Socioeconomic aspects of the circumstances and consequences of car crashes among young adults

Learning With a Supervisor Who has Traffic Offences and Young Driver Crashes: The DRIVE Study 13-Year Follow-Up

PURPOSE

Young learner drivers commonly must record substantial supervised practice driving before independent licensure. Supervisory driver requirements can be limited or highly regulated, yet research is lacking on the effectiveness of different approaches. The current objective was to explore whether young drivers who were mostly supervised by someone who they perceived had traffic offences versus no offences had different crash records over a period of 13 years postlicensing.

METHODS

DRIVE is an Australian prospective cohort study of more than 20,000 drivers who were aged 17-24 years and newly licensed during 2003-2004. They completed detailed baseline questionnaires, including whether the person they identified as supervising their learner driving the most had perceived traffic offences in the past 12 months. Responses were linked to their state crash, hospitalization, and death records to 2016. A parametric survival model was created to calculate hazard ratios of time to crash for those reporting that their supervisor had 0 versus 1 and 0 versus 2+ perceived offences, adjusting for the participants' prior crash history and other covariates.

RESULTS

After adjusting for covariates, 369 participants reporting supervisory drivers with 2+ perceived offences, compared to 15,451 participants reporting no such offences, had up to 1.67 (95% confidence interval 1.10-2.53 at 6 months) times the rate of any crash for the first 2.5 years and up to 2.01 (95% confidence interval 1.26-3.19 at 3.5 years) times the rate of crashes resulting in injury for 5.5 years.

DISCUSSION

Although overall supervision by a driver with two or more perceived offences was low, further attention is needed to ensure improved supervised driving experiences, with mentoring programs and professional instructor partnerships worthy of exploration.

Self-harm in adolescence and risk of crash: a 13-year cohort study of novice drivers in New South Wales, Australia

INTRODUCTION

Self-harm and suicide are leading causes of morbidity and death for young people, worldwide. Previous research has identified self-harm is a risk factor for vehicle crashes, however, there is a lack of long-term crash data post licensing that investigates this relationship. We aimed to determine whether adolescent self-harm persists as crash risk factor in adulthood.

METHODS

We followed 20 806 newly licensed adolescent and young adult drivers in the DRIVE prospective cohort for 13 years to examine whether self-harm was a risk factor for vehicle crashes. The association between self-harm and crash was analysed using cumulative incidence curves investigating time to first crash and quantified using negative binominal regression models adjusted for driver demographics and conventional crash risk factors.

RESULTS

Adolescents who reported self-harm at baseline were at increased risk of crashes 13 years later than those reporting no self-harm (relative risk (RR) 1.29: 95% CI 1.14 to 1.47). This risk remained after controlling for driver experience, demographic characteristics and known risk factors for crashes, including alcohol use and risk taking behaviour (RR 1.23: 95% CI 1.08 to 1.39). Sensation seeking had an additive effect on the association between self-harm and single-vehicle crashes (relative excess risk due to interaction 0.87: 95% CI 0.07 to 1.67), but not for other types of crashes.

DISCUSSION

Our findings add to the growing body of evidence that self-harm during adolescence predicts a range of poorer health outcomes, including motor vehicle crash risks that warrant further investigation and consideration in road safety interventions. Complex interventions addressing self-harm in adolescence, as well as road safety and substance use, are critical for preventing health harming behaviours across the life course.

Socioeconomic and Demographic Factors Effect in Association with Driver's Medical Services after Crashes

Motor vehicle crashes are the third leading cause of preventable-injury deaths in the United States. Previous research has found links between the socioeconomic characteristics of driver residence zip codes and crash frequencies. The objective of the study is to extend earlier work by investigating whether the socioeconomic characteristics of a driver’s residence zip code influence their likelihood of resulting in post-crash medical services. Data were drawn from General Use Model (GUM) data for police crash reports linked to hospital records in Kentucky, Utah, and Ohio. Zip-code-level socioeconomic data from the American Community Survey were also incorporated into analyses. Logistic regression models were developed for each state and showed that the socioeconomic variables such as educational attainment, median housing value, gender, and age have p-values < 0.001 when tested against the odds of seeking post-crash medical services. Models for Kentucky and Utah also include the employment-to-population ratio. The results show that in addition to age and gender, educational attainment, median housing value and rurality percentage at the zip code level are associated with the likelihood of a driver seeking follow-up medical services after a crash. It is concluded that drivers from areas with lower household income and lower educational attainment are more likely to seek post-crash medical services, primarily in emergency departments. Female drivers are also more likely to seek post-crash medical services.

Injury severity and increased socioeconomic differences: A population-based cohort study

BACKGROUND

Several studies have documented an inverse gradient between socioeconomic status (SES) and injury mortality, but the evidence is less consistent for injury morbidity. The aim of this study was to investigate the association between SES and injury severity for acute hospitalizations in a nationwide population-based cohort.

METHODS

We conducted a registry-based cohort study of all individuals aged 25-64 years residing in Norway by 1st of January 2008. This cohort was followed from 2008 through 2014 using inpatient registrations for acute hospitalizations due to all-cause injuries. We derived two measures of severity: threat-to-life using the International Classification of Disease-based Injury Severity Score (ICISS), and threat of disability using long-term disability weights from the Injury-VIBES project. Robust Poisson regression models, with adjustment for age, sex, marital status, immigrant status, municipality population size and healthcare region of residence, were used to calculate incidence rate ratios (IRRs) by SES measured as an index of education, income, and occupation.

RESULTS

We identified 177,663 individuals (7% of the population) hospitalized with at least one acute injury in the observation period. Two percent (n = 4,186) had injuries categorized with high threat-to-life, while one quarter (n = 43,530) had injuries with high threat of disability. The overall adjusted IRR of hospitalization among people with low compared to high SES was 1.57 (95% CI 1.55, 1.60). Comparing low to high SES, injuries with low threat-to-life were associated with an IRR of 1.56 (95% CI 1.54, 1.59), while injuries with high threat-to-life had an IRR of 2.25 (95% CI 2.03, 2.51). Comparing low to high SES, injuries with low, medium, and high threat of disability were associated with IRRs of respectively, 1.15 (95% CI 1.11, 1.19), 1.70 (95% CI 1.66, 1.73) and 1.99 (95% CI 1.92, 2.07).

DISCUSSION

We observed an inverse gradient between SES and injury morbidity, with the steepest gradient for the most severe injuries. This suggests a need for targeted preventive measures to reduce the magnitude and burden of severe injuries for patients with low socioeconomic status.

Risky youth to risky adults: Sustained increased risk of crash in the DRIVE study 13 years on

The objective of this study was to investigate if drivers who exhibit risky driving behaviours during youth (aged 17-24 years) have an increased risk of car crash up to 13 years later. We used data from the DRIVE study, a 2003/04 survey of 20,806 young novice drivers in New South Wales, Australia. The data were linked with police crash, hospital and deaths data up to 2016. We analysed differences in crash associated with 13 items of risky driving behaviours using negative binominal regression models adjusted for driver demographics, driving exposure and known crash risk factors. The items were summarised in one index and grouped into quintiles for the analysis. After adjusting for confounding, drivers of the third (RR 1.16, 95% CI 1.05-1.30), fourth (RR1.22, 95% CI1.09-1.36) and fifth quintile (RR 1.36, 95% CI 1.21-1.53) had higher crash rates compared to the lowest risk-takers. Drivers with the highest scores on the risky driving measure had higher rates of crash related hospital admission or death (RR 1.92, 95% CI 1.13-3.27), crashes in wet conditions (RR 1.35,95% CI 1.05-1.73), crashes in darkness (RR 1.55, 95% CI 1.25-1.93) and head-on crashes (RR 2.14, 95% CI 1.07-4.28), compared with drivers with the lowest scores. Novice adolescent drivers who reported high levels of risky driving when they first obtained a driver licence remained at increased risk of crash well into adulthood. Measures that successfully reduce early risky driving, have the potential to substantially reduce road crashes and transport related injuries and deaths over the lifespan.

Is adolescent multiple risk behaviour associated with reduced socioeconomic status in young adulthood and do those with low socioeconomic backgrounds experience greater negative impact? Findings from two UK birth cohort studies

BACKGROUND

Adolescent multiple risk behaviour (MRB) is associated with negative outcomes such as police arrests, unemployment and premature mortality and morbidity. What is unknown is whether MRB is associated with socioeconomic status (SES) in adulthood. We test whether adolescent MRB is associated with socioeconomic status (SES) in young adulthood and whether it is moderated by early life SES variables.

METHODS

Prospective cohort studies; British Cohort Study 1970 (BCS70) and Avon Longitudinal Study of Parents and Children (ALSPAC), born in 1991-1992, were used and two comparable MRB variables were derived. Logistic regression was used to determine the association between MRB and young adult SES. The moderating effect of three early life SES variables was assessed using logistic regression models with and without interaction parameters. Evidence to support the presence of moderation was determined by likelihood ratio tests ≤p = 0.05. Multiple imputation was used to account for missing data.

RESULTS

Adolescents had a median of two risk behaviours in BCS70 and three in ALSPAC. Adolescent MRB was negatively associated with young adult SES (university degree attainment) in BCS70 (OR 0.81, 95% CI: 0.76, 0.86) and ALSPAC (OR 0.85, 95% CI: 0.82, 0.88). There was a dose response relationship, with each additional risk behaviour resulting in reduced odds of university degree attainment. MRB was associated occupational status at age 34 in BCS70 (OR 0.86 95% CI: 0.82, 0.90). In BCS70, there was evidence that maternal education (p = 0.03), parental occupational status (p = 0.009) and household income (p = 0.03) moderated the effect of adolescent MRB on young adult SES in that the negative effect of MRB is stronger for those with low socioeconomic backgrounds. No evidence of moderation was found in the ALSPAC cohort.

CONCLUSIONS

Adolescence appears to be a critical time in the life course to address risk behaviours, due to the likelihood that behaviours established here may have effects in adulthood. Intervening on adolescent MRB could improve later SES outcomes and thus affect health outcomes later in life. Evidence for a moderation effect in the BCS70 but not ALSPAC suggests that more detailed measures should be investigated to capture the nuance of contemporary young adult SES.

No effect of the Penalty Point System on road traffic accident mortality among men with a high socioeconomic status in Spain

The purpose of this study was to assess the effect of the Penalty Point System (PPS) on road traffic accident mortality by gender and socioeconomic status. We conducted a nationwide prospective study covering adult people living in Spain on November 2001. They were followed up until 30 Nov 2007 to determine vital status and cause of death. An interrupted time-series analysis was used to assess whether PPS (explanatory variable) had both immediate and long-term effect on the rates of road traffic accident mortality (RTAMs) separately by gender. Subjects were classified by socioeconomic status (low and high) using two indicators: educational attainment (up to lower secondary education; upper secondary education or more) and occupation (manual and non-manual workers). We performed several segmented Poisson regression models, controlling for trend, seasonality, 2004 road safety measures and fuel consumption as proxy for traffic exposure. Among men, we found a decrease on the RTAMs immediately after PPS in those with low educational level (16.2 %, IC95 %: 6.1 %-25.2 %) and manual workers (16.3 %, IC95 %: 2.8 %-27.8 %), and a non-significant increase among those with high education level and non-manual workers (6.2 % and 1.8 %). Among women, there were no significant differences in the immediate effect of PPS by socioeconomic status. We did not identify significant trend changes between pre-PPS and post-PPS periods in any socioeconomic group. In a context of downward trend of traffic mortality, the PPS implementation led to an immediate reduction on death rates only among men with a low socioeconomic status.

Are there sex differences in crash and crash-related injury between men and women? A 13-year cohort study of young drivers in Australia

BACKGROUND

Young men have long been known to be disproportionately impacted by road crash and crash-related injury compared to young women and older drivers. However, there is limited insight into how sex differences in crash and crash-related injury changes over time as men and women get older and gain more driving experience. To explore sex differences in crash and crash-related injury, we undertook a sex disaggregated analysis in a large longitudinal cohort of over 20,000 young drivers in New South Wales, Australia, for up to 13 years after they first attained their independent car driver licence.

METHODS

DRIVE Study survey data from 2003-04 were linked with police, hospital and deaths data up to 2016. Sex differences were analysed using cumulative incidence curves investigating time to first crash and in negative binominal regression models adjusted for driver demographics and crash risk factors.

RESULTS

After adjusting for demographics and driving exposure, compared with women, men had 1.25 (95% CI 1.18-1.33), 2.07 (1.75-2.45), 1.28 (95% CI 1.13-1.46), 1.32 (95% CI 1.17-1.50) and 1.59 (95% CI 1.43-1.78) times higher rates of any crash, single vehicle crash, crash on streets with a speed limit of 80 km/h or above, crash in wet conditions and crash in the dark, respectively. By contrast, men were less likely to be involved in crashes that resulted in hospitalisation compared to women 0.73 (95% CI 0.55-0.96).

CONCLUSIONS

Young men are at increased risk of crash, and this risk persists as they get older and gain more driving experience. Despite lower risk of crash, women are at higher risk of crash related injury requiring hospitalisation. These differences in men's and women's risk of crash and injury signal the need for better understanding of how sex and/or gender may contribute to risk of crash and injury across the life-course.

Socioeconomic status during youth and risk of car crash during adulthood. Findings from the DRIVE cohort study

BACKGROUND

Young drivers of low socioeconomic status (SES) have a disproportionally high risk of crashing compared with their more affluent counterparts. Little is known if this risk persists into adulthood and if it differs between men and women.

METHODS

We used data from a 2003/2004 Australian survey of young drivers (n=20 806), which included measures of drivers' demographics and established crash risk factors. These data were linked to police-reported crash, hospital and death data up to 2016. We used negative binomial regression models to estimate the association between participants' SES, with car crash.

RESULTS

After adjusting for confounding, drivers of lowest SES had 1.30 (95% CI 1.20 to 1.42), 1.90 (95% CI 1.25 to 2.88), 3.09 (95% CI 2.41 to 3.95) and 2.28 (95% CI 1.85 to 2.82) times higher rate of crash, crash-related hospitalisation, crash in country areas and crash on streets with a speed limit of 80 km/hour or above compared with drivers of highest SES, respectively. For single-vehicle crashes, women in the lowest SES groups had 2.88 (95% CI 1.83 to 4.54) times higher rate of crash compared with those in the highest SES group, but no differences were observed for men from different SES groups.

CONCLUSION

Young drivers who lived in areas of low SES at the time of the survey had a sustained increased risk of crash over the following 13 years compared with drivers from the most affluent areas. Our findings suggest that in addition to traditional measures, road transport injury prevention needs to consider the wider social determinants of health.

Social, economic, and legislative factors and global road traffic fatalities

BACKGROUND

Road traffic fatalities (RTF) is the 8th cause of mortality around the world. At the end of the Decade of Action, it would be of utmost importance to revisit our knowledge on the determinants of RTF. The aim of this study is to assess factors related to RTF at global level.

METHODS

We used road safety development index which accounts for the interactions between system, human and products to assess the RTF in 115 and 113 countries in 2013 and 2016, respectively. To analyze data, three statistical procedures (linear regression, classification and regression trees, and multivariate adaptive regression splines) were employed.

RESULTS

Classification and regression trees has the best performance amongst all others followed by multivariate adaptive regression splines for 2013 and 2016 data set with an R2 around 0.83. Results show that any increase in human development index was associated with RTF reduction. Comparing RTF data of 2013 and 2016, 8 countries experienced a change of more than 30%, which demonstrated a significant relationship with GINI index (named after Corrado Gini). Considering the three components of human development index, it is revealed that education explained most of RTF variation in classification and regression trees model followed by income and life expectancy.

CONCLUSION

Policymakers should consider road collisions as a socio-economic issue. In this regard, they can make provisions to reduce RTF in the long run by focusing on enhancing the three components of human development index, mainly education. However, there is a need to investigate the causation pathway among these three components with RTF with different time-trend procedures.

Identifying high-risk commercial vehicle drivers using sociodemographic characteristics

Crash data, from the state of Kentucky, for the 2015-2016 period, show that per capita crash rates and increases in crash-related fatalities were higher than the national average. In an effort to explain why the U.S. Southeast experiences higher crash rates than other regions of the country, previous research has argued the regions unique socioeconomic conditions provide a compelling explanation. Taking this observation as a starting point, this study examines the relationship between highway safety and socioeconomic and demographic characteristics, using an extensive crash dataset from Kentucky. Its focus is single- and two-unit crashes that involve commercial motor vehicles (CMVs) and automobiles. Using binary logistic regression and the quasi-induced exposure technique to analyze data on the socioeconomic and demographic attributes of the zip codes in which drivers reside, factors are identified which can serve as indicators of crash occurrence. Variables such as income, education level, poverty level, employment, age, gender, and rurality of the driver's zip code influence the likelihood of a driver being at fault in a crash. Socioeconomic factors exert a similar influence on CMV and automobile crashes, irrespective of the number of vehicles involved. Research findings can be used to identify groups of drivers most likely to be involved in crashes and develop targeted and efficient safety programs.

Targeted prevention of road traffic deaths in Greece: a multifactorial 5-year census-based study

BACKGROUND

Between 2012 and 2016, Greece suffered yearly more than 800 deaths from road traffic incidents (RTIs), holding one of the worst performances in the European Union for RTI-related deaths per population. Our primary aim is to identify risk factors associated with mortality to set a targeted policy framework on road safety.

METHODS

This is a retrospective analysis of data collected prospectively from Traffic Police. A correlation of 29 factors with adult drivers' mortality was made, applying multivariate logistic regression models. At a second stage, a scoping literature review identified the best possible targeted prevention measures.

RESULTS

A total of 93,019 drivers with a mean age of 42.2 ± 0.1 years were recorded, of which 2772 (3%) died. Age above 65 (aOR 3.1, p < 0.001), non-use of seatbelt (aOR 8.2, p < 0.001) or helmet (aOR 2.85, p < 0.001) and alcohol consumption (aOR 3.3 for cars, 4 for motorbikes, p < 0.001) were the driver-related parameters with the strongest correlation with a fatal outcome. Drivers' behavior with specific high-risk maneuvers increased odds of death 2-4 times, depending on vehicle type. One-lane, rural road network was the environmental factor with the most significant impact. Based on the results of the analyses, our scoping review identified and suggested 23 specific measures for the Greek government and policymakers to examine.

CONCLUSION

Human-related factors were the parameters with the strongest impact on mortality after an RTI in Greece. These findings demonstrate an educational gap that must be primarily addressed with the introduction of missing road safety education in schools and an intensified and innovative population awareness campaign.

The Importance of Place of Residence on Hospitalized Outcomes for Severely Injured Trauma Patients: A Trauma Registry Analysis

PURPOSE

Socioecological factors are understudied in relation to trauma patients' outcomes. This study investigated the association of neighborhood socioeconomic disadvantage (SED) and remoteness of residence on acute length of hospital stay days (ALSD) and inpatient mortality.

METHODS

A retrospective cohort study was conducted on adults hospitalized for major trauma in a Level 1 trauma center in southeast Queensland from 2014 to 2017. Neighborhood SED and remoteness indices were linked to individual patient variables. Step-wise multivariable negative binomial regression and proportional hazards regression analyses were undertaken, adjusting for injury and patient factors. Outcomes were ALSD and inpatient mortality.

FINDINGS

We analyzed 1,025 patients. Statistically significant increased hazard of inpatient mortality was found for older age (HR 3.53, 95% CI: 1.77-7.11), injury severity (HR 5.27, 95% CI: 2.78-10.02), remoteness of injury location (HR 1.75, 95% CI: 1.06-2.09), and mechanisms related to intentional self-harm or assault (HR 2.72, 95% CI: 1.48-5.03,). Excess mortality risk was apparent for rural patients sustaining less severe injuries (HR 4.20, 95% CI: 1.35-13.10). Increased risk for longer ALSD was evident for older age (RR 1.35, 95% CI: 1.07-1.71), head injury (RR 1.39, 95% CI: 1.19-1.62), extremity injuries (RR 1.82, 95% CI: 1.55-2.14), and higher injury severity scores (ISS) (RR 1.51, 95%: CI: 1.29-1.76).

CONCLUSIONS

Severely injured rural trauma patients are more likely to be socioeconomically disadvantaged and sustain injuries predisposing them to worse hospital outcomes. Further research is needed to understand more about care pathways and factors influencing the severity, mechanism and clinical consequences of rural-based traumatic injuries.

The Incidence of Road Traffic Crashes Among Young People Aged 15-20 Years: Differences in Behavior, Lifestyle and Sociodemographic Indices in the Galilee and the Golan

Background: Adolescent injuries and fatalities constitute a world health concern and present a major public health burden. Of all childhood injuries in Israel 61.8% occur during road traffic crashes. The risk of being injured or killed in a road traffic crash is especially high among individuals deemed to have a low socio-economic status, but, there also exist crucial risk factors for road traffic crashes that are intrinsic social determinants of health, including behavior, lifestyle, education and employment. These associations are explored in this study. Aim: To examine the contribution of socioeconomic inequalities to the incidence of road traffic crashes among adolescents living in the Galilee and the Golan. Methods: A large retrospective study of trauma records (N = 3293) of 15-20-year-old patients who were injured in road traffic crashes and admitted to Ziv Medical Center between 2004 and 2015 was performed. These patients were subcategorized according to their home address. Using census data and other databases associations between socioeconomic inequalities, intrinsic social determinants and the prevalence of road crashes were investigated. Results: Road traffic crashes in the Galilee and the Golan are more frequent among residents of low socioeconomic areas. Fifty-five percent of drivers are from the areas of lowest socioeconomic level (levels 2 to 4) and are responsible for 60% of the road traffic injuries admitted to Ziv Medical Center (p < 0.001). In contrast, 42% of drivers are from areas of medium socioeconomic level (levels 5 and 6) but are responsible for only 35% of road traffic injuries (p < 0.001). Young women in the Galilee and the Golan are less likely to be involved in road traffic crashes-35.8% compared to 64.2% in young men. Conclusions: This research has shown that youth, male gender, socioeconomic status, education level and the quality of road infrastructure are important factors in the incidence of road traffic crashes in the Galilee and the Golan. This should be taken into consideration by policy makers in order to develop appropriate interventions in road safety targeted at multiple levels.

Evaluating the impact of an injury prevention measure regarding different sociodemographic factors

BACKGROUND

Road traffic collisions (RTC) remain a major problem especially among young road users. Injury prevention measures and licensing systems have increasingly been developed to counteract some of the negative effects of RTCs in youth. The Prevent Alcohol and Risk Related Trauma in Youth (P.A.R.T.Y.) program is an injury prevention program that promotes prevention through reality education. In this study, the impact of the program on different sociodemographic subgroups of school students was analyzed. The aim was to find out which subgroups were influenced the most and how improvements to the program can be made.

METHODS

Evaluation was performed in a pre-post-intervention setting by means of a standardized questionnaire. The questionnaire contained three different sections with a total of 22 questions to identify students' responses regarding risk-behavior and risk-assessment. Evaluation was done at two different points on the same day (pre-and post-intervention). Data were analyzed with a focus on gender, age, residential area and level of education. Cronbach's alpha was used to check all questions for reliability. Data were analyzed using the t-test and the Wilcoxon signed-rank test with significance defined as p less than 0.05.

RESULTS

The study sample contains 193 students (range 14-17 years of age, 44% male). Female students show better results regarding risk-behavior and risk-awareness. The same applies to students of a higher educational level. And students ≥ 16 years showed significantly better results in all three sections compared to younger students.

CONCLUSIONS

Morbidity and mortality due to RTCs is a major problem in the group of young road users. Especially male road users between 14 and 17 years of age with a low educational level are at high risk to sustain road traffic injuries. Our results show that the P.A.R.T.Y. program has a stronger effect on young female students. Additionally, a significant effect was measured on students ≥ 16 years of age and on students with a higher educational level. Prevention measures need to be evaluated and further improved particularly in order to address the high-risk group of young, male road users with a lower educational status.

Demographic and regional characteristics of road traffic injury deaths in Jiangsu Province, China

Background

The study investigates the magnitude and distribution of fatal road traffic injuries (RTIs) in the Chinese province of Jiangsu by road user.

Method

The 13 694 RTI deaths and years of potential life lost (YPLL) that occurred in 2012 were analysed; vulnerable and non-vulnerable road users were considered separately. Age-adjusted mortality and YPLL were compiled and the association between demographic characteristics and RTI mortality rate was analysed using negative binomial regression.

Results

The age-adjusted RTI mortality and YPLL in Jiangsu in 2012 were 18.14 (95% CI: 17.84-18.45) and 494.3 (95% CI: 492.7-496.0) per 100 000 population. Half of the deaths were among pedestrians and for vulnerable road users as a whole, male fatalities were over three times that of female (adjusted incidence rate ratio = 3.26, 95% CI: 1.89-3.77). Fatalities in the oldest age group (80+ years) were over 14 times that of the youngest one (0-9 years) (adjusted incidence rate ratio = 14.13, 95% CI: 9.49-21.01). Fatality rates in the central and northern regions surpassed that of the south.

Conclusion

As in the rest of the country, RTIs are a considerable public health problem in Jiangsu where fatality and YPLL rates fall heavily on pedestrians, men, and older persons and are more pronounced in the less developed regions.

[Traffic accidentability and risky driving behavior in young people in New Caledonia. Results of study Situation Sociale et Comportements de Santé des Jeunes en Nouvelle-Calédonie]

BACKGROUND

New Caledonia has one of the highest global rates of death from road accidents: 240 deaths per million inhabitants in 2011 with a majority of young people. However, research on driving behaviors has remained rare.

METHODS

A cross-sectional survey based on face-to-face questionnaire with 1400 male and female youth aged 16 to 25 was conducted in 2007. It was used to measure the frequency of accidents and to compute a score of driving behaviors and their associations with socio-demographic characteristics, lifestyles as well as other health behaviors. RESULTS - 

CONCLUSION

A total of 10.6% of boys and 6.5% of girls reported a car accident in the previous twelve months period. Among male participants risky driving behavior was associated with having a degree (ORa=2, 95% CI [1.1-3.8]), sport practices (ORa=3.7, 95% CI [1.9-7.05]), involvement in a fight in the last twelve months (ORa=2.2, 95% CI [1.4-3.4]) and precocity of cannabis use (ORa=1.8, 95% CI [1.2-2.8]). Youth living in couple and those with children presented with higher risk-taking scores. Among female participants, young age at cannabis initiation (ORa=3.1, 95% CI [1.5-6.4]) and at sexual debut (ORa=2.4, 95% CI [1.1-5.1]) were associated with driving risk-taking. Finally, younger age at first alcohol intoxication was associated with risky behavior on the road in both sexes. These results highlighted the multidimensional nature of risk-taking behaviors on the road and showed that they are part of, for boys and girls, a larger pattern of risky behaviors. Such results suggest to include behaviors on the road in a comprehensive approach of prevention.

Trends in Socioeconomic Inequalities in Motor Vehicle Accident Deaths in the United States, 1995-2010

Motor vehicle accident (MVA) mortality has been declining overall, but little is known about trends by socioeconomic position. We examined trends in education-related inequalities in US MVA death rates from 1995 to 2010. We used mortality data from the National Center for Health Statistics and population estimates from the Current Population Survey, and we calculated vehicle- and person-miles traveled using data from the National Household Travel Survey. We used negative binomial regression to estimate crude and age-, sex-, and race-adjusted mortality rates among adults aged 25 years or more. We found larger mortality decreases among the more highly educated and some evidence of mortality increases among the least educated. Adjusted death rates were 15.3 per 100,000 population (95% confidence interval (CI): 10.7, 19.9) higher at the bottom of the education distribution than at the top of the education distribution in 1995, increasing to 17.9 per 100,000 population (95% CI: 14.8, 21.0) by 2010. In relative terms, adjusted death rates were 2.4 (95% CI: 1.7, 3.0) times higher at the bottom of the education distribution than at the top in 1995, increasing to 4.3 times higher (95% CI: 3.4, 5.3) by 2010. Inequality increases were larger in terms of vehicle-miles traveled. Although overall MVA death rates declined during this period, socioeconomic differences in MVA mortality have persisted or worsened over time.

Young adult's own and parental social characteristics predict injury morbidity: a register-based follow-up of 135,000 men and women

Background

Sociodemographic differences in injury mortality are well-established, but population-level studies on social patterns of injury morbidity remain few in numbers, particularly among young adults. Yet injuries are the leading cause of mortality, morbidity and disability among young people. Studies among children have shown steep social gradients in severe injuries, but less is known on the social patterning of injuries in late adolescence and early adulthood, when young people are in the process of becoming independent adults. This study examines how young adults’ current living arrangements, education, main economic activity, and parental social background are associated with hospital-treated injuries in late adolescence and early adulthood.

Methods

The study uses prospective, individual-level data gathered from several administrative sources. From a representative 11% sample of the total Finnish population, we included young people between ages 17–29 years during the follow-up (N = 134 938). We used incidence rates and Cox proportional hazards models to study hospital-treated injuries and poisonings in 1998–2008.

Results

Higher rates of injury were found among young adults living alone, single mothers, the lower educated and the non-employed, as well as those with lower parental social background, experience of childhood family changes or living with a single parent, and those who had left the parental home at a young age. Injury risks were consistently higher among young adults with lower education, but current living arrangements and main economic activity showed some age-related nuances in the associations: both earlier and later than average transitions in education, employment, and family formation associated with increased injury risks. The social differentials were strongest in poisonings, intentional self-harm, and assaults, but social patterns were also found in falls, traffic-related injuries and other unintentional injuries, underlining the existence of multiple distinct mechanisms and pathways behind the differentials.

Conclusions

The transition to adulthood is a life period of heightened risk of injury, during which both parental social background and the young people’s own social position are important determinants of serious injuries that require inpatient care.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-1763-9) contains supplementary material, which is available to authorized users.

Risk factors associated with traffic violations and accident severity in China

With the recent economic boom in China, vehicle volume and the number of traffic accident fatalities have become the highest in the world. Meanwhile, traffic accidents have become the leading cause of death in China. Systematically analyzing road safety data from different perspectives and applying empirical methods/implementing proper measures to reduce the fatality rate will be an urgent and challenging task for China in the coming years. In this study, we analyze the traffic accident data for the period 2006-2010 in Guangdong Province, China. These data, extracted from the Traffic Management Sector-Specific Incident Case Data Report, are the only officially available and reliable source of traffic accident data (with a sample size>7000 per year). In particular, we focus on two outcome measures: traffic violations and accident severity. Human, vehicle, road and environmental risk factors are considered. First, the results establish the role of traffic violations as one of the major risks threatening road safety. An immediate implication is: if the traffic violation rate could be reduced or controlled successfully, then the rate of serious injuries and fatalities would be reduced accordingly. Second, specific risk factors associated with traffic violations and accident severity are determined. Accordingly, to reduce traffic accident incidence and fatality rates, measures such as traffic regulations and legislation-targeting different vehicle types/driver groups with respect to the various human, vehicle and environment risk factors-are needed. Such measures could include road safety programs for targeted driver groups, focused enforcement of traffic regulations and road/transport facility improvements. Data analysis results arising from this study will shed lights on the development of similar (adjusted) measures to reduce traffic violations and/or accident fatalities and injuries, and to promote road safety in other regions.

Wheels, skills and thrills: a social marketing trial to reduce aggressive driving from young men in deprived areas

Young men from poorer backgrounds are associated with high road traffic collision levels. However, solving this problem has proven very difficult. Hence this paper summarises the findings of a UK government funded two-year trial of a cross-discipline intervention to reduce aggressive driving amongst this group. The intervention reported on here departed from traditional approaches such as fear appeals, stand-alone educational approaches, or punitive measures. Instead, the discipline of social marketing was used to provide overarching direction and structure for the trial, with a key focus on motivation and engagement. The project rested on a strong education and training platform and included a bespoke coaching programme, incentives, and an in-vehicle measurement and feedback device. The project had three development phases leading to the final trial. First, a literature and case study review identified possible design strategies. Second, these strategies were explored using primary research in the form of a qualitative inquiry. Third, a pre-trial design phase sought to introduce key components of the intervention to the trial cohort, retaining some flexibility before committing to the final design. Young males with a history of challenging behaviour (e.g. criminal records, driving convictions) from an economically deprived area within a UK city were recruited. Of 42 recruits, 23 successfully completed the trial. Behaviour changes were measured pre-, during and post-trial through a combination of driver performance data measured by in-vehicle data recorders (IVDRs), assessments of driving undertaken by trained observers, and self-assessment surveys and interviews with trial participants. Results indicate a significant average improvement in driving skills amongst participants who completed the trial. Given the difficulty in engaging and changing behaviour of this specific group, this is regarded as a significant finding. In summary the study provides an indication of proof of concept for the intervention in improving driving skills. However the limited sample size and lack of control group mean that further work will be required to validate these findings. It is recommended that a feasibility study with higher cohort volumes is undertaken, before attempting a full scale trial.

Disparity surveillance of nonfatal motor vehicle crash injuries

OBJECTIVE

The lack of race information for nonfatal motor vehicle crash injuries in the United States has limited the understanding of racial disparities in motor vehicle crashes (MVCs). In this article, we describe a pilot surveillance project in Nebraska that linked crash reports and driver's license records to investigate racial disparity among nonfatal MVC injuries.

METHODS

The project linked 43,157 severely and nonseverely injured drivers from crash reports between 2006 and 2010 to the corresponding state driver's license database so that drivers' race information from each MVC could be retrieved. A log rate model was used to examine the likelihood of MVC injuries by drivers' race along the dimensions of age, sex, and place of residence.

RESULTS

Black drivers had 31.6 and 87 percent more severe and nonsevere injuries, respectively, than white drivers. Rural residents were more likely than urban residents to have severe MVC injuries. Controlling for residence status, age, and sex did not alter the basic pattern that black drivers had higher rates of nonfatal MVC injuries.

CONCLUSIONS

The linkage approach provides an effective way to obtain additional information for MVC injury disparity surveillance. To reduce racial disparities in severe and nonsevere MVC injuries, race-sex-, race-age-, and race-location-specific interventions should be considered based on their significant contributions to disparity.

The Tinker Toy Test as a Measure of the Dysexecutive Syndrome in Those from Differing Socio-Economic Backgrounds

We investigated the impact of socio-economic status (SES) on executive functioning in a group of participants who were at least six months post Acquired Brain Injury (ABI). Challenges exist when measuring executive function in a developing country: norms developed in the country of test origin are rarely transferable to other populations and cultural differences require local test-item adaptation. Furthermore, SES has a graded impact upon cognitive functioning: those from lower socio-economic circumstances tend to produce inferior test scores to those from more affluent backgrounds. Not controlling for these effects may induce diagnostic errors. Three measures of executive functioning, the Wisconsin Card Sorting Test, the Iowa Gambling Test, and the Tinker Toy Test (TTT) were administered to 25 participants who were drawn from a South African Welfare organisation dedicated to supporting and assisting those with acquired brain injury. Sensitivity to race (as a possible measure of SES) was only elicited using the TTT. This test which is simple to administer, ecologically appropriate, and non-language based appears to be a useful adjunct as a measure of executive function in those with ABI from varying SES backgrounds.

Healthy travel and the socio-economic structure of car commuting in Cambridge, UK: a mixed-methods analysis

Car use is associated with substantial health and environmental costs but research in deprived populations indicates that car access may also promote psychosocial well-being within car-oriented environments. This mixed-method (quantitative and qualitative) study examined this issue in a more affluent setting, investigating the socio-economic structure of car commuting in Cambridge, UK. Our analyses involved integrating self-reported questionnaire data from 1142 participants in the Commuting and Health in Cambridge study (collected in 2009) and in-depth interviews with 50 participants (collected 2009-2010). Even in Britain's leading 'cycling city', cars were a key resource in bridging the gap between individuals' desires and their circumstances. This applied both to long-term life goals such as home ownership and to shorter-term challenges such as illness. Yet car commuting was also subject to constraints, with rush hour traffic pushing drivers to start work earlier and with restrictions on, or charges for, workplace parking pushing drivers towards multimodal journeys (e.g. driving to a 'park-and-ride' site then walking). These patterns of car commuting were socio-economically structured in several ways. First, the gradient of housing costs made living near Cambridge more expensive, affecting who could 'afford' to cycle and perhaps making cycling the more salient local marker of Bourdieu's class distinction. Nevertheless, cars were generally affordable in this relatively affluent, highly-educated population, reducing the barrier which distance posed to labour-force participation. Finally, having the option of starting work early required flexible hours, a form of job control which in Britain is more common among higher occupational classes. Following a social model of disability, we conclude that socio-economic advantage can make car-oriented environments less disabling via both greater affluence and greater job control, and in ways manifested across the full socio-economic range. This suggests the importance of combining individual-level 'healthy travel' interventions with measures aimed at creating travel environments in which all social groups can pursue healthy and satisfying lives.

Substance use and social, health and safety-related factors among fatally injured drivers

OBJECTIVE

The aim of this study was to examine different socio-demographic, health and safety-related factors, and psychoactive substance use among fatally injured drivers in road traffic accidents in Finland during 2006-2008.

METHODS

An accident information register maintained by the Traffic Safety Committee of Insurance Companies (VALT) of the Finnish Motor Insurers' Centre was used as basic data, and the basic data were complemented with further toxicological analytical information retrieved from autopsy reports from the Department of Forensic Medicine, Helsinki University. The data included all the drivers (n=556) who were driving a motor vehicle and who died in a road traffic accident in Finland during 2006-2008.

RESULTS

Of all the 556 fatally injured drivers 43% (n=238) had psychoactive substance findings. 51% (n=121) of substance positive drivers had a finding for alcohol only, the rest had a finding for one or more illicit/medicinal drugs impairing driving ability, and possibly also alcohol. Fatally injured drivers with alcohol findings were significantly younger (mean age 34 years) than sober drivers (mean age 44 years) or drivers with findings for drugs (mean age 45 years). Socio-demographic background did not differ substantially among drunken/drugged and sober drivers, although drivers with alcohol findings had a slightly lower education and socioeconomic position. Previous substance abuse problems were highly prevalent among drivers with substance findings and mental or both mental and physical health problems were more common among drivers with drug findings. The non-use of safety equipment and driving at a high speed were more common among fatally injured drivers with substance findings.

CONCLUSIONS

Substance abuse and mental health problems, as well as reckless driving behavior were more pronounced among fatally injured drivers with substance findings when compared to sober drivers. Thus, prevention and early intervention concerning substance abuse, mental health problems and DUI are essential. Improved traffic safety cannot be achieved by means of traffic policy only, but integration with other policies, such as health and social policy should be strengthened.

Deprived neighborhoods and risk of road trauma (incidence and severity) among under 25year-olds in the Rhône Département (France)

INTRODUCTION

Previous research has shown that there are inequalities with regard to traffic accident risk between different social categories. This study describes the influence of the type of residential municipality (with or without deprived urban areas, "ZUS, zones urbaines sensibles"), used as an indicator of contextual deprivation, on the incidence and severity of road trauma involving people of under 25years of age in the Rhône.

METHOD

Injury data were taken from The Rhône Road Trauma Registry. The study covers the 2004-2007 period, with 13,589 young casualties. The incidence of traffic injury of all severities were computed according to the type of municipality and the age, gender, and type of road user. The ratios of the incidences of deprived municipalities, compared with others were calculated. Subsequently the severity factors and incidences according to the severity level (ISS 1-8, ISS 9+) were studied.

RESULTS

For the main types of road users except motorized two-wheeler users, the incidences were higher in the deprived municipalities: the greatest difference was for pedestrians, where the incidences were almost twice those of other municipalities. This excess risk, constituting a health inequality topic rarely considered, was even greater in municipalities with two or three ZUSs. It was essentially observed for minor injuries among motorists, cyclists, and pedestrians.

CONCLUSIONS

While the incidence increased among people less than 25years of age, the severity of road injuries was lower in deprived neighborhoods, contrary to what is suggested by other studies. This lower severity disappeared when taking into account the crash characteristics.

IMPACT ON INDUSTRY

The incidence of injuries as a pedestrian, cyclist or motorist is higher among young people living in deprived municipalities. These areas should therefore be the targets of dedicated education programs, as well as further investigations about urban planning.

Social inequalities in road traffic deaths at age 16-20 years among all 611,654 Norwegians born between 1967 and 1976: a multilevel analysis

Background

Road traffic injury is a major cause of death among youths.

Aims

To estimate mortality differences in family socioeconomic position (SEP) and municipal disadvantage level.

Methods

Data on all Norwegians born in 1967–76, gathered from national registries, were linked by a unique national identification number. The 611 654 participants were followed-up for 5 years from age 16 years. Parental education level, father's income level, and proportion of high-income earners in the municipality served as SEP indicators. Associations between SEP and road traffic deaths were analysed by multilevel Poisson regression.

Results

Road traffic deaths (n=676, rate 22.2 per 100 000 person-years) constituted a major cause of death, of which 91.9% were motor vehicle occupants. SEP distributions differed according to gender and type of motor vehicle crash (collision, non-collision). There was an inverse relationship between municipal proportions of high-income earners and mortality (population attributable fraction (PAF) 0.43, 95% CI 0.30 to 0.53) in all categories of gender-specific crash types. Family SEP gradients were not found except for male non-collision deaths, where increasing mortality was found in association with decreasing parental education level (PAF 0.94, 95% CI 0.59 to 0.99) and increasing paternal income (PAF 0.25, 95% CI 0.06 to 0.40).

Conclusion

The different SEP patterns for road traffic deaths across gender and motor vehicle crash type illustrate that heterogeneity of social inequalities in health can be found even within narrow age bands and for similar causes of death.

Incapacidade por traumatismo raquimedular secundário a acidentes de trânsito

OBJETIVO: Analisar as vítimas de acidentes de trânsito que apresentam incapacidade decorrente de lesão medular. MÉTODOS: Foram avaliados os prontuários de 719 vítimas de acidentes de trânsito que solicitaram benefício devido as lesões decorrentes e selecionadas as que sofreram traumatismo raquimedular. As variáveis idade, sexo, tipo de acidente, lesões decorrentes, e grau de incapacidade de acordo com a Classificação Internacional de Funcionalidade, Incapacidade e Saúde foram então analisadas. RESULTADOS: Dos 32 casos de incapacidade total (4,5%), 11 pacientes eram portadores de traumatismo raquimedular (34,37%) (RR=13,245, IC 95% de 0,267 a 0,966). Incapacidade funcional foi obervada em 360 pacientes (50,1%), e destes sete possuiam TRM (1,9%) (RR=0,508; IC 95% de 0,267 a 0,966). Houve incapacidade leve em 327 pacientes (45,48%), sendo que seis destas vítimas sofreram TRM (1,83%) (RR=0,398, IC 95% de 0,211 a 0,765). Os automóveis foram responsáveis por 70,83% das lesões medulares, a motocicleta 20,83 e o atropelamento 12,5%. CONCLUSÕES: O TRM incapacita mais adultos jovens do sexo masculino, constituindo a segunda maior causa de incapacidade total entre os sobreviventes de acidentes de trânsito e ocupando um segundo plano em relação a incapacidade funcional. A incidência de sequela por TRM foi de 0,38%, a maioria em ocupantes de automóveis (70,83%).

The effect of daily-activity patterns on crash involvement

The main purpose of this study is to analyze the effect of daily-activity and travel patterns on the risk of crash involvement. To this end, we develop a model that integrates daily-activity and travel choices in a single framework, recognizing that these variables affect the risk of crashes. This model can therefore provide predictions of the expected changes in risk levels from the implementation of measures that affect the daily-activity patterns and the socio-economic characteristics of the population. The empirical analysis makes use of data collected during a household survey that includes crash information and trip diaries. The model is applied in a case study of an Arab town in Israel to analyze various transportation policies. The results of this research show that in addition to individuals' demographic and socio-economic characteristics, their daily-activity and travel patterns also have an impact on the risk of being involved in car crashes. The case study showed the potential of this framework for analyzing the effect of various social and transportation policies on road safety. To the best of our knowledge, this is the first time such relationships have been tested by using a disaggregate model and the first time activity-based models have been used to analyze exposure to the risk of road crashes.

Young adolescents' independent mobility, related factors and association with transport to school. A cross-sectional study

Background

Children's independent mobility differs between groups of adolescents, but knowledge is lacking on how mobility-limiting factors interact. This study explores the association between factors that can affect young adolescents' mobility, searching for typical patterns within a geographical area where mobility is both relatively high and promoted (in this case Stockholm County, Sweden). An additional question is how clusters of limiting factors and demographic attributes relate to active commuting to school.

Methods

A sample of 7th grade students (ca 13-14 years old) in Stockholm County, Sweden, answered a survey (n = 1008). A cluster analysis was performed on variables descriptive of the respondents and of potential limitations to their independent mobility, such as fears, coping, traffic situation in the neighbourhood and parent/child opinions on mobility (18 variables and 50 categories). Active commuting to/from school was compared using proportion (with 95% confidence intervals) by cluster.

Results

Five consistent and distinct clusters were identified. Among the most discriminating factors were fears experienced in the neighbourhood, strategies to cope with fear, type of housing and traffic environment. Girls were over-represented in the two clusters most typical of respondents experiencing fears (either several of these or darkness in particular) and boys in two others where housing (house vs. apartment) and neighbourhood conditions played a more determinant role. The proportion of active commuting among respondents was quite similar over clusters but was nonetheless higher in the cluster (over girls) reporting more fears and other factors limiting mobility.

Conclusions

Whereas fears - and coping - are more typical of adolescent girls in the formation of the clusters, household and neighbourhood characteristics are more typical of boys. Broadly speaking, there seem to be two groups of girls with fears but these differ based on types of fear, ways of coping with fear and their living conditions. The association between the limitations to mobility and active commuting is unclear, the latter being higher among those disclosing a broader range of limiting factors, including fears.

Who by accident? The social morphology of car accidents

Prior studies in the sociology of accidents have shown that different social groups have different rates of accident involvement. This study extends those studies by implementing Bourdieu's relational perspective of social space to systematically explore the homology between drivers' social characteristics and their involvement in specific types of motor vehicle accident. Using a large database that merges official Israeli road-accident records with socioeconomic data from two censuses, this research maps the social order of road accidents through multiple correspondence analysis. Extending prior studies, the results show that different social groups indeed tend to be involved in motor vehicle accidents of different types and severity. For example, we find that drivers from low socioeconomic backgrounds are overinvolved in severe accidents with fatal outcomes. The new findings reported here shed light on the social regularity of road accidents and expose new facets in the social organization of death.

Individual and Areal Risk Factors for Road Traffic Injury Deaths: Nationwide Study in South Korea

This study determines the individual and areal risk factors for road traffic injury deaths in South Korea. The risk factors that influence road traffic injury deaths are defined by multilevel Poisson regression analysis. It is seen that not only demographic factors but also individual educational level, which represents socioeconomic status, influences road traffic injury deaths. The material deprivation index, which represents areal socioeconomic status, and W statistics, as a measure of the quality of the emergency medical system in an area, also influence road traffic injury deaths. Based on this study, the most vulnerable group for road traffic injury deaths is elderly men with a low level of education who live in the most deprived areas.Therefore, preventive policies focusing on both these areas and this population demographic should be established.

Fatal crash trends for Australian young drivers 1997-2007: geographic and socioeconomic differentials

BACKGROUND

Little has been published on changes in young driver fatality rates over time. This paper examines differences in Australian young driver fatality rates over the last decade, examining important risk factors including place of residence and socioeconomic status (SES).

METHODS

Young driver (17-25years) police-recorded passenger vehicle crashes were extracted from New South Wales State records from 1997-2007. Rurality of residence and SES were classified into three levels based on drivers' residential postcode: urban, regional, or rural; and high, moderate, or low SES areas. Geographic and SES disparities in trends of fatality rates were examined by the generalized linear model. Chi-square trend test was used to examine the distributions of posted speed limits, drinking driving, fatigue, seatbelt use, vehicle age, night-time driving, and the time from crash to death across rurality and socioeconomic status.

RESULTS

Young driver fatality rate significantly decreased 5% per year (p<0.05); however, stratified analyses (by rurality and by SES) showed that only the reduction among urban drivers was significant (average 5% decrease per year, p<0.01). The higher relative risk of fatality for rural versus urban drivers, and for drivers of low versus high SES remained unchanged over the last decade. High posted speed limits, fatigue, drink driving and seatbelt non-use were significantly associated with rural fatalities, whereas high posted speed limit, fatigue, and driving an older vehicle were significantly related to low SES fatality.

CONCLUSION

The constant geographic and SES disparities in young driver fatality rates highlight safety inequities for those living in rural areas and those of low SES. Better targeted interventions are needed, including attention to behavioral risk factors and vehicle age.

Road traffic crash circumstances and consequences among young unlicensed drivers: a Swedish cohort study on socioeconomic disparities

Background

Young car drivers run a higher risk of road traffic crash and injury not only because of their lack of experience but also because of their young age and their greater propensity for adopting unsafe driving practices. Also, low family socioeconomic position increases the risk of crash and of severe crash in particular. Whether this holds true for young unlicensed drivers as well is not known. Increasing attention is being drawn to the prevalence and practice of unlicensed driving among young people as an important contributor to road traffic fatalities.

Methods

This is a population-based cohort study linking Swedish national register data for a cohort of 1 616 621 individuals born between 1977 and 1991. Crash circumstances for first-time road traffic crash (RTC) were compared considering licensed and unlicensed drivers. The socioeconomic distribution of injury was assessed considering household socioeconomic position, social welfare benefits, and level of urbanicity of the living area. The main outcome measure is relative risk of RTC.

Results

RTCs involving unlicensed drivers were over-represented among male drivers, suspected impaired drivers, severe injuries, crashes occurring in higher speed limit areas, and in fair road conditions. Unlicensed drivers from families in a lower socioeconomic position showed increased relative risks for RTC in the range of 1.75 to 3.25. Those living in rural areas had an increased relative risk for a severe RTC of 3.29 (95% CI 2.47 - 4.39) compared to those living in metropolitan areas.

Conclusions

At the time of the crash, young unlicensed drivers display more risky driving practices than their licensed counterparts. Just as licensed drivers, unlicensed young people from low socioeconomic positions are over-represented in the most severe injury crashes. Whether the mechanisms lying behind those similarities compare between these groups remains to be determined.

How do car crashes happen among young drivers aged 18-20 years? Typical circumstances in relation to license status, alcohol impairment and injury consequences

AIM

The study aims to clarify the most typical circumstances in which car crashes involving young drivers and leading to the occurrence of injuries and to consider the various licensing statuses of the drivers in such crashes.

METHOD

Young Swedish drivers born between 1984 and 1986 were followed up in the Police register (2003-2004) for their involvement in car crashes as drivers (n=2448). A set of five variables (25 categories) descriptive of those crashes was analyzed simultaneously by means of cluster analysis. Associations between crash clusters and licensing status (including none), licensing duration and alcohol involvement were also measured.

RESULTS

Five clusters were identified, typical of one or some specific crash type(s): single-vehicle in sparsely populated areas, front-on collisions, crashes at dawn or at dusk, turning, cars of later model, crashes in urban areas and speed limits below 50 km/h. Clusters differ in consequences and in the proportions of alcohol impaired drivers involved but not regarding proportions of novice drivers. Unlicensed drivers were found in excess in some clusters (especially single and night time crashes).

CONCLUSION

Young drivers are involved in crashes leading to injuries in rather specific circumstances. For some of them, novice drivers or even unlicensed drivers are over-represented, which points to the need for targeted counter-measures, alongside those general ones already in place.

A pattern analysis of traffic crashes fatal to older drivers

A synthesis of the various crash circumstances in which older drivers die is lacking. This study is based on data from Sweden's national archive of fatal RTCs, and focuses on crashes in which the deceased driver was aged 65+ (2002-2004; n=152). Crash patterns were identified by means of cluster analysis using a sub-set of 12 variables describing both driver and crash event characteristics. Crashes where the driver had died of natural causes prior to crash made up 19.7% of the cases (30 crashes) and were mainly single crashes. Four additional clusters were also identified. Two involved making left turns at intersections, one over-represented among men, occurring typically at weekends, in low-speed areas (30.6%), and the second one, over-represented among women, consisting of crashes in dry road conditions, and on intermediate-speed roads (21.5%). A third cluster included head-on and single-vehicle crashes occurring in dry road conditions but on high-speed roads (29.8%). The last cluster consisted of crashes occurring during the winter and on high-speed roads (18.2%). Older drivers die in traffic in various circumstances, sometimes prior to crashing. Some circumstances cannot be easily alleviated but others could, e.g., through modifications of the road traffic environment and car active safety measures that can help compensate for age-related shortcomings.

[The incidence and patterns of unintentional injuries in daily life in Korea: a nationwide study]

OBJECTIVES

This study was conducted to estimate the cumulative incidence rate (CIR) of unintentional injuries in Korean daily life and to describe the pattern of unintentional injuries.

METHODS

The study population was the people who used the National Health Insurance because of injuries (ICD code: S00-T98) during 2006. The stratified sample according to gender, age and the severity of injury (NISS, New Injury Severity Score) was randomly selected. The questions on the questionnaire were developed as a reference for an international classification tool (ICECI, International Classification of External Causes of Injury). The questions included the locations of injury, the mechanisms of injury and the results of injury. Moreover, we used age, gender, region and income variables for analysis.

RESULTS

The CIR of unintentional injuries that occurred in daily life for 1 year per 100,000 persons was 17,606, and the CIR of severe injuries was 286. Many injuries were occurred at home (29.6%), public places (19.0%), school (13.7%) and near home (12.0%). The major mechanisms of injuries were slipping (48.8%), contact (14.0%), physical over-exertion (13.8%), and fall (6.6%). Infants and old aged people were vulnerable to injuries, and those who lived rural area and who were in a low income level were vulnerable too.

CONCLUSIONS

We signified the risk groups and risk settings of unintentional injuries in Korean daily life. These results could contribute to establishing strategies for injury prevention and implementing these strategies.

Pattern analysis of suicide mortality surveillance data in urban South Africa

The typical circumstances of suicide occurrence in post-apartheid urban South Africa are described. Data comprise suicide cases from all geographical locations (urban municipalities) where an injury surveillance system has full coverage. Typical patterns were identified by means of a classification technique applied to eight variables descriptive of the events, their victims, and the suicide level of the cities. Six suicide mortality patterns were identified, most being race-specific and each associated with particular suicide methods. Preventive strategies should target local communities and specific population subgroups, and be appropriate and responsive to their sociocultural needs.

Effects of neighbourhood and individual factors on injury risk in the entire Swedish population: a 12-month multilevel follow-up study

In this cumulative incidence study of the entire population of Sweden, we examined the association between neighbourhood income level and injury risks across a comprehensive set of individual variables. The population, stratified by age (0-14, 15-64, and > or =65 years), was followed for incident injury events in 1998. Multilevel logistic regression was used to examine the associations between neighbourhood income level and injury, including deaths from injury. Risks were analyzed, taking individual demographic and socioeconomic variables and alcohol/substance abuse into account. Falls were the most frequent non-fatal injuries in all age groups. People (0-14 years and 15-64 years) in the most deprived neighbourhoods exhibited higher odds of injuries (OR = 1.15; CI = 1.08-1.22 and OR = 1.34; CI = 1.26-1.43, respectively) than those in the same age groups in the most affluent neighbourhoods (OR = 1). In the full model, injury odds ratios decreased but remained significant in people 0-14 years. The large between-neighbourhood variance in all age groups indicated variation between neighbourhoods in injury incidence. Our results suggest that interventions focused on contextual aspects of neighbourhoods, in addition to individual behaviours, may have a positive impact on injury prevention.

Distribution and characteristics of road traffic crashes in the Chaoyang District of Beijing, China

In many developing urban settings, economic growth and motorization are coupled with increasing rates of road traffic injuries (RTIs). By highlighting typical sites and circumstances at/in which car crashes occur, more specific targets for prevention can be identified. The study is based on police data for a 1-year period and covers the Chaoyang District, the biggest district of Beijing City. Focus is placed on crash patterns and their distribution by types of road and areas. Both fatal and non-fatal crashes are considered (n=754). In the main, the crashes occurred in relatively favorable driving circumstances (e.g., sunny weather, flat and straight roads, asphalted roads, and good traffic signals and road markings). They were also quite evenly distributed over time of day, day of week and season. Five crash patterns were highlighted, of which three were strongly associated with specific areas and four with specific types of road. The study supports the idea that type of road and RTI severity or pattern are closely related. It contributes to the development of context-relevant prevention measures aimed at reducing road crashes and minimizing their consequences and also supports safe planning of the road traffic environment.

The social accident: a theoretical model and a research agenda for studying the influence of social and cultural characteristics on motor vehicle accidents

The paper develops a sociological model to explain collisions between two drivers or more. The "Social Accident" model presented here integrates empirical findings from prior studies and extant sociological theories. Sociological theory posits that social groups have unique cultural characteristics, which include a distinctive world view and ways of operating that influence its members. These cultural characteristics may cause drivers in different groups to interpret a given situation differently; therefore, they will make conflicting decisions that may possibly lead to road accidents. The proposed model may contribute to an understanding of the social mechanism related to interactions and communication among drivers by presenting new directions for understanding accidents and collisions. The paper concludes with suggestions for future research that will employ the model to assess its predictive and practical utility.

Car crash and injury among young drivers: contribution of social, circumstantial and car attributes

The objective of the study was to assess the independent contribution of individual, car and circumstantial features in severe and fatal car crashes involving young drivers. A prospective longitudinal, register-based cohort study was conducted at national level (in Sweden), in which people born in the years 1970-1972 (n = 334070) were followed up for the period 1988-2000 (aged 16-18 years in 1988) for their first two-car crashes leading to severe or fatal injury. Ten variables descriptive of the driver (sociodemographics), the car (safety level) and the crash have been analysed using multiple logistic regressions for male and female drivers separately, compiling crude and adjusted odds ratios with 95% CI. When controlling for other features, none of the variables descriptive of male and female drivers' socio-demographic characteristics impacts significantly on the odds of being severely injured or dying in a car-to-car crash. After adjustment, significant excess risks are observed for speed limits higher than the lowest one, type of crash other than rear end collision and road and light conditions other than favourable (dry and daylight), for both male and female drivers. For males only, cars from all car safety levels have significantly higher odds than those from the safest category. Among male and female young drivers, class differences in the risk of being severely injured in a traffic injury are substantial. Yet, despite this imbalance, crash characteristics (for males and females) and safety level of the vehicle driven (for males) remain the most determinant factors of crash severity. Understanding the social patterning of road traffic injuries is a challenge for public health and it seems that qualitative and quantitative differences in crash exposure offer part of the explanation. Young drivers from all social groups need, however, to be sensitized to the risk factors.

Socioeconomic differences and motorcycle injuries: age at risk and injury severity among young drivers. A Swedish nationwide cohort study

STUDY OBJECTIVE

The study examines whether there are socioeconomic differences among young motorcycle drivers (aged 16-25) involved in road-traffic injuries with regard to age and injury severity.

DESIGN

Nationwide retrospective register-based cohort study.

SETTING AND PARTICIPANTS

Subjects born in 1970-1972 were extracted from the Swedish Population and Housing Census of 1985 (n = 334,070). Individual records from the 1985 census were linked to police-reported data and hospital-based data for the period 1988-1995 on the basis of a search for each subject's first registered road-traffic injury as a motorcycle driver (n = 2034). Information on household socioeconomic group was taken from the Swedish census of 1985. Two categories of crash severity were analysed (minor injury and severe/fatal injury), based on assessments of the police and according to length of hospitalization.

MAIN RESULTS

Incidence of motorcycle injury varies considerably according to age of driver, reaching a peak at the age of 17. The greatest differences in injury risk between socioeconomic groups are present when their members are aged 17-19. At the age of 18, subjects belonging to low socioeconomic positions run a risk of injury occurrence 2.5 times higher than those belonging to the highest socioeconomic category. Young drivers in lower socioeconomic groups have higher odds for both minor and severe injuries than their counterparts in the highest socioeconomic group, but there is no further increase for the latter.

CONCLUSIONS

The study demonstrates how crucial the first years of driving are in relation to injury, and how wide the gap is in terms of socioeconomic differences at these ages, suggesting that this is the most appropriate time for intervention.

First car-to-car crashes involving young adult drivers: main patterns and their relation to car and driver characteristics

The primary objective of the study was to examine the relationship between patterns in car-to-car crashes involving young drivers and car and driver characteristics and the research design was a national register-based prospective cohort study. Individual records in a cohort born 1970-1972 are linked to road-traffic-crash data (1988-2000). Subjects' first police-registered two-car crash leading to severe or fatal injury (n = 4875) are identified. Typical crash patterns are highlighted and associations between pattern and both car and individual socio-demographic characteristics are tested. Four crash patterns are highlighted. Male drivers and those with lower educational attainment are over-represented in all patterns. Pattern-based risk levels vary considerably according to car safety level and driver's age at time of injury and socio-economic status. Crash patterns might be considered in young adult driver education systems, bearing in mind the consistent higher risks of male drivers and of drivers with lower educational attainment.

The social patterning of injury repetitions among young car drivers in Sweden

A national register-based cohort study was conducted to explore whether the social patterning of car drivers suffering injury repetitions differs from that of once-injured drivers in a cohort of young persons in Sweden (aged 18-26). Injury repeaters were defined as individuals sustaining injuries as a car driver on more than one occasion over an 8-year period. Only subjects obtaining a driver's licence before the age of 27 were included in the study. The social variables considered were, in turn, gender, socioeconomic position of origin, and own educational attainment. Attention was also paid to age at licensing. Two types of comparisons were made, using odds ratios with 95% confidence intervals. First, the odds of injury repeaters were computed using the once-injured car drivers as a reference group. Second, odds were compiled for once, twice, and three or more times injured people, using the non-injured at all as a comparison group. The results show that, by and large, the injury-risk distribution of car drivers with injury repetition does not differ from that of one-injury drivers with regard to gender, education, or socioeconomic group. However, drivers from self-employed households show greater odds of injury repetition (OR 1.65, CI 1.02-2.67) than of one injury compared with drivers from the families of non-manual employees. Since the number of injury repeaters is low and their socioeconomic distribution is very similar to that of the once injured, there is no need to regard them as a group at excess risk or different from the one-time injured. Reducing risk levels and risk differentials for the one time injured should therefore receive priority with regard to traffic-injury prevention.