Mature Driver Laws and State Predictors of Motor Vehicle Crash Fatality Rates Among the Elderly: A Cross-sectional Ecological Study

Effectiveness of road safety interventions: An evidence and gap map

Background

Road Traffic injuries (RTI) are among the top ten leading causes of death in the world resulting in 1.35 million deaths every year, about 93% of which occur in low- and middle-income countries (LMICs). Despite several global resolutions to reduce traffic injuries, they have continued to grow in many countries. Many high-income countries have successfully reduced RTI by using a public health approach and implementing evidence-based interventions. As many LMICs develop their highway infrastructure, adopting a similar scientific approach towards road safety is crucial. The evidence also needs to be evaluated to assess external validity because measures that have worked in high-income countries may not translate equally well to other contexts. An evidence gap map for RTI is the first step towards understanding what evidence is available, from where, and the key gaps in knowledge.

Objectives

The objective of this evidence gap map (EGM) is to identify existing evidence from all effectiveness studies and systematic reviews related to road safety interventions. In addition, the EGM identifies gaps in evidence where new primary studies and systematic reviews could add value. This will help direct future research and discussions based on systematic evidence towards the approaches and interventions which are most effective in the road safety sector. This could enable the generation of evidence for informing policy at global, regional or national levels.

Search Methods

The EGM includes systematic reviews and impact evaluations assessing the effect of interventions for RTI reported in academic databases, organization websites, and grey literature sources. The studies were searched up to December 2019.

Selection Criteria

The interventions were divided into five broad categories: (a) human factors (e.g., enforcement or road user education), (b) road design, infrastructure and traffic control, (c) legal and institutional framework, (d) post-crash pre-hospital care, and (e) vehicle factors (except car design for occupant protection) and protective devices. Included studies reported two primary outcomes: fatal crashes and non-fatal injury crashes; and four intermediate outcomes: change in use of seat belts, change in use of helmets, change in speed, and change in alcohol/drug use. Studies were excluded if they did not report injury or fatality as one of the outcomes.

Data Collection and Analysis

The EGM is presented in the form of a matrix with two primary dimensions: interventions (rows) and outcomes (columns). Additional dimensions are country income groups, region, quality level for systematic reviews, type of study design used (e.g., case-control), type of road user studied (e.g., pedestrian, cyclists), age groups, and road type. The EGM is available online where the matrix of interventions and outcomes can be filtered by one or more dimensions. The webpage includes a bibliography of the selected studies and titles and abstracts available for preview. Quality appraisal for systematic reviews was conducted using a critical appraisal tool for systematic reviews, AMSTAR 2.

Main Results

The EGM identified 1859 studies of which 322 were systematic reviews, 7 were protocol studies and 1530 were impact evaluations. Some studies included more than one intervention, outcome, study method, or study region. The studies were distributed among intervention categories as: human factors (n = 771), road design, infrastructure and traffic control (n = 661), legal and institutional framework (n = 424), post-crash pre-hospital care (n = 118) and vehicle factors and protective devices (n = 111). Fatal crashes as outcomes were reported in 1414 records and non-fatal injury crashes in 1252 records. Among the four intermediate outcomes, speed was most commonly reported (n = 298) followed by alcohol (n = 206), use of seatbelts (n = 167), and use of helmets (n = 66). Ninety-six percent of the studies were reported from high-income countries (HIC), 4.5% from upper-middle-income countries, and only 1.4% from lower-middle and low-income countries. There were 25 systematic reviews of high quality, 4 of moderate quality, and 293 of low quality.

Authors' Conclusions

The EGM shows that the distribution of available road safety evidence is skewed across the world. A vast majority of the literature is from HICs. In contrast, only a small fraction of the literature reports on the many LMICs that are fast expanding their road infrastructure, experiencing rapid changes in traffic patterns, and witnessing growth in road injuries. This bias in literature explains why many interventions that are of high importance in the context of LMICs remain poorly studied. Besides, many interventions that have been tested only in HICs may not work equally effectively in LMICs. Another important finding was that a large majority of systematic reviews are of low quality. The scarcity of evidence on many important interventions and lack of good quality evidence-synthesis have significant implications for future road safety research and practice in LMICs. The EGM presented here will help identify priority areas for researchers, while directing practitioners and policy makers towards proven interventions.

Mandatory Vision Test for Driver License Renewal in Association With Traffic Fatality and Injury Among Older Road Users in Utah

In 2011, Utah began requiring that drivers aged 65 years and older pass a vision test at each license renewal. This study aims to investigate if the mandatory vision test associated with motor vehicle fatality and injury rates in older road users. We fit controlled interrupted time series analysis models to compare fatality and injury rates for older adults (65+) affected by the law to younger adults (45-64) unaffected by the law. The models yielded estimates of differential level and slope changes in fatality and injury rates, which we used to estimate policy associations. We did not find evidence that implementing an accelerated vision test for older adults in Utah was associated with a reduction in injury or fatality rates among older (65+) drivers and non-drivers relative to those aged 45-64. Other strategies might be considered to prevent fatal motor vehicle crashes (MVCs) in older adults.

The relationship between ambient temperatures and road traffic injuries: a systematic review and meta-analysis

Traffic accidents cause considerable economic losses and injuries. Although the adverse effects of a change in ambient temperatures on human health have been widely documented, its effects on road traffic safety are still debated. This systematic review and meta-analysis was performed to synthesize available data on the association between ambient temperature and the risks of road traffic accidents (RTAs) and traffic accident injuries (TAIs). We searched 7 different databases to locate studies. The subgroup analyses were stratified by temperature type, temperature exposure, region, mean temperature, mortality, study period, statistical model, and source of injury data. This study was registered with PROSPERO under the number CRD42021264660. This is the first meta-analysis to investigate the association between ambient temperature and road traffic safety. A total of 34 high-temperature effect estimates were reported, and two additional studies reported the relationship between low temperatures and TAI risk. The meta-analysis results found a significant association between the high temperature and RTAs, and the pooled RR was 1.025 (95%CI 1.014, 1.035). The risk of TAI was also significantly associated with temperature increases. Subgroup analyses found that using daily mean temperatures, the RR value of road traffic accidents was 1.024 (95%CI 0.939, 1.116), and the RR value of road traffic injuries was 1.052 (95%CI 1.024, 1.080). Hourly temperatures significantly increased the risk of RTA, while the risk of TAI was not significantly increased by hourly temperature. The sensitivity analysis indicated that the results were stable, and no obvious publication bias was detected. The results of this systematic review and meta-analysis suggest that increases in ambient temperature are associated with an increased risk of RTAs and TAIs. These findings add to the evidence of the impact of ambient temperature on road traffic safety.

Driving Performance in Older Adults: Current Measures, Findings, and Implications for Roadway Safety

Background and Objectives

Over 10,000 people a day turn 65 in the United States. For many older adults, driving represents an essential component of independence and is one of the most important factors in overall mobility. Recent survey studies in older adults suggest that up to 60% of older adult drivers with mild cognitive impairment, and up to 30% with dementia, continue to drive. The purpose of this review is to provide a comprehensive and detailed resource on the topics of cognition and driving for clinicians, researchers, and policymakers working on efforts related to older adult drivers.

Research Design and Methods

Publications on PubMed and Medline and discussions with experts working in geriatrics, technology, driving policy, psychology, and diverse aspects of driving performance were utilized to inform the current review.

Results

Research indicates that there is a complex and inverse correlation between multiple cognitive measures, driving performance, and risky driving behaviors. The fragmented nature of available peer-reviewed literature, and a reliance on correlative data, do not currently allow for the identification of the temporal and reciprocal nature of the interplay between cognition and driving endpoints.

Discussion and Implications

There are currently no widely accepted definitions, conceptual models, or uniform set of analyses for conducting geriatric research that is focused on driving. Establishing conventions for conducting research that harmonizes the fields of geriatrics, cognition, and driving research is critical for the development of the evidence base that will inform clinical practice and road safety policy.

Road traffic accidents involving elderly people: an integrative review

Abstract Objective: To identify the epidemiological and socio-demographic profile of elderly victims of traffic accidents reported in articles published in scientific literature from 2013 to 2018. Method: The Literatura Latino Americana em Ciências da Saúde (Latin American Literature in Health Sciences), Base de Dados de Enfermagem (Database in Nursing), Scientific Electronic Library Online, and Medical Literature Analysis and Retrieval System Online databases were used, with the guiding question being: What is the scientific production on traffic accidents involving elderly people? A total of 355 articles were found. After the application of the selection criteria, 16 were evaluated, and nine remained for final analysis. Results: The age range was 60 to 69 years and the majority of the sample were men, who were married and had low schooling. Being run over was the most frequent accident. The width of the traffic lanes and the time of the accident influenced the frequency and risk of accidents and the severity of the injuries. Conclusion: Younger elderly persons were the most affected, and being run over was the most frequent type of accident.

Behind the wheel: community consultation informs adaptation of safe-transport program for older drivers

BACKGROUND

Safe-transport is important to well-being in later life but balancing safety and independence for older drivers can be challenging. While self-regulation is a promising tool to promote road safety, more research is required to optimise programs.

METHODS

Qualitative research was used to inform the choice and adaptation of a safe-transport education program for older drivers. Three focus groups were conducted with older drivers living in northwest Sydney to explore four key areas related to driving in later life including aged-based licensing, stopping or limiting driving, barriers to driving cessation and alternative modes of transportation. Data were analysed using content analysis.

RESULTS

Four categories emerged from the data; bad press for older drivers, COMPETENCE not age, call for fairness in licensing regulations, and hanging up the keys: It's complicated! Two key issues being (1) older drivers wanted to drive for as long as possible but (2) were not prepared for driving cessation; guided the choice and adaption of the Knowledge Enhances Your Safety (KEYS) program. This program was adapted for the Australian context and focus group findings raised the need for practical solutions, including transport alternatives, to be added. Targeted messages were developed from the data using the Precaution Adoption Process Model (PAPM), allowing the education to be tailored to the individual's stage of behaviour change.

CONCLUSION

Adapting our program based on insights gained from community consultation should ensure the program is sensitive to the needs, skills and preferences of older drivers.