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Redelmeier DA, Wang J, Thiruchelvam D. COVID Vaccine Hesitancy and Risk of a Traffic Crash. Am J Med 2023; 136:153-162.e5. [PMID: 36470796 PMCID: PMC9716428 DOI: 10.1016/j.amjmed.2022.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 10/27/2022] [Accepted: 11/02/2022] [Indexed: 12/03/2022]
Abstract
BACKGROUND Coronavirus disease (COVID) vaccine hesitancy is a reflection of psychology that might also contribute to traffic safety. We tested whether COVID vaccination was associated with the risks of a traffic crash. METHODS We conducted a population-based longitudinal cohort analysis of adults and determined COVID vaccination status through linkages to individual electronic medical records. Traffic crashes requiring emergency medical care were subsequently identified by multicenter outcome ascertainment of all hospitals in the region over a 1-month follow-up interval (178 separate centers). RESULTS A total of 11,270,763 individuals were included, of whom 16% had not received a COVID vaccine and 84% had received a COVID vaccine. The cohort accounted for 6682 traffic crashes during follow-up. Unvaccinated individuals accounted for 1682 traffic crashes (25%), equal to a 72% increased relative risk compared with those vaccinated (95% confidence interval, 63-82; P < 0.001). The increased traffic risks among unvaccinated individuals extended to diverse subgroups, was similar to the relative risk associated with sleep apnea, and was equal to a 48% increase after adjustment for age, sex, home location, socioeconomic status, and medical diagnoses (95% confidence interval, 40-57; P < 0.001). The increased risks extended across the spectrum of crash severity, appeared similar for Pfizer, Moderna, or other vaccines, and were validated in supplementary analyses of crossover cases, propensity scores, and additional controls. CONCLUSIONS These data suggest that COVID vaccine hesitancy is associated with significant increased risks of a traffic crash. An awareness of these risks might help to encourage more COVID vaccination.
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Affiliation(s)
- Donald A Redelmeier
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ont, Canada; Department of Medicine, University of Toronto, Ont, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Ont, Canada; Division of General Internal Medicine; Center for Leading Injury Prevention Practice Education & Research, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada.
| | - Jonathan Wang
- Department of Medicine, University of Toronto, Ont, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Ont, Canada
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ont, Canada; Institute for Clinical Evaluative Sciences (ICES), Toronto, Ont, Canada
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Affiliation(s)
- Donald A Redelmeier
- Departments of Medicine and of Surgery, University of Toronto, Toronto, Ontario, Canada.,Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences,Toronto, Ontario, Canada.,Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.,Center for Leading Injury Prevention Practice Education & Research, Toronto, Ontario, Canada
| | - Junaid A Bhatti
- Departments of Medicine and of Surgery, University of Toronto, Toronto, Ontario, Canada.,Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Institute for Clinical Evaluative Sciences,Toronto, Ontario, Canada
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Schlenker MB, Thiruchelvam D, Redelmeier DA. Association of Cataract Surgery With Traffic Crashes. JAMA Ophthalmol 2018; 136:998-1007. [PMID: 29955857 PMCID: PMC6142973 DOI: 10.1001/jamaophthalmol.2018.2510] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2018] [Accepted: 05/04/2018] [Indexed: 01/19/2023]
Abstract
Importance Cataracts are the most common cause of impaired vision worldwide and may increase a driver's risk of a serious traffic crash. The potential benefits of cataract surgery for reducing a patient's subsequent risk of traffic crash are uncertain. Objective To conduct a comprehensive longitudinal analysis testing whether cataract surgery is associated with a reduction in serious traffic crashes where the patient was the driver. Design, Setting, and Participants Population-based individual-patient self-matching exposure-crossover design in Ontario, Canada, between April 1, 2006, and March 31, 2016. Consecutive patients 65 years and older undergoing cataract surgery (n = 559 546). Interventions First eye cataract extraction surgery (most patients received second eye soon after). Main Outcomes and Measures Emergency department visit for a traffic crash as a driver. Results Of the 559 546 patients, mean (SD) age was 76 (6) years, 58% were women (n = 326 065), and 86% lived in a city (n = 481 847). A total of 4680 traffic crashes (2.36 per 1000 patient-years) accrued during the 3.5-year baseline interval and 1200 traffic crashes (2.14 per 1000 patient-years) during the 1-year subsequent interval, representing 0.22 fewer crashes per 1000 patient-years following cataract surgery (odds ratio [OR], 0.91; 95% CI, 0.84-0.97; P = .004). The relative reduction included patients with diverse characteristics. No significant reduction was observed in other outcomes, such as traffic crashes where the patient was a passenger (OR, 1.03; 95% CI, 0.96-1.12) or pedestrian (OR, 1.02; 95% CI, 0.88-1.17), nor in other unrelated serious medical emergencies. Patients with younger age (OR, 1.27; 95% CI, 1.13-1.14), male sex (OR, 1.64; 95% CI, 1.46-1.85), a history of crash (baseline OR, 2.79; 95% CI, 1.94-4.02; induction OR, 4.26; 95% CI, 2.01-9.03), more emergency visits (OR, 1.34; 95% CI, 1.19-1.52), and frequent outpatient physician visits (OR, 1.17; 95% CI, 1.01-1.36) had higher risk of subsequent traffic crashes (multivariable model). Conclusions and Relevance This study suggests that cataract surgery is associated with a modest decrease in a patient's subsequent risk of a serious traffic crash as a driver, which has potential implications for mortality, morbidity, and costs to society.
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Affiliation(s)
- Matthew B. Schlenker
- Department of Ophthalmology and Vision Sciences, University of Toronto, Toronto, Ontario, Canada
- Kensington Vision and Research Centre, Toronto, Ontario, Canada
- Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences in Ontario, Toronto, Ontario, Canada
| | - Donald A. Redelmeier
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences in Ontario, Toronto, Ontario, Canada
- Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
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Abstract
OBJECTIVE To test whether a full moon contributes to motorcycle related deaths. DESIGN Population based, individual level, double control, cross sectional analysis. SETTING Nighttime (4 pm to 8 am), United States. PARTICIPANTS 13 029 motorcycle fatalities throughout the United States, 1975 to 2014 (40 years). MAIN OUTCOME MEASURE Motorcycle fatalities during a full moon. RESULTS 13 029 motorcyclists were in fatal crashes during 1482 relevant nights. The typical motorcyclist was a middle aged man (mean age 32 years) riding a street motorcycle with a large engine in a rural location who experienced a head-on frontal impact and was not wearing a helmet. 4494 fatal crashes occurred on the 494 nights with a full moon (9.10/night) and 8535 on the 988 control nights without a full moon (8.64/night). Comparisons yielded a relative risk of 1.05 associated with the full moon (95% confidence interval 1.02 to 1.09, P=0.005), a conditional odds ratio of 1.26 (95% confidence interval 1.17 to 1.37, P<0.001), and an absolute increase of 226 additional deaths over the study interval. The increase extended to diverse types of motorcyclists, vehicles, and crashes; was accentuated during a supermoon; and replicated in analyses from the United Kingdom, Canada, and Australia. CONCLUSION The full moon is associated with an increased risk of fatal motorcycle crashes, although potential confounders cannot be excluded. An awareness of the risk might encourage motorcyclists to ride with extra care during a full moon and, more generally, to appreciate the power of seemingly minor distractions at all times.
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Affiliation(s)
- Donald A Redelmeier
- Department of Medicine, University of Toronto, Canada; Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON M4N 3M5, Canada
| | - Eldar Shafir
- Department of Psychology, Princeton University, NJ, USA; Woodrow Wilson School of Public and International Affairs, Princeton University, NJ, USA
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Abstract
UNLABELLED Bright sunlight may create visual illusions that lead to driver error, including fallible distance judgment from aerial perspective. We tested whether the risk of a life-threatening motor vehicle crash was increased when driving in bright sunlight.This longitudinal, case-only, paired-comparison analysis evaluated patients hospitalized because of a motor vehicle crash between January 1, 1995 and December 31, 2014. The relative risk of a crash associated with bright sunlight was estimated by evaluating the prevailing weather at the time and place of the crash compared with the weather at the same hour and location on control days a week earlier and a week later.The majority of patients (n = 6962) were injured during daylight hours and bright sunlight was the most common weather condition at the time and place of the crash. The risk of a life-threatening crash was 16% higher during bright sunlight than normal weather (95% confidence interval: 9-24, P < 0.001). The increased risk was accentuated in the early afternoon, disappeared at night, extended to patients with different characteristics, involved crashes with diverse features, not apparent with cloudy weather, and contributed to about 5000 additional patient-days in hospital. The increased risk extended to patients with high crash severity as indicated by ambulance involvement, surgical procedures, length of hospital stay, intensive care unit admission, and patient mortality. The increased risk was not easily attributed to differences in alcohol consumption, driving distances, or anomalies of adverse weather.Bright sunlight is associated with an increased risk of a life-threatening motor vehicle crash. An awareness of this risk might inform driver education, trauma staffing, and safety warnings to prevent a life-threatening motor vehicle crash. LEVEL OF EVIDENCE Epidemiologic Study, level III.
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Affiliation(s)
- Donald A. Redelmeier
- Department of Medicine, University of Toronto
- Evaluative Clinical Sciences, Sunnybrook Research Institute
- Institute of Clinical Evaluative Sciences (ICES)
- Institute for Health Policy Management and Evaluation
- Division of General Internal Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sheharyar Raza
- Department of Medicine, University of Toronto
- Evaluative Clinical Sciences, Sunnybrook Research Institute
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Schlenker MB, Thiruchelvam D, Redelmeier DA. Intravitreal anti-vascular endothelial growth factor treatment and the risk of thromboembolism. Am J Ophthalmol 2015; 160:569-580.e5. [PMID: 26116264 DOI: 10.1016/j.ajo.2015.06.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2015] [Revised: 06/14/2015] [Accepted: 06/16/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the subsequent risk of thromboembolic events in patients receiving intravitreal ranibizumab and bevacizumab for age-related macular degeneration or macular edema. DESIGN Population-based crossover analysis with self-matched historical control data. METHODS setting: Ontario, Canada, between April 1, 2006, and March 31, 2013. STUDY POPULATION Consecutive patients 65 and older who initiated intravitreal treatment (N = 57 919). INTERVENTION Intravitreal injection of ranibizumab or bevacizumab. MAIN OUTCOME MEASURES Emergency visits for thromboembolic events spanning 1-4 years before treatment were compared to 1 year after treatment. Also examined were other secondary events including hip fractures, congestive heart failure, angina, falls, depression, cholecystitis, and total emergencies, as well as a control group following cataract surgery. RESULTS A total of 57 919 patients were included who accounted for 1858 thromboembolic emergencies (48 per month) during the 3-year Baseline interval and 1077 thromboembolic emergencies (83 per month) during the 1-year Subsequent interval after initiating treatment. The absolute change in risk equaled an increase from 10.7 to 18.6 per 1000 patients annually after initiation of treatment (rate ratio 1.74; 95% confidence interval 1.58-1.92; P < .0001). The relative increase was particularly pronounced for ischemic stroke (rate ratio 2.18; 95% confidence interval 1.94-2.46; P < .0001). The observed increase exceeded trends due to aging, applied across patients with diverse characteristics, occurred with each medication (ranibizumab and bevacizumab), was not apparent for emergencies unrelated to thromboembolic events, and did not occur in a control group following cataract surgery. CONCLUSIONS Intravitreal anti-vascular endothelial growth factor medications ranibizumab and bevacizumab may contribute to systemic thromboembolic events in patients aged 65 years or older.
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Affiliation(s)
- Matthew B Schlenker
- Department of Ophthalmology & Vision Sciences, University of Toronto, Toronto, Canada.
| | - Deva Thiruchelvam
- Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Institute for Clinical Evaluative Sciences in Ontario, Toronto, Canada
| | - Donald A Redelmeier
- Department of Medicine, University of Toronto, Toronto, Canada; Evaluative Clinical Sciences Program, Sunnybrook Research Institute, Toronto, Canada; Institute for Clinical Evaluative Sciences in Ontario, Toronto, Canada; Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Canada
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Redelmeier DA, Zung JD, Thiruchelvam D, Tibshirani RJ. Fibromyalgia and the Risk of a Subsequent Motor Vehicle Crash. J Rheumatol 2015; 42:1502-10. [PMID: 25979716 DOI: 10.3899/jrheum.141315] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Motor vehicle crashes are a widespread contributor to mortality and morbidity, sometimes related to medically unfit motorists. We tested whether patients diagnosed with fibromyalgia (FM) have an increased risk of a subsequent serious motor vehicle crash. METHODS We conducted a population-based self-matched longitudinal cohort analysis to estimate the incidence rate ratio of crashes among patients diagnosed with FM relative to the population norm in Ontario, Canada. We included adults diagnosed from April 1, 2006, to March 31, 2012, excluding individuals younger than 18 years, living outside Ontario, lacking valid identifiers, or having only a single visit for the diagnosis. The primary outcome was an emergency department visit as a driver involved in a motor vehicle crash. RESULTS The patients (n = 137,631) accounted for 738 crashes during the first year of followup after diagnosis, equal to an incidence rate ratio of 2.44 compared with the population norm (95% CI 2.27-2.63, p < 0.001). The crash rate was more than twice the population norm for those with a new or a persistent diagnosis. The increased risk included patients with diverse characteristics, approached the rate observed among other patients diagnosed with alcoholism, and was mitigated among those who received dedicated FM care or a physician warning for driving safety. CONCLUSION A diagnosis of FM is associated with an increased risk of a subsequent motor vehicle crash that might justify medical interventions for traffic safety.
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Affiliation(s)
- Donald A Redelmeier
- From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA.D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University.
| | - Jeremy D Zung
- From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA.D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University
| | - Deva Thiruchelvam
- From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA.D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University
| | - Robert J Tibshirani
- From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA.D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University
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Redelmeier DA, Yarnell CJ, Tibshirani RJ. Physicians' warnings for unfit drivers and risk of road crashes. N Engl J Med 2013; 368:87. [PMID: 23281992 DOI: 10.1056/nejmc1212928] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Redelmeier DA, Yarnell CJ, Thiruchelvam D, Tibshirani RJ. Physicians' warnings for unfit drivers and the risk of trauma from road crashes. N Engl J Med 2012; 367:1228-36. [PMID: 23013074 DOI: 10.1056/nejmsa1114310] [Citation(s) in RCA: 102] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Physicians' warnings to patients who are potentially unfit to drive are a medical intervention intended to prevent trauma from motor vehicle crashes. We assessed the association between medical warnings and the risk of subsequent road crashes. METHODS We identified consecutive patients who received a medical warning in Ontario, Canada, between April 1, 2006, and December 31, 2009, from a physician who judged them to be potentially unfit to drive. We excluded patients who were younger than 18 years of age, who were not residents of Ontario, or who lacked valid health-card numbers under universal health insurance. We analyzed emergency department visits for road crashes during a baseline interval before the warning and a subsequent interval after the warning. RESULTS A total of 100,075 patients received a medical warning from a total of 6098 physicians. During the 3-year baseline interval, there were 1430 road crashes in which the patient was a driver and presented to the emergency department, as compared with 273 road crashes during the 1-year subsequent interval, representing a reduction of approximately 45% in the annual rate of crashes per 1000 patients after the warning (4.76 vs. 2.73, P<0.001). The lower rate was observed across patients with diverse characteristics. No significant change was observed in subsequent crashes in which patients were pedestrians or passengers. Medical warnings were associated with an increase in subsequent emergency department visits for depression and a decrease in return visits to the responsible physician. CONCLUSIONS Physicians' warnings to patients who are potentially unfit to drive may contribute to a decrease in subsequent trauma from road crashes, yet they may also exacerbate mood disorders and compromise the doctor-patient relationship. (Funded by the Canada Research Chairs program and others.).
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Redelmeier DA, Chan WK, Mullainathan S, Shafir E. Social benefit payments and acute injury among low-income mothers. OPEN MEDICINE : A PEER-REVIEWED, INDEPENDENT, OPEN-ACCESS JOURNAL 2012; 6:e101-8. [PMID: 23687523 PMCID: PMC3654504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/15/2011] [Revised: 03/30/2012] [Accepted: 04/09/2012] [Indexed: 11/20/2022]
Abstract
BACKGROUND Human error due to risky behaviour is a common and important contributor to acute injury related to poverty. We studied whether social benefit payments mitigate or exacerbate risky behaviours that lead to emergency visits for acute injury among low-income mothers with dependent children. METHODS We analyzed total emergency department visits throughout Ontario to identify women between 15 and 55 years of age who were mothers of children younger than 18 years, who were living in the lowest socio-economic quintile and who presented with acute injury. We used universal health care databases to evaluate emergency department visits during specific days on which social benefit payments were made (child benefit distribution) relative to visits on control days over a 7-year interval (1 April 2003 to 31 March 2010). RESULTS A total of 153 377 emergency department visits met the inclusion criteria. We observed fewer emergencies per day on child benefit payment days than on control days (56.4 v. 60.1, p = 0.008). The difference was primarily explained by lower values among mothers age 35 years or younger (relative reduction 7.29%, 95% confidence interval [CI] 1.69% to 12.88%), those living in urban areas (relative reduction 7.07%, 95% CI 3.05% to 11.10%) and those treated at community hospitals (relative reduction 6.83%, 95% CI 2.46% to 11.19%). No significant differences were observed for the 7 days immediately before or the 7 days immediately after the child benefit payment. INTERPRETATION Contrary to political commentary, we found that small reductions in relative poverty mitigated, rather than exacerbated, risky behaviours that contribute to acute injury among low-income mothers with dependent children.
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