if they measured injury-related mortality, outcomes associated with hospital admission, post-injury physical or psychological function and analysed these outcomes in relation to geographic location.

RESULTS

Of the 2,213 studies identified, 47 studies were included revealing three key groups of outcomes: mortality (n = 35), other in-hospital outcomes (n = 8); and recovery-focused outcomes (n = 12). A variety of measures were used to classify rurality across studies with inconsistent definitions of rurality/remoteness. Of the studies reporting injury-related mortality, findings suggest that there is a greater risk of fatality in rural areas overall and in the pre-hospital phase. For those patients that survived to hospital, the majority of studies included identified no difference in mortality between rural and urban patient groups. In the small number of studies that reported other in-hospital and recovery outcomes no consistent trends were identified.

CONCLUSION

Rural patients had a higher overall and pre-hospital mortality following injury. However, once admitted to hospital, there was no significant difference in mortality. Inconsistencies were noted across measures of rurality measures highlighting the need for more specific and consistent international classification methods. Given the paucity of data on the impact of geography on non-mortality outcomes, there is a clear need to develop a larger evidence base on regional variation in recovery following injury to inform the optimisation of post-discharge care services.

Exploring the relationships between drivers' familiarity and two-lane rural road accidents. A multi-level study

Previous research has suggested that drivers' route familiarity/unfamiliarity (using different definitions of familiarity), and the interactions between familiar and unfamiliar drivers, may affect both the driving performances and the likelihood of road crashes. The purpose of this study is to provide a contribution in the search for relationships between familiarity and crashes by: 1) introducing a measure of familiarity based on the distance from residence; 2) analyzing a traffic and accident dataset referred to rural two-lane sections of the Norwegian highways E6 and E39; 3) using a multi-level approach, based on different perspectives, from a macro analysis to more detailed levels. In the macro analyses, the accident rates computed for different seasons and for different summer traffic variation rates (used as indicators of the share of familiar drivers in the flow) were performed. At the second level, a logistic regression model was used to explain the familiarity/unfamiliarity of drivers (based on their distance from residence), through variables retrieved from the database. In the last step, an in-depth analysis considering also accident types and dynamics was conducted. In the macro analysis, no differences were found between accident rates in the different conditions. Whereas, as emerged from the detailed analyses, the factors: high traffic volume, low summer traffic variation, autumn/winter, minor intersections/driveways, speed limits <80 km/h, travel purposes (commuting/not working) are associated to higher odds of having familiar drivers involved in crashes; while the factors: high traffic volume, high summer traffic variation, summer, head on/rear end-angle crashes, heavy vehicles involved, travel purposes (not commuting), young drivers involved are associated to higher odds of finding unfamiliar drivers involved. To a minor extent, some indications arise from the in-depth analyses about crash types and dynamics, especially for familiar drivers. With regard to the definitions used in this article, the familiarity was confirmed as an influential factor on the accident risk, possibly due to distraction and dangerous behaviors, while the influence of being unfamiliar on the accident proneness has some unclarified aspects. However, crashes to unfamiliar drivers may cluster at sites showing high summer traffic variation and in summer months.

Rural and Urban Differences in Passenger-Vehicle-Occupant Deaths and Seat Belt Use Among Adults - United States, 2014

PROBLEM/CONDITION

Motor-vehicle crashes are a leading cause of death in the United States. Compared with urban residents, rural residents are at an increased risk for death from crashes and are less likely to wear seat belts. These differences have not been well described by levels of rurality.

REPORTING PERIOD

2014.

DESCRIPTION OF SYSTEMS

Data from the Fatality Analysis Reporting System (FARS) and the Behavioral Risk Factor Surveillance System (BRFSS) were used to identify passenger-vehicle-occupant deaths from motor-vehicle crashes and estimate the prevalence of seat belt use. FARS, a census of U.S. motor-vehicle crashes involving one or more deaths, was used to identify passenger-vehicle-occupant deaths among adults aged ≥18 years. Passenger-vehicle occupants were defined as persons driving or riding in passenger cars, light trucks, vans, or sport utility vehicles. Death rates per 100,000 population, age-adjusted to the 2000 U.S. standard population and the proportion of occupants who were unrestrained at the time of the fatal crash, were calculated. BRFSS, an annual, state-based, random-digit-dialed telephone survey of the noninstitutionalized U.S. civilian population aged ≥18 years, was used to estimate prevalence of seat belt use. FARS and BRFSS data were analyzed by a six-level rural-urban designation, based on the U.S. Department of Agriculture 2013 rural-urban continuum codes, and stratified by census region and type of state seat belt enforcement law (primary or secondary).

RESULTS

Within each census region, age-adjusted passenger-vehicle-occupant death rates per 100,000 population increased with increasing rurality, from the most urban to the most rural counties: South, 6.8 to 29.2; Midwest, 5.3 to 25.8; West, 3.9 to 40.0; and Northeast, 3.5 to 10.8. (For the Northeast, data for the most rural counties were not reported because of suppression criteria; comparison is for the most urban to the second-most rural counties.) Similarly, the proportion of occupants who were unrestrained at the time of the fatal crash increased as rurality increased. Self-reported seat belt use in the United States decreased with increasing rurality, ranging from 88.8% in the most urban counties to 74.7% in the most rural counties. Similar differences in age-adjusted death rates and seat belt use were observed in states with primary and secondary seat belt enforcement laws.

INTERPRETATION

Rurality was associated with higher age-adjusted passenger-vehicle-occupant death rates, a higher proportion of unrestrained passenger-vehicle-occupant deaths, and lower seat belt use among adults in all census regions and regardless of state seat belt enforcement type.

PUBLIC HEALTH ACTIONS

Seat belt use decreases and age-adjusted passenger-vehicle-occupant death rates increase with increasing levels of rurality. Improving seat belt use remains a critical strategy to reduce crash-related deaths in the United States, especially in rural areas where seat belt use is lower and age-adjusted death rates are higher than in urban areas. States and communities can consider using evidence-based interventions to reduce rural-urban disparities in seat belt use and passenger-vehicle-occupant death rates.

Factors Associated with Pediatric Mortality from Motor Vehicle Crashes in the United States: A State-Based Analysis

OBJECTIVE

To examine geographic variation in motor vehicle crash (MVC)-related pediatric mortality and identify state-level predictors of mortality.

STUDY DESIGN

Using the 2010-2014 Fatality Analysis Reporting System, we identified passengers <15 years of age involved in fatal MVCs, defined as crashes on US public roads with ≥1 death (adult or pediatric) within 30 days. We assessed passenger, driver, vehicle, crash, and state policy characteristics as factors potentially associated with MVC-related pediatric mortality. Our outcomes were age-adjusted, MVC-related mortality rate per 100 000 children and percentage of children who died of those in fatal MVCs. Unit of analysis was US state. We used multivariable linear regression to define state characteristics associated with higher levels of each outcome.

RESULTS

Of 18 116 children in fatal MVCs, 15.9% died. The age-adjusted, MVC-related mortality rate per 100 000 children varied from 0.25 in Massachusetts to 3.23 in Mississippi (mean national rate of 0.94). Predictors of greater age-adjusted, MVC-related mortality rate per 100 000 children included greater percentage of children who were unrestrained or inappropriately restrained (P < .001) and greater percentage of crashes on rural roads (P = .016). Additionally, greater percentages of children died in states without red light camera legislation (P < .001). For 10% absolute improvement in appropriate child restraint use nationally, our risk-adjusted model predicted >1100 pediatric deaths averted over 5 years.

CONCLUSIONS

MVC-related pediatric mortality varied by state and was associated with restraint nonuse or misuse, rural roads, vehicle type, and red light camera policy. Revising state regulations and improving enforcement around these factors may prevent substantial pediatric mortality.

How do the definitions of urban and rural matter for transportation safety? Re-interpreting transportation fatalities as an outcome of regional development processes

Urban and rural places are integrated through economic ties and population flows. Despite their integration, most studies of road safety dichotomize urban and rural places, and studies have consistently demonstrated that rural places are more dangerous for motorists than urban places. Our study investigates whether these findings are sensitive to the definition of urban and rural. We use three different definitions of urban-rural continua to quantify and compare motor vehicle occupant fatality rates per person-trip and person-mile for the state of Wisconsin. The three urban-rural continua are defined by: (1) popular impressions of urban, suburban, and rural places using a system from regional economics; (2) population density; and (3) the intensity of commute flows to core urbanized areas. In this analysis, the three definitions captured different people and places within each continuum level, highlighting rural heterogeneity. Despite this heterogeneity, the three definitions resulted in similar fatality rate gradients, suggesting a potentially latent "rural" characteristic. We then used field observations of urban-rural transects to refine the definitions. When accounting for the presence of higher-density towns and villages in rural places, we found that low-density urban places such as suburbs and exurbs have fatality rates more similar to those in rural places. These findings support the need to understand road safety within the context of regional development processes instead of urban-rural categories.

How would increasing seat belt use affect the number of killed or seriously injured light vehicle occupants?

The expected effects of increasing seat belt use on the number of killed or seriously injured (KSI) light vehicle occupants have been estimated for three scenarios of increased seat belt use in Norway, taking into account current seat belt use, the effects of seat belts and differences in crash risk between belted and unbelted drivers. The effects of seat belts on fatality and injury risk were investigated in a meta-analysis that is based on 24 studies from 2000 or later. The results indicate that seat belts reduce both fatal and non-fatal injuries by 60% among front seat occupants and by 44% among rear seat occupants. Both results are statistically significant. Seat belt use among rear seat occupants was additionally found to about halve fatality risk among belted front seat occupants in a meta-analysis that is based on six studies. Based on an analysis of seat belt wearing rates among crash involved and non-crash involved drivers in Norway it is estimated that unbelted drivers have 8.3 times the fatal crash risk and 5.2 times the serious injury crash risk of belted drivers. The large differences in crash risk are likely to be due to other risk factors that are common among unbelted drivers such as drunk driving and speeding. Without taking into account differences in crash risk between belted and unbelted drivers, the estimated effects of increasing seat belt use are likely to be biased. When differences in crash risk are taken into account, it is estimated that the annual numbers of KSI front seat occupants in light vehicles in Norway could be reduced by 11.3% if all vehicles had seat belt reminders (assumed seat belt wearing rate 98.9%), by 17.5% if all light vehicles had seat belt interlocks (assumed seat belt wearing rate 99.7%) and by 19.9% if all front seat occupants of light vehicles were belted. Currently 96.6% of all (non-crash involved) front seat occupants are belted. The effect on KSI per percentage increase of seat belt use increases with increasing initial levels of seat belt use. Had all rear seat occupants been belted, the number of KSI front seat occupants could additionally be reduced by about 0.6%. The reduction of the number of KSI rear seat occupants would be about the same in terms of numbers of prevented KSI.

Residence place as a risk factor in different types of fatal car accidents

The association between place of residence, population density, relief and type of event (collision or non-collision of the vehicle) has not been evaluated in developing countries. The main objective of this study is to determine the differential factors associated with the occurrence of deaths of collision and non-collision automobile users in Patagonia, Argentina. A multiple logistic regression analysis was performed using as the dependent variable death by car accident (collision or non-collision of the vehicle) and sex, age, place of residence of the victim, relief and population density as the independent variables. Collision fatalities were related to areas of high population density, while non-collision fatalities were related to areas of low population density, mountainous landscape and place of residence of the victims outside the Patagonian region. The results obtained in this study indicate the need to develop differential primary prevention policies by place of residence of car occupants, focusing on Patagonia non-resident drivers and by emphasising non-collision accidents.

Graduated driver license nighttime compliance in U.S. teen drivers involved in fatal motor vehicle crashes

BACKGROUND

Examination of teen driver compliance with graduated driver licensing (GDL) laws could be instrumental in identifying factors associated with persistently high motor vehicle mortality rates.

METHODS

Fatality analysis reporting system (FARS) data from the years 2006 to 2009 were used in this nation-wide cross-sectional study of drivers covered by a state nighttime GDL law (n=3492). A new definition of weekend, based on the school night in relation to the teenage social landscape, redefined Friday night as a weekend night and Sunday night as a weekday/school night and compared it to previous weekend definitions. Multiple logistic regression was used to examine independent effects of demographic, behavioral, environmental, contextual, and other factors on compliance with nighttime GDL laws. All analyses were performed in Stata version 11.

RESULTS

Given coverage under nighttime GDL laws, drivers aged 15-17 years were non-compliant in 14.9% of the fatal MVCs in which they were involved, and nearly one-fifth (18.8%) of all fatalities aged 15-17 years were associated with non-compliance. Mortality risk was 10% higher using a revised social (school night) versus traditional (Sat-Sun) weekend definitions. In multivariable analysis, drivers non-compliant with nighttime GDL laws were more likely to be drinking (OR=4.97, 3.85-6.40), unbelted (OR=1.58, 1.25-1.99), driving on the weekend (OR=1.82, 1.47-2.24), and killed (OR=1.31, 1.04-1.65).

CONCLUSION

GDL non-compliance contributes to teen motor vehicle mortality. Legislative and enforcement efforts targeting non-school night driving, seatbelt nonuse and alcohol have potential to further reduce teen driving mortality.

An examination of the environmental, driver and vehicle factors associated with the serious and fatal crashes of older rural drivers

Motor vehicle crashes involving rural drivers aged 75 years and over are more than twice as likely to result in a serious or fatal injury as those involving their urban counterparts. The current study examined some of the reasons for this using a database of police-reported crashes (2004-2008) to identify the environmental (lighting, road and weather conditions, road layout, road surface, speed limit), driver (driver error, crash type), and vehicle (vehicle age) factors that are associated with the crashes of older rural drivers. It also determined whether these same factors are associated with an increased likelihood of serious or fatal injury in younger drivers for whom frailty does not contribute to the resulting injury severity. A number of environmental (i.e., undivided, unsealed, curved and inclined roads, and areas with a speed limit of 100km/h or greater) and driver (i.e., collision with a fixed object and rolling over) factors were more frequent in the crashes of older rural drivers and additionally associated with increased injury severity in younger drivers. Moreover, when these environmental factors were entered into a logistic regression model to predict whether older drivers who were involved in crashes did or did not sustain a serious or fatal injury, it was found that each factor independently increased the likelihood of a serious or fatal injury. Changes, such as the provision of divided and sealed roads, greater protection from fixed roadside objects, and reduced speed limits, appear to be indicated in order to improve the safety of the rural driving environment for drivers of all ages. Additionally, older rural drivers should be encouraged to reduce their exposure to these risky circumstances.

Increased population density of neurosurgeons associated with decreased risk of death from motor vehicle accidents in the United States

Object

Motor vehicle accidents (MVAs) are a leading cause of death and disability in young people. Given that a major cause of death from MVAs is traumatic brain injury, and neurosurgeons hold special expertise in this area relative to other members of a trauma team, the authors hypothesized that neurosurgeon population density would be related to reduced mortality from MVAs across US counties.

Methods

The Area Resource File (2009–2010), a national health resource information database, was retrospectively analyzed. The primary outcome variable was the 3-year (2004–2006) average in MVA deaths per million population for each county. The primary independent variable was the density of neurosurgeons per million population in the year 2006. Multiple regression analysis was performed, adjusting for population density of general practitioners, urbanicity of the county, and socioeconomic status of the county.

Results

The median number of annual MVA deaths per million population, in the 3141 counties analyzed, was 226 (interquartile range [IQR] 151–323). The median number of neurosurgeons per million population was 0 (IQR 0–0), while the median number of general practitioners per million population was 274 (IQR 175–410). Using an unadjusted analysis, each increase of 1 neurosurgeon per million population was associated with 1.90 fewer MVA deaths per million population (p < 0.001). On multivariate adjusted analysis, each increase of 1 neurosurgeon per million population was associated with 1.01 fewer MVA deaths per million population (p < 0.001), with a respective decrease in MVA deaths of 0.03 per million population for an increase in 1 general practitioner (p = 0.007). Rural location, persistent poverty, and low educational level were all associated with significant increases in the rate of MVA deaths.

Conclusions

A higher population density of neurosurgeons is associated with a significant reduction in deaths from MVAs, a major cause of death nationally. This suggests that the availability of local neurosurgeons is an important factor in the overall likelihood of survival from an MVA, and therefore indicates the importance of promoting neurosurgical education and practice throughout the country.

Risk factors for fatal crashes in rural Australia

This paper presents findings from the rural and remote road safety study, conducted in Queensland, Australia, from March 2004 till June 2007, and compares fatal crashes and non-fatal but serious crashes in respect of their environmental, vehicle and operator factors. During the study period there were 613 non-fatal crashes resulting in 684 hospitalised casualties and 119 fatal crashes resulting in 130 fatalities. Additional information from police sources was available on 103 fatal and 309 non-fatal serious crashes. Over three quarters of both fatal and hospitalised casualties were male and the median age in both groups was 34 years. Fatal crashes were more likely to involve speed, alcohol and violations of road rules and fatal crash victims were 2½ times more likely to be unrestrained inside the vehicle than non-fatal casualties, consistent with current international evidence. After controlling for human factors, vehicle and road conditions made a minimal contribution to the seriousness of the crash outcome. Targeted interventions to prevent fatalities on rural and remote roads should focus on reducing speed and drink driving and promoting seatbelt wearing.

Evaluation of the Click It or Ticket intervention in Utah

OBJECTIVE

To evaluate the Click It or Ticket (CIOT) intervention conducted in Utah by comparing changes in safety belt use using observational safety belt surveys pre- and post-intervention.

METHODS

Observational surveys of safety belt use for drivers and front seat passengers (collectively referred to as front seat occupants) were conducted before and after the media and enforcement blitz of the CIOT intervention. Data were collected from 16 urban sites during the daytime and nighttime. Logistic regression and generalized estimating equations were used to compute odds ratios for safety belt use adjusted for front seat occupant characteristics.

RESULTS

Overall safety belt use was observed at 76.5% pre-intervention and 84.8% post-intervention, an improvement of 8.3% (95% confidence interval [CI]: 5.2%, 11.3%). Daytime and nighttime safety belt use improved by 7.8% (95% CI: 3.5%, 12.1%) and 9.7% (95% CI: 6.4%, 13.0%), respectively. While males showed a greater improvement (9.9%) in safety belt use when compared to females (5.7%); males were still less likely to use safety belts than females.

CONCLUSIONS

The CIOT intervention is associated with increased safety belt use at the sites observed in Utah, including among the two high risk groups targeted by the intervention: nighttime occupants and males.

A residential location approach to traffic safety: two case studies from Germany

This paper aims to spatially differentiate the road accident risk associated with living at a certain place of residence. Official accident data usually record the place the accident occurred, but not the casualties' places of residence. Among those involved in an accident at a certain place there may obviously be some non-residents, such as in-commuters and transients. Hence spatial analysis based on place of accident may not be suitable for drawing conclusions about specific risk levels for people living in certain places. People's risk of encountering an accident in areas other than that where they live may vary with their mobility. We report on two case studies for the German states of North Rhine-Westphalia and Lower Saxony, which are based on casualties' places of residence. We draw on two data sets both of which have specific advantages and disadvantages. From the data we calculate population-based risk figures on the district level and, for Lower Saxony, on the municipality level. For North Rhine-Westphalia these are categorised by age group and transport mode. We also investigate to what extent accident related analyses can be used to estimate residential related risks. The results show that the risk of being killed or seriously injured in a road accident is considerably lower for the population of agglomeration cores than for the suburban and rural population. Macro-economically this means that suburban and rural areas have markedly higher accident costs than cities.

Crash risk of older drivers after attending a mature driver education program

PURPOSE

The primary aim of this study was to determine if the crash rate of aging drivers can be mitigated by post-license driver education.

DESIGN AND METHODS

This study of 884 older drivers who attended the 55 Alive/Mature Driving program was conducted in three phases. Phase 1, which examined self-selection bias of seniors attending the driver education program, and Phase 2, which examined changes in crash rate after attending the program, were carried out through analysis of driving records before and after attending the course. In Phase 3, the use of selection, optimization, and compensation strategies by older male drivers who attended 55 Alive/Mature Driving was addressed through focus group interviews.

RESULTS

Findings showed a self-selection bias among older drivers who attended 55 Alive/Mature Driving. Results also showed attendance at the program was associated with an increased number of crashes for men aged 75 years and older, but no effect on subsequent crashes of younger men and women of all ages. Focus group sessions suggested older men who attended the program used fewer strategies to cope with their declining skills.

IMPLICATIONS

Recognizing and understanding characteristics and behaviors of older drivers who attend remedial driver education is essential to the design and delivery of successful driver safety programs.