Analysis of risk factors affecting driver injury and crash injury with drivers under the influence of alcohol (DUI) and non-DUI

Choosing to drive from alcohol serving establishments (ASEs)

OBJECTIVE

The prevalence of Driving Under the Influence (DUI) of alcohol or drugs has become a prominent factor in the occurrence of severe road crashes worldwide. Driving often occurs after visiting, and presumably drinking, at Alcohol-Serving Establishments (ASEs), and is thus of interest as a possible source of DUI events.

METHODS

We apply statistical and machine learning models to the Victorian Integrated Survey of Travel and Activity (VISTA) to identify factors that contribute to driving in trips from ASEs in Australia's state of Victoria.

RESULTS

Our results highlight that approximately 10% of individuals who traveled to ASEs as car passengers switched to driving after leaving there. It was also observed that travel distance shorter than 1 km and activity duration between 3 and 4 h positively impacts the mode switching from car driver to other modes in ASEs trips. Further findings illustrate a decline in driving after midnight, with an increase in the use of public transport and taxis. Individuals prefer driving for long-distance ASEs trips and walking for short distances. Going home also increased the likelihood of driving, whereas engaging in other social activities did not. Longer stays at ASEs and leaving vehicles overnight reduce the propensity to drive, likely due to increased alcohol consumption during these times.

CONCLUSIONS

These findings suggest behavioral adjustments that can mitigate driving under the influence. Specifically, people may walk for short-distance trips and use public transport or taxis for longer ASEs trips.

Causal Inference with Case-Only Studies in Injury Epidemiology Research

Purpose of Review

We review the application and limitations of two implementations of the "case-only design" in injury epidemiology with example analyses of Fatality Analysis Reporting System data.

Recent Findings

The term "case-only design" covers a variety of epidemiologic designs; here, two implementations of the design are reviewed: (1) studies to uncover etiological heterogeneity and (2) studies to measure exposure effect modification. These two designs produce results that require different interpretations and rely upon different assumptions. The key assumption of case-only designs for exposure effect modification, the more commonly used of the two designs, does not commonly hold for injuries and so results from studies using this design cannot be interpreted. Case-only designs to identify etiological heterogeneity in injury risk are interpretable but only when the case-series is conceptualized as arising from an underlying cohort.

Summary

The results of studies using case-only designs are commonly misinterpreted in the injury literature.

Exploring Influential Factors Affecting the Severity of Urban Expressway Collisions: A Study Based on Collision Data

When traffic collisions occur on urban expressways, the consequences, including injuries, the loss of lives, and damage to properties, are more serious. However, the existing research on the severity of expressway traffic collisions has not been deeply explored. The purpose of this research was to investigate how various factors affect the severity of urban expressway collisions. The severity of urban expressway collisions was set as the dependent variable, which could be divided into three categories: slight collisions, severe collisions, and fatal collisions. Ten variables, including individual characteristics, collision characteristics, and road environment conditions, were selected as independent factors. Based on 975 valid urban expressway collisions, an ordered logistic regression model was established to evaluate the impacts of influence factors on the severity of these crashes. The results show that gender, collision modality, road pavement conditions, road surface conditions, and visibility are significant factors that affect the severity of urban expressway collisions. Females were more likely to be involved in more severe urban expressway collisions than males. For collisions involving pedestrians and non-motorized vehicles, the risk of more severe injury was 7.508 times higher than that associated with vehicle-vehicle collisions. The probability of more severe collisions on urban expressways with poor pavement conditions and wet surface conditions is greater than that on urban expressways with good pavement conditions and dry surface conditions. In addition, as visibility increases, the probability of more severe collisions on urban expressways gradually decreases. These results provide more effective strategies to reduce casualties as a result of urban expressway collisions.

Real-Time Nanoscopic Rider Safety System for Smart and Green Mobility Based upon Varied Infrastructure Parameters

To create a safe bicycle infrastructure system, this article develops an intelligent embedded learning system using a combination of deep neural networks. The learning system is used as a case study in the Northumbria region in England’s northeast. It is made up of three components: (a) input data unit, (b) knowledge processing unit, and (c) output unit. It is demonstrated that various infrastructure characteristics influence bikers’ safe interactions, which is used to estimate the riskiest age and gender rider groups. Two accurate prediction models are built, with a male accuracy of 88 per cent and a female accuracy of 95 per cent. The findings concluded that different infrastructures pose varying levels of risk to users of different ages and genders. Certain aspects of the infrastructure are hazardous to all bikers. However, the cyclist’s characteristics determine the level of risk that any infrastructure feature presents. Following validation, the built learning system is interoperable under various scenarios, including current heterogeneous and future semi-autonomous and autonomous transportation systems. The results contribute towards understanding the risk variation of various infrastructure types. The study’s findings will help to improve safety and lead to the construction of a sustainable integrated cycling transportation system.

Alcohol-impaired Walking in 16 Countries: A Theory-Based Investigation

Alcohol is a global risk factor for road trauma. Although drink driving has received most of the scholarly attention, there is growing evidence of the risks of alcohol-impaired walking. Alcohol-impaired pedestrians are over-represented in fatal crashes compared to non-impaired pedestrians. Additionally, empirical evidence shows that alcohol intoxication impairs road-crossing judgements. Besides some limited early research, much is unknown about the global prevalence and determinants of alcohol-impaired walking. Understanding alcohol-impaired walking will support health promotion initiatives and injury prevention. The present investigation has three aims: (1) compare the prevalence of alcohol-impaired walking across countries; (2) identify international groups of pedestrians based on psychosocial factors (i.e., Theory of Planned Behaviour (TPB) and perceptions of risk); and (3) investigate how segments of pedestrians form their intention for alcohol-impaired walking using the extended TPB (i.e. subjective norm, attitudes, perceived control, and perceived risk). A cross-sectional design was applied. The target behaviour question was "have you been a pedestrian when your thinking or physical ability (balance/strength) is affected by alcohol?" to ensure comparability across countries. Cluster analysis based on the extended TPB was used to identify groups of countries. Finally, regressions were used to predict pedestrians' intentions per group. A total of 6,166 respondents (Age M(SD) = 29.4 (14.2); Males = 39.2%) completed the questionnaire, ranging from 12.6% from Russia to 2.2% from Finland. The proportion of participants who reported never engaging in alcohol-impaired walking in the last three months ranged from 30.1% (Spain) to 83.1% (Turkey). Four groups of countries were identified: group-1 (Czech Republic, Spain, and Australia), group-2 (Russia and Finland), group-3 (Japan), and group-4 (final ten countries including Colombia, China, and Romania). Pedestrian intentions to engage in alcohol- impaired walking are predicted by perceptions of risk and TPB-psychosocial factors in group-1 and group-4. Favourable TPB-beliefs and low perceived risk increased alcohol-impaired walking intentions. Conversely, subjective norms were not significant in group-2 and only perceived risk predicted intention in group-3. The willingness of pedestrians to walk when alcohol-impaired differs significantly across the countries in this study. Perceived risk was the only common predictor among the 16 countries.

Traumatic stress and the circadian system: neurobiology, timing and treatment of posttraumatic chronodisruption

Background: Humans have an evolutionary need for a well-preserved internal 'clock', adjusted to the 24-hour rotation period of our planet. This intrinsic circadian timing system enables the temporal organization of numerous physiologic processes, from gene expression to behaviour. The human circadian system is tightly and bidirectionally interconnected to the human stress system, as both systems regulate each other's activity along the anticipated diurnal challenges. The understanding of the temporal relationship between stressors and stress responses is critical in the molecular pathophysiology of stress-and trauma-related diseases, such as posttraumatic stress disorder (PTSD). Objectives/Methods: In this narrative review, we present the functional components of the stress and circadian system and their multilevel interactions and discuss how traumatic stress can affect the harmonious interplay between the two systems. Results: Circadian dysregulation after trauma exposure (posttraumatic chronodisruption) may represent a core feature of trauma-related disorders mediating enduring neurobiological correlates of traumatic stress through a loss of the temporal order at different organizational levels. Posttraumatic chronodisruption may, thus, affect fundamental properties of neuroendocrine, immune and autonomic systems, leading to a breakdown of biobehavioral adaptive mechanisms with increased stress sensitivity and vulnerability. Given that many traumatic events occur in the late evening or night hours, we also describe how the time of day of trauma exposure can differentially affect the stress system and, finally, discuss potential chronotherapeutic interventions. Conclusion: Understanding the stress-related mechanisms susceptible to chronodisruption and their role in PTSD could deliver new insights into stress pathophysiology, provide better psychochronobiological treatment alternatives and enhance preventive strategies in stress-exposed populations.

An integrated spatio-temporal approach to examine the consequences of driving under the influence (DUI) in crashes

Driving under the influence (DUI) is illegal in the United States because a driver's mental and motor skills can be seriously impaired by alcohol or drugs. Consequently, DUI violators' involvement in severe crashes is high. Motivated by the spatial and temporal nature of traffic crashes, this study introduces an integrated spatio-temporal approach to analyzing highway safety data. Specifically, this study estimates Geographically and Temporally Weighted Regression (GTWR) models to understand the consequences of DUI in crashes. GTWR can theoretically outperform traditional regression methods by accounting for unobserved heterogeneity that may be related to the location and time of a crash. Using Southeast Michigan crash data, this study finds that DUI is associated with a 25% higher likelihood of injury in a crash. The association between injury severity and DUI varies significantly across space and time. From the spatial aspect, DUI crashes in rural or small-town areas are more likely to cause injuries than urban crashes. From the temporal aspect, different times are associated with varying relationships between injury severity and DUI. If focusing on DUI crashes in late nights and early mornings, on Fridays, the entire northeast part from Clinton Charter Township to Port Huron is associated with severer injuries than other regions including Detroit's urban area and its south. On Mondays, the DUI crashes in the northwest are also more likely to cause severe injuries. The methodology introduced in this study takes advantage of modern computational tools and localized crash/inventory data. This method offers researchers and practitioners an opportunity to understand highway safety outcomes in great spatial and temporal details and customize safety countermeasures for specific locations and times such as saturation patrols.

Modeling head-on crash severity with drivers under the influence of alcohol or drugs (DUI) and non-DUI

Objective: The objective of this research is to identify and compare contributing factors to head-on crashes with drivers under and not under the influence of alcohol or drugs.Methods: The head-on crash data are collected from 2005 to 2013 in North Carolina from four aspects: vehicle, driver, roadway, and environmental characteristics. The final dataset includes 9,153 head-on crashes. A mixed logit model is developed to analyze the crash dataset involving drivers under and not under the influence of alcohol or drugs.Results: According to the obtained results, factors such as rural roadways, adverse weather, curve road, and high speed limit are among the most significant contributing factors to both head-on crashes with DUI and non-DUI. In addition, the results of this research demonstrate that high speed limit is found to be better modeled as random-parameters at specific injury severity levels for head-on crashes with DUI. Besides the factors mentioned above, dark light condition, old drivers, pickups, and motorcycles also significantly affect the severity of head-on crashes with non-DUI.Conclusions: The results of this study identify various factors that significantly affect the severity of head-on crashes with drivers under and not under the influence of alcohol or drugs. Also, the mixed logit model examines the heterogeneous effects and correlation in unobserved factors by allowing coefficients to be randomly distributed. The findings of this study call for more attention to head-on crashes and provide a reference for planners and engineers when developing and selecting countermeasures to reduce and/or mitigate head-on crashes.

Rear seating position is associated with a higher risk of mortality in motor vehicle crashes: analysis of Japanese Trauma Data Bank

Aim

The study examined the association of vehicle seating positions with the risk of death in serious motor vehicle crashes (MVCs) in Japan.

Methods

Data from the Japan Trauma Data Bank between 2004 and 2015 were analyzed. All MVC drivers with the legal age for driving and all copassengers were enrolled (n = 23,040). The cases were divided into three groups based on their seating position during the crash: the driver seat, front passenger seat, and rear passenger seats. The primary outcome variable was in‐hospital mortality. Multivariable logistic regression analysis was used to assess the association between the seating position and in‐hospital mortality. Potential factors associated with each seating position and in‐hospital mortality were also assessed.

Results

The odds ratios (ORs) for deaths were estimated for front and rear passengers compared to those for the driver in MVCs. The adjusted ORs (95% confidence interval [CI]) for death were 0.96 (0.84–1.11) and 1.22 (1.04–1.42) for front and rear passengers, respectively. Factors significantly associated with MVC deaths were age over 71 years (OR = 3.38; 95% CI, 2.58–4.41), male gender (OR = 1.54; 95% CI, 1.39–1.71), and night driving (OR = 1.17; 95% CI, 1.06–1.29).

Conclusions

This hospital‐based study suggested that rear seating increased the risk of MVC‐related death. Further studies are needed in order to find mechanisms of the increase in mortality by the seating position.

The effect of lowering the legal blood alcohol concentration limit on driving under the influence (DUI) in southern Taiwan: a cross-sectional retrospective analysis

OBJECTIVES

We aimed to profile the epidemiological changes of driving under the influence (DUI) in southern Taiwan after the legal blood alcohol concentration (BAC) limit was lowered from 50 to 30 mg/dL in 2013.

SETTING

Level 1 trauma medical centre in southern Taiwan.

PARTICIPANTS

Data from 7447 patients (4375 males and 3072 females) were retrieved from the trauma registry system of a single trauma centre to examine patient characteristics (gender, age and BAC), clinical outcome variables (Abbreviated Injury Score, Injury Severity Score and mortality) and vehicular crash-related factors (vehicle type, airbag use in car crashes, helmet use in motorcycle crashes and time of crash) before and after the BAC limit change.

RESULTS

Our results indicated that the percentage of DUI patients significantly declined from 10.99% (n=373) to 6.64% (n=269) after the BAC limit was lowered. Airbag use in car crashes (OR: 0.30, 95% CI 0.10 to 0.88, p=0.007) and helmet use in motorcycle crashes (OR: 0.20, 95% CI 0.15 to 0.26, p<0.001) was lower in DUI patients compared with non-DUI patients after the BAC limit change, with significant negative correlation. DUI behaviour increased crash mortality risk before the BAC limit change (OR: 4.33, 95% CI 2.20 to 8.54), and even more so after (OR: 5.60, 95% CI 3.16 to 9.93). The difference in ORs for mortality before and after the change in the BAC legal limit was not significant (p=0.568).

CONCLUSION

This study revealed that lowering the BAC limit to 30 mg/dL significantly reduced the number of DUI events, but failed to result in a significant reduction in mortality in these trauma patients.

Physical and cognitive functions affecting road traffic injuries among senior drivers

BACKGROUND

The size of elderly populations is growing in most areas of the world. The Thai Eleventh National Economic and Social Development Plan revealed an increase in the elderly, while numbers of younger, working-age adults decreased. Thailand has become an aging society since 2015, which is significant in that senior adults have a higher risk of involvement in motor vehicle accidents and are more susceptible to injuries and fatalities. This study investigated the role of physical and cognitive function with regard to road traffic injury in senior drivers.

METHODS

A community survey was carried out among people aged 60 years and older in the villages representing four regions of Thailand. Face-to-face interviews and anthropometric measurements were used to gather data including individual characteristics, medical history, risk behaviors, cognitive function and traffic injury within the last 12 months. Associations between risk factors and injury were assessed by the chi-square tests, and comparison of the cognitive function score between the injury and non-injury groups was identified using the independent t-test.

RESULTS

A total of 314 completed questionnaires were used for analysis. Ten percent of respondents had experienced a road traffic injury in the last 12 months. Analysis revealed that level of cognitive function, smoking behavior and been diagnosed with arthritis were associated with road traffic injury incidence in senior drivers (p-value < 0.05).

CONCLUSION

Results revealed the potential need for strategies to increase road traffic safety in senior drivers. Special protection should be prioritized for the elderly with physical and cognitive impairment.

Outcomes of Emergency Medical Service Usage in Severe Road Traffic Injury during Thai Holidays

Introduction

Thailand has the highest mortality from road traffic injury (RTI) in the world. There are usually higher incident rates of RTI in Thailand over long holidays such as New Year and Songkran. To our knowledge, there have been no studies that describe the impact of emergency medical service (EMS) utilization by RTI patients in Thailand. We sought to determine the outcomes of EMS utilization in severe RTIs during the holidays.

Methods

We conducted a retrospective review study by using a nationwide registry that collected RTI data from all hospitals in Thailand during the New Year holidays in 2008–2015 and Songkran holidays in 2008–2014. A severe RTI patient was defined as one who was admitted, transferred to another hospital, or who died at the emergency department (ED) or during referral. We excluded patients who died at the scene, those who were not transported to the ED, and those who were discharged from the ED. Outcomes associated with EMS utilization were identified by using multiple logistic regression and adjusted by using factors related to injury severity.

Results

Overall we included 100,905 patients in the final analysis; 39,761 severe RTI patients (39.40%; 95% confidence interval [CI] 95% CI [39.10%–39.71%]) used EMS transportation to hospitals. Severe RTI patients transported by EMS had a significantly higher mortality rate in the ED and during referral than that those who were not (2.00% vs. 0.78%, p < 0.001). Moreover, EMS use was significantly associated with increased mortality rate in the first 24 hours of admission to hospitals (1.38% for EMS use vs. 0.57% for no EMS use, p < 0.001). EMS utilization was a significant predictor of mortality in EDs and during referral (adjusted odds ratio [OR] 2.19; 95% CI [1.88–2.55]), and mortality in the first 24 hours of admission (adjusted OR 2.31; 95% CI [1.95–2.73]).

Conclusion

In this cohort, severe RTI patients transported by EMS had a significantly higher mortality rate than those who went to hospitals using private vehicles during these holidays.

Estimation of the Disease Burden Attributable to 11 Risk Factors in Hubei Province, China: A Comparative Risk Assessment

In order to estimate the health losses caused by common risk factors in the Hubei province, China, we calculated the deaths and disability-adjusted life years (DALYs) attributable to 11 risk factors. We estimated the exposure distributions of risk factors in Hubei Province in 2013 from the monitoring system on chronic disease and related risk factors, combined with relative risk (RR) in order to calculate the population attributable fraction. Deaths and DALYs attributed to the selected risk factors were then estimated together with cause-specific deaths and DALYs. In total, 53.39% of the total deaths and 36.23% of the total DALYs in Hubei were a result of the 11 selected risk factors. The top five risk factors were high blood pressure, smoking, high body mass index, diet low in fruits and alcohol use, accounting for 14.68%, 12.57%, 6.03%, 3.90% and 3.19% of total deaths, respectively, and 9.41%, 7.22%, 4.42%, 2.51% and 2.44% of total DALYs, respectively. These risk factors, especially high blood pressure, smoking and high body mass index, significantly influenced quality of life, causing a large number of deaths and DALYs. The burden of chronic disease could be substantially reduced if these risk factors were effectively controlled, which would allow people to enjoy healthier lives.