Effect of valvular heart diseases, migraine headaches, and perianal diseases on the risk of involvement in motor vehicle crashes

Migraine headaches are associated with motor vehicle crashes and driving habits among older drivers: Prospective cohort study

BACKGROUND

Migraine headache is common in older adults, often causing symptoms that may affect driving safety. This study examined associations of migraine with motor vehicle crashes (MVCs) and driving habits in older drivers and assessed modification of associations by medication use.

METHODS

In a multi-site, prospective cohort study of active drivers aged 65-79 (53% female), we assessed prevalent migraine (i.e., ever had migraine, reported at enrollment), incident migraine (diagnosis first reported at a follow-up visit), and medications typically used for migraine prophylaxis and treatment. During 2-year follow-up, we recorded self-reported MVCs and measured driving habits using in-vehicle GPS devices. Associations of prevalent migraine with driving outcomes were estimated in multivariable mixed models. Using a matched design, associations of incident migraine with MVCs in the subsequent year were estimated with conditional logistic regression. Interactions between migraine and medications were tested in all models.

RESULTS

Of 2589 drivers, 324 (12.5%) reported prevalent migraine and 34 (1.3%) incident migraine. Interactions between migraine and medications were not statistically significant in any models. Prevalent migraine was not associated with MVCs in the subsequent 2 years (adjusted OR [aOR] = 0.98; 95% CI: 0.72, 1.35), whereas incident migraine significantly increased the odds of having an MVC within 1 year (aOR = 3.27; 1.21, 8.82). Prevalent migraine was associated with small reductions in driving days and trips per month and increases in hard braking events in adjusted models.

CONCLUSION

Our results suggest substantially increased likelihood of MVCs in the year after newly diagnosed migraine, indicating a potential need for driving safety interventions in these patients. We found little evidence for MVC risk or substantial changes in driving habits associated with prevalent migraine. Future research should examine timing, frequency, and severity of migraine diagnosis and symptoms, and use of medications specifically prescribed for migraine, in relation to driving outcomes.

The Influence of Migraine on Driving: Current Understanding, Future Directions, and Potential Implications of Findings

OBJECTIVE

To review the published findings relevant to migraine and driving performance, with an intent to encourage discussion on research which may broaden understanding in this area and help educate healthcare providers and their patients.

BACKGROUND

Motor vehicle crashes result in more than 35,000 deaths and more than 2 million injuries annually in the United States. Migraine is one of the most prevalent diseases in the world, and many symptoms associated with migraine attacks have the potential to negatively influence driving ability.

METHODS

We reviewed the published findings related to migraine and driving performance. Study findings relevant to symptoms of migraine and their potential effect on driving were also reviewed. This required a more expansive exploration of the literature beyond migraine, for example, review of the literature relating to the effect of pain, sleepiness, visual disturbances, or vertigo on driving. Finally, the potential effects of treatment for migraine on driving were reviewed.

RESULTS

Literature on the effect of migraine on driving performance is sparse and, in general published studies on the topic have a number of limitations. Based on review of the literature pertaining to other disorders, it seems feasible that some symptoms occurring as part of the migraine attack could impact driving performance, although formal study in this area is lacking. Many of the approved treatments for migraine have the potential to impact driving, yet this has not been specifically studied, and the extent to which these risks are communicated to patients is not clear.

CONCLUSION

The impact of migraine on driving performance has been largely neglected, with few studies specifically designed to address the topic, and relevant studies were generally small with limited control of confounders. This area requires more focus, given a potential for impact on road safety.

Medical conditions, medication use, and their relationship with subsequent motor vehicle injuries: examination of the Canadian National Population Health Survey

PURPOSE

To examine the effects of various medical conditions and medications on subsequent motor vehicle injuries (MVIs).

METHOD

The National Population Health Survey, a large, nationally representative, longitudinal study of Canadians, included self-reported medical conditions of asthma, arthritis/rheumatism, back problems excluding arthritis, high blood pressure, migraine headaches, diabetes, heart disease and distress, and medication use during the past month for asthma, high blood pressure, diabetes, heart, codeine/pethidine (Demerol)/morphine, other pain relievers, antidepressants, tranquilizers, and sleeping medication. Path analyses were used to examine the odds of subsequent MVI for different medical conditions and medication use reported prior to the MVI (in the previous wave of the survey) while controlling for age and sex.

RESULTS

Increased odds of subsequent MVIs were found for asthma (odds ratio [OR]: 1.864, 95% confidence interval [CI]: 1.281, 2.713), arthritis/rheumatism (OR: 1.659, 95% CI: 1.163, 2.365), back problems (OR: 2.169, 95% CI: 1.624, 2.895), and migraines (OR: 1.631, 95% CI: 1.125, 2.364) but not for high blood pressure (OR: 1.435, 95% CI: 0.944, 2.181), diabetes (OR: 1.479, 95% CI: 0.743, 2.944), heart disease (OR: 2.627, 95% CI: 0.941, 7.334) or distress (OR: 1.153, 95% CI: 0.840, 1.581). Except for migraine with codeine/pethidine/morphine, this effect persisted regardless of whether medication was used to treat the condition. Respondents who reported using certain medications, namely, codeine/pethidine/morphine (OR: 2.215, 95% CI: 1.274, 3.850), other pain medication (OR: 1.630, 95% CI: 1.242, 2.139), antidepressants (OR: 2.664. 95% CI: 1.602, 4.429), and sleeping medication (OR: 2.059, 95% CI: 1.161, 3.651), had increased odds of subsequent MVI, independent of related medical condition, whereas tranquillizers showed no increased odds of subsequent MVIs.

CONCLUSIONS

This study suggests that the relationship between medical conditions, medications, and MVIs is complex but consistent with other studies.

Central and Paracentral Visual Field Defects and Driving Abilities

The effect of central and paracentral visual field defects on driving abilities has until now received little attention. To date studies and surveys have concentrated on visual acuity and peripheral field loss. Here we summarise for the first time those diseases causing central visual field defects likely to be associated with binocular visual acuity adequate for driving.

Understanding the effect of deployment on the risk of fatal motor vehicle crashes: a nested case-control study of fatalities in Gulf War era veterans, 1991-1995

Motor vehicle crashes (MVCs) are an important cause of morbidity and premature loss of life among military personnel during peacetime and particularly following combat. A nested case-control study of fatal MVC occurring between 1991 and 1995 was conducted in a cohort of Gulf War era veterans. Cases were validated MVC deaths in the Fatality Analysis Reporting System. Controls were selected using risk set sampling by gender and year of case ascertainment in a 10:1 ratio. Preliminary results, consistent with previous reports of increased fatal MVC risk among returning combat veterans, showed a crude odds ratio of 1.45 (95% confidence interval 1.27-1.65). Multivariable logistic regression modeling was used to identify important independent predictors, as well as to quantify the influence of deployment on a risk profile for fatal MVC. Because of significant interaction between deployment and inpatient diagnosis of substance abuse, the final model was stratified by deployment status. Results suggest that demographic, military, and behavioral characteristics of deployed healthy warriors are similar to the risk profile for fatal MVC. In addition to young, single, high school-educated, enlisted male personnel, those who served during times of ground combat, particularly in infantry, gun crews, or seamanship occupations, should be targeted for preventive interventions.

Age-specific patterns of factors related to fatal motor vehicle traffic crashes: focus on young and elderly drivers

This population-based study examines patterns of fatal motor vehicle traffic crashes (MVTCs) by age group (16-24, 25-64, 65+) among Canadian drivers. The Canadian Traffic Accident Information Databank (TRAID) provided information about fata MVTCs between 1984 and 1993. Distribution of risk factors was compared by age group. Crude odds ratios and 95% CIs were calculated for both young and elderly drivers compared with middle-aged drivers. The middle-age group was selected as reference population since it demonstrates the lowest risk of fatality. Compared to the middle-aged group, young drivers demonstrated excess risk for (1) risk-taking behaviours and conditions, specifically alcohol and illicit drug use, speeding, non use of seat belts, fatigue and falling asleep, and inexperience; (2) crashes during the summer, during weekends and at night; and (3) single-vehicle collisions and on performing overtaking manoeuvres. Excess risk among elderly drivers was noted for (1) medical and physical conditions, inattention and inexperience; (2) driver actions, for example, improper turning, failure to yield right-to-way; (3) occurrence on weekdays and during the day; and (4) collisions at intersection and vehicle--vehicle sideswipes. The results show notable differences in risk factors by age group and confirm the need for preventive efforts that incorporate age-specific strategies.

The acceptable risk of driving after myocardial infarction: are bus drivers a special case?

BACKGROUND

Bus drivers frequently encounter difficulty in returning to their former employment after recovery from myocardial infarction. The risk that a recurrence of myocardial infarction may cause a personal-injury accident is analyzed.

METHODS

The Cumulative Medical Index and Current Contents was searched systematically from 1980 to date, accepting papers irrespective of language. Relevant earlier material was drawn from the author's published reviews on bus driving and myocardial infarction and vehicle accidents. One hundred twenty-three articles were included in the database, of which 110 were used in the review.

RESULTS

The risk of a personal injury accident or fatality from a sudden cardiovascular incident is calculated as the product of typical driving time per day (Td = 0.167), vehicle characteristics (V) (a low factor of 0.167 for an urban bus because of slow speed and use of reserved curb lanes), the risk of recurrence of a sudden cardiovascular incident (SCI) (.015, somewhat greater in bus drivers than in the general population), and the risk that such an incident will cause a personal-injury accident (Ac) (at 0.005, probably lower than in the general population because of low vehicle speeds and the bus driver's experience in defensive driving).

CONCLUSIONS

The overall risk is 0.00002, 1 in 50,000 driver-years, is lower than accepted for passenger-car operators, and only slightly greater than for the older symptom-free adult. Bus drivers who meet the current standards of the Canadian Cardiovascular Society should be encouraged to return to their former employment.