Risk of 30-day mortality and its association with alcohol concentration level among driver victims of motor vehicle crashes: comparison of population- and hospital-based designs

Alcohol and driving-How bad is the combination? A meta-analysis

OBJECTIVE

The objective of this study was to summarize existing knowledge on the association between driving under the influence of alcohol and road safety outcomes and to assess factors that may explain why these estimates vary.

METHODS

Based on studies of the association between blood alcohol concentration (BAC) levels and crashes, we used multilevel metaregression to calculate summary effects of BAC level and analyze potential moderators of the association.

RESULTS

Based on 60 studies and 393 effect estimates, we found that BAC level, outcome severity, use of hospital data, and geographical region contributed to heterogeneity in results.

CONCLUSION

The effect of BAC on crash and injury risk and culpability is stronger at higher BAC levels and for more serious outcomes. The relationship between BAC level and outcome is approximately exponential. The relationship is stronger in studies from Nordic countries than in studies from other countries, possibly because of the relatively low level of drunk driving in these countries. Studies based on hospital data and studies using non-crash-involved control groups find smaller effects on average.

Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population-based retrospective study

BACKGROUND

Limited studies have assessed the association of motor vehicle crashes (MVCs) during pregnancy with adverse maternal outcomes using a population-based nationwide dataset that covers all MVCs.

METHODS

A total of 20 844 births from women who had been involved in MVCs during pregnancy were obtained from the National Birth Notification (BN) Database in Taiwan. We randomly selected 83 274 control births from women in the BN matched on age, gestational age and crash date. All study subjects were linked to medical claims and the Death Registry to identify the maternal outcomes after crashes. Conditional logistic regression models were used to estimate the adjusted odds ratio (aOR) and 95% CI of adverse outcomes associated with MVCs during pregnancy.

RESULTS

Pregnant women involved in MVCs had significantly higher risks of placental abruption (aOR=1.51, 95% CI 1.30 to 1.74), prolonged uterine contractions (aOR=1.31, 95% CI 1.11 to 1.53), antepartum haemorrhage (aOR=1.19, 95% CI 1.12 to 1.26) and caesarean delivery (aOR=1.05, 95% CI 1.02 to 1.09) than the controls. Such elevated risks tended to be higher in the MVCs with greater severity. Scooter riders had higher ORs of various adverse maternal outcomes than car drivers.

CONCLUSIONS

Women involved in MVCs during pregnancy were at increased risk of various adverse maternal outcomes, especially in those with severe MVCs and riding scooters at MVCs. These findings suggest that clinicians should be aware of these effects, and educational materials that include the above information should be provided as part of prenatal care.

Risk of motorcycle collisions among patients with type 2 diabetes: a population-based cohort study with age and sex stratifications in Taiwan

AIMS

To investigate the overall and sex-age-specific absolute and relative risks of motorcycle collisions at road traffic accidents among patients with type 2 diabetes.

METHODS

A cohort study in Taiwan was conducted by following 989,495 patients with type 2 diabetes and the same number of matched controls recruited between 2010 and 2012 to the end of 2016. Collision events by motorcycle driver victims were identified from the Police-reported Traffic Accident Registry. Overall and sex-age-specific incidence rates of collision involving motorcycle driver victims were estimated under Poisson assumption. The Cox proportional hazard regression models were performed to estimate the hazard ratios (HRs) and 95% confidence intervals (CIs) of collision in association with type 2 diabetes.

RESULTS

Over an up to 7 years of follow-up, patients with type 2 diabetes had a higher incidence rate of motorcycle collision than controls at 1.16 and 0.89 per 100 person-years, respectively, which represented a significantly elevated HR of 1.28 (95% CI 1.27-1.30) after adjusting for potential confounders including various diabetic complications. The elevated HR was similarly seen in both men and women patients, and was significantly decreasing with increasing age regardless of sex. Little evidence supported the dose-response relationship between duration of type 2 diabetes and motorcycle collision risk.

CONCLUSIONS

After adjustment for common diabetic complications and comorbidities that could impair driving performance, patients with type 2 diabetes still suffered from increased risk of motorcycle collisions, regardless of sex, but was more evident in younger than in older patients.