Motor vehicle and fall related deaths among older Americans 1990-98: sex, race, and ethnic disparities

OBJECTIVES

To examine differences in motor vehicle and fall related death rates among older adults by sex, race, and ethnicity.

METHODS

Annual mortality tapes for 1990-98 provided demographic data including race and ethnicity, date, and cause of death. Trend analyses were conducted using Poisson regression.

RESULTS

From 1990-98, overall motor vehicle related death rates remained stable while death rates from unintentional falls increased. Motor vehicle and fall related death rates were higher among men. Motor vehicle related death rates were higher among people of color while fall related death rates were higher among whites. Among whites, fall death rates increased significantly during the study period, with an annual relative increase of 3.6% for men and 3.2% for women.

CONCLUSIONS

The risk of death from motor vehicle and fall related injuries among older adults differed by sex, race and ethnicity, results obscured by simple age and sex specific death rates. This study found important patterns and disparities in these death rates by race and ethnicity useful for identifying high risk groups and guiding prevention strategies.

Driving cessation: what older former drivers tell us

OBJECTIVES

To understand why older drivers living in a community setting stop driving.

DESIGN

A cross-sectional study within a longitudinal cohort.

SETTING

A geographically defined community in southern California.

PARTICIPANTS

1,950 respondents age 55 and older who reported ever being licensed drivers.

MEASUREMENTS

A mailed survey instrument of self-reported driving habits linked to prior demographic, health, and medical information.

RESULTS

Of the 1,950 eligible respondents, 141 had stopped driving within the previous 5 years. Among those who stopped, mean age was 85.5 years, 65.2% were female, and the majority reported they were in very good (43.4%) or good (34.0%) health. Nearly two-thirds reported driving less than 50 miles per week prior to stopping and 12.1% reported a motor vehicle crash during the previous 5 years. The most common reasons reported for stopping were medical (41.0%) and age-related (19.4%). In bivariate analyses, age and miles driven per week were each associated with cessation (P < or = .001). Medical conditions, crashes in the previous 5 years, and gender did not reach statistical significance at the P < or = .05 level. Logistic regression results found that the number of medical conditions was inversely associated with driving cessation.

CONCLUSION

The relationship between medical conditions and driving is complex; while medical conditions were the most common reason given for driving cessation, those who stopped had fewer medical conditions than current drivers. This suggests that a broader measure of general health or functional ability may play a dominant role in decisions to stop driving.

Characteristics of child passenger deaths and injuries involving drinking drivers

CONTEXT

Motor vehicle-related injury is the leading cause of death for children and young adults aged 1 to 24 years in the United States. Approximately 24% of child traffic deaths involve alcohol.

OBJECTIVE

To examine characteristics of crashes involving child passenger deaths and injuries associated with drinking drivers to identify opportunities for prevention.

DESIGN, SETTING, AND PARTICIPANTS

Descriptive epidemiological analysis of 1985-1996 datafrom the Fatality Analysis Reporting System on deaths among US child passengers (aged 0-14 years) and 1988-1996 data from the General Estimates System on nonfatal injuries.

MAIN OUTCOME MEASURES

Child passenger death or injury by driver characteristics (eg, driver age, blood alcohol concentration, and driving history).

RESULTS

In 1985-1996, there were 5555 child passenger deaths involving a drinking driver. Of these deaths, 3556 (64.0%) occurred while the child was riding with a drinking driver; 67.0% of these drinking drivers were old enough to be the parent or caregiver of the child. Of all drivers transporting a child who died, drinking drivers were more likely than nondrinking drivers to have had a previous license suspension (17.1% vs 7.1%) or conviction for driving while intoxicated (7.9% vs 1.2%). Child restraint use decreased as both the child's age and the blood alcohol concentration of the child's driver increased. In 1988-1996, an estimated 149,000 child passengers were nonfatally injured in crashes involving a drinking driver. Of these, 58,000 (38.9%) were riding with a drinking driver when injured in the crash.

CONCLUSIONS

These data indicate that the majority of drinking driver-related child passenger deaths in the United States involve a child riding unrestrained in the same vehicle with a drinking driver. Typically, the drinking driver transporting the child is old enough to be the child's parent or caregiver.

Surveillance for injuries and violence among older adults

PROBLEM/CONDITION

Injuries and violence are major causes of disability and death among adults aged > or =65 years in the United States. Injuries impair older adults' quality of life and result in billions of dollars in health-care expenditures each year.

REPORTING PERIOD

This report reviews 1987-1996 data regarding fall-related deaths, 1988-1996 data on hospitalizations for hip fracture, 1990-1997 data regarding motor vehicle-related injuries, 1990-1996 data on suicides, and 1987-1996 data on homicides.

DESCRIPTION OF SYSTEMS

Data on fall-related deaths, suicides, and homicides are from the National Center for Health Statistics annual mortality data tapes for 1987-1996. Homicide data are supplemented with information from the Federal Bureau of Investigation's Supplemental Homicide Reports for 1987-1996. Data on hospitalizations for hip fracture are from the 1988-1996 National Hospital Discharge Surveys. Information regarding motor vehicle-related injuries for 1990-1997 is from the National Highway Traffic Safety Administration's Fatality Analysis Reporting System and General Estimates System.

RESULTS

Rates of fall-related deaths for older adults increased sharply with advancing age and were consistently higher among men in all age categories. Men were 22% more likely than women to sustain fatal falls. A trend of increasing rates of fall-related deaths was observed from 1987 through 1996 in the United States, although rates were consistently lower for women throughout this period. Rates of hospitalizations for hip fracture differed by age and were higher for white women than for other groups. Rates increased with advancing age for both sexes but were consistently higher for women in all age categories. U.S. hospitalization rates for hip fracture increased for women from 1988 through 1996 while the rates for men remained stable. Rates of motor vehicle-related injuries increased slightly from 1990 through 1997, and marked variations in state-specific death rates were observed; in most states, older men had death rates approximately twice those for older women. Although suicide rates remain higher among older adults than among any other age group, rates of suicide among adults aged > or =65 years decreased 16% during the study period. Suicide rates among older adults varied by sex and age group. Homicide rates declined 36% among older adults. Homicide rates were highest for black men, followed by black women and white men; the homicide risk for blacks relative to whites decreased from 4.8 to 3.9 per 100,000 persons, indicating that the gap between rates for blacks and whites is closing. Half of the older homicide victims were killed by someone they knew.

INTERPRETATION

The increase in rates of fall-related deaths and hip fracture hospitalizations from 1988 through 1996 might reflect a change in the proportion of adults aged > or =85 years compared with those aged 65-84 years - a change that results, in part, from reduced mortality from cardiovascular and other chronic diseases. Fall-related death rates might be higher among older men because they often have a higher prevalence of comorbid conditions than women of similar age. Racial differences in hospitalization rates might have some underlying biologic basis; the prevalence of osteoporosis, a condition that contributes to reduced bone mass and increased bone fragility, is greatest among older white women. Compared with whites aged > or =65 years, blacks of comparable ages have greater bone mass and are less likely to sustain fall-related hip fractures. Additional studies are needed to determine why rates of motor vehicle-related injury have increased slightly among older adults and why these rates vary by state. Declining rates of suicide among older adults might be related to changes in the effect or type of risk factors traditionally observed in this age group. Research is needed to identify reasons for variations in suicide rates among older persons. Homicides among olde

Unsafe motor vehicle practices among substance-using college students

This study examines the relationship between substance use and behaviors that increase the risk for motor vehicle crashes and crash-related injuries. The investigation uses National College Health Risk Behavior Survey data collected in 1995 by the Centers for Disease Control and Prevention. These data are representative of 2- and 4-year undergraduate college students in private and public colleges and universities in the United States. Smokers, episodic heavy drinkers, marijuana users and users of illegal drugs in combination with alcohol were significantly more likely to drive after drinking alcohol and ride with a driver who had been drinking alcohol and significantly less likely to wear safety belts while driving or while riding in a car as a passenger. This study indicates that college students who are substance users are more likely to behave in a manner which increases their risk for motor vehicle crashes and motor vehicle crash injuries.

A comparison of driver- and passenger-based estimates of alcohol-impaired driving

INTRODUCTION

Persons who drive after drinking or ride with drinking drivers are at increased risk of motor vehicle crash. Although alcohol is involved in 40% of fatal motor vehicle crashes yearly, there exist few systems to monitor alcohol-impaired driving. In this study we compare driver- and passenger-based estimates of the prevalence of alcohol-impaired driving.

DESIGN

A random-digit-dialing telephone survey of the United States. Participants were adults aged 18 or older who were English- or Spanish-speaking from 5238 households (response rate = 56.1%).

RESULTS

From the 4603 respondents who reported driving in the preceding 30 days, we estimate that there were 126 million drinking-driving episodes in the United States in 1994. From the 4380 passengers in the preceding 30 days, we estimate 191 million episodes. Three percent of respondents self-reported as drinking drivers (4.8% of males and 1.3% of females) and 4.9% as passengers of drinking drivers. Drinking drivers were more likely to be passengers of drinking drivers (44% versus 4% of nondrinking drivers). Drinking drivers were also more than twice as likely to report drinking daily, and only one half as likely to report always wearing their safety belts.

CONCLUSION

Passengers who report riding with a drinking driver may provide an important estimate of the prevalence of drinking driving. Passengers of drinking drivers represent a high-risk group that is not considered in most prevention efforts. Because being a passenger of a drinking driver is not illegal, it may be an easier topic for clinicians to broach than drinking and driving.

Young driver involvement in fatal motor vehicle crashes and trends in risk behaviors, United States, 1988-95

OBJECTIVE

To review trends and risk factors in fatal motor vehicle crashes (MVCs) for drivers aged 15-20 years.

METHODS

Fatality Analysis Reporting System data from 1988 to 1995 were used. Drivers were divided into three age strata: 15-17 years, 18-20 years, and > or = 21 years. Comparisons were made based on rates of driver involvement in fatal MVCs, the percentage of drivers involved in night time fatal MVCs, fatal MVCs without the use of restraints, and fatal MVCs with positive blood alcohol concentration.

RESULTS

Over the eight years, the rate of driver involvement in fatal MVCs for those 15-17 dropped 15.5%; for those 18-20 years it dropped 22.0%, and for those > or = 21 years it declined 13.5%. When combining both age groups results were similar. In 1988, 60.4% of young drivers involved in fatal MVCs were not using restraints, but by 1995 the percentage dropped to 46.0%. Night time fatal crashes, the second most frequent risk behavior, declined from 41.7% in 1988 to 35.2% in 1995. Alcohol related traffic fatalities were responsible for 32.1% of fatal MVCs among young drivers in 1988 and for 20.3% in 1995.

CONCLUSION

To accelerate these trends, implementation and evaluation of complete graduated driver licensing systems (GDLSs) is recommended. Under GDLSs, young drivers are subject to zero alcohol tolerance, curfews, and passenger restraint requirements.

Injuries to rescue workers following the Oklahoma City bombing

The objective of this study was to identify and describe physical injuries to rescue workers in the aftermath of the Oklahoma City bombing. Data were obtained from medical records from 16 hospital emergency departments and specialty clinics in the Oklahoma City area, and reported visits to medical providers at the bombing site. Participants were rescue personnel from the Oklahoma City Fire Department, the mutual aid fire stations in the Oklahoma City area, the Federal Emergency Management Agency's Urban Search and Rescue teams, and military personnel stationed near Oklahoma City. All participants were involved in the rescue and recovery operation. The two main outcome measures were (1) the number, types, and rates of injuries; and (2) comparisons of case-finding methods, including medical chart review and telephone interview. The most common injuries were strains and sprains (21.4%), foreign bodies in eyes (14.5%), and laceration/crush/puncture wounds (18.4%). Of the four case-finding mechanisms, telephone interviews following the event identified the largest number of cases (84.5%). Most injuries were minor; some injuries such as chemical burns were preventable. The potential utility of other data collection mechanisms is considered.

Legal requirements for confidentiality in hospice care

In the absence of federal legislation or a federal constitutional right to medical privacy, state law governs hospice workers' legal obligations. States differ in the breadth and clarity of their law, how strongly they encourage preservation of confidentiality, what aspects of a medical encounter are confidential, and when a patient is deemed to have waived the right. All states, however, recognize a legal duty of confidentiality in certain circumstances, but also recognize exceptions to the duty. Understanding the law is necessary but not sufficient; hospice staff should be prepared to adjust procedures and physical surroundings to protect confidentiality.

Risk of heat-related injury to disaster relief workers in a slow-onset flood disaster

Heat-related injury or illness (HRI) occurs when the body can no longer maintain a healthy core temperature. During the 1993 Midwest floods, several risk factors HRI were present for workers involved in sandbagging activities. Medical claims filed by Illinois National Guard troops were used to identify injuries. HRI was the most frequently reported injury diagnosis, at 19.3% (23 of 119 injuries). HRI represented 16.0% of injuries to men and 41.7% of injuries to women. HRI can be influenced by high ambient temperatures, high humidity, and prolonged exertion, all of which were present in Illinois. Our results indicate that HRI is a potential problem in disaster relief situations. Further investigation using more detailed data is needed to confirm these findings. Implementation of a few simple preventive measures may decrease the impact of this problem.

Alternate forms of the Auditory-Verbal Learning Test: issues of test comparability, longitudinal reliability, and moderating demographic variables

The present investigation examines the alternate-form and longitudinal reliability of two versions of the Auditory-Verbal Learning Test (AVLT) on a large, multiregional, healthy male sample. Subjects included 2,059 bisexual and homosexual HIV-seronegative males recruited from the Multicenter AIDS Cohort Study from centers in Baltimore, Chicago, Los Angeles, and Pittsburgh. The findings revealed no significant differences between forms upon initial or 1-year longitudinal administration, supporting the equivalence of the two versions. However, significant practice effects were noted longitudinally, arguing for the need of appropriate retest normative data. Furthermore, as age, ethnicity, and education were found to significantly affect test performance, it is recommended that normative data be interpreted according to these variables. In addition to providing normative and longitudinal data, this investigation presents information concerning the use and limitations of the alternate forms of the AVLT.