Three year injury crash records of new licensees with suspensions or invalidity periods lasting 90 days or more.

A subset of new licensees, namely the ones with suspensions or invalidity periods of at least 90 days are studied. This subpopulation is comprised of 3,550 men and 1,295 women for whom the study file contains age, gender, licensing exam performance, and the dates all police reported crashes for the first three years after licensing. This group is compared with the complementary subpopulation of 53,069 men and 58,464 women. The average injury crash rate per year, not prorated, is 0.057 for men and 0.033 for women, about twice the rate for those without lengthy suspensions. These licensees are older, have lower success rates at licensing exams, and have a longer learning period than the others. Separate logistic-normal regression models for men and for women are estimated for the probability of a collision in a year using the available explanatory variables.

Impact of diabetes on crash risks of truck-permit holders and commercial drivers.

OBJECTIVE: The U.S. and some Canadian government agencies have waived commercial license restrictions for some insulin-using diabetic drivers. However, the U.S. Federal Highway Administration is no longer giving waivers. Scientific evidence to support such regulations has been sparse. This article presents detailed analyses of crash risks for users and nonusers of insulin among diabetic truck-permit holders in Québec, Canada. RESEARCH DESIGN AND METHODS: Diabetic truck-permit holders were group-matched by age to a random sample of healthy permit holders. Data on permits, medical conditions, and crashes involving 13,453 permit holder-years in 1987-1990 were extracted from the files of the public insurer for automobile injuries in Québec. Additional health status data were obtained from the provincial public health insurer. A telephone survey was conducted to collect data on driving patterns and exposure. Risk ratios were estimated using negative binomial regression models. RESULTS: Risk ratios for crashes vary by category of diabetes. Permit holders for single-unit trucks (STs) who are diabetic without complications and not using insulin have an increased crash risk of 1.68 when compared with healthy permit holders of the same permit class. When controlling for risk exposure, commercial drivers with an ST permit and the same diabetic condition have an increased risk of 1.76. Insulin use is not associated with higher crash risk. CONCLUSIONS: The increased crash risk for the group with uncomplicated diabetes not using insulin is a new finding. The lack of consistent increases in crash risks among diabetic commercial drivers with complications or who use insulin may be a "healthy worker effect" masking the real risk, because these licensees have a lower participation rate as professional drivers.

Taxi drivers' accidents: how binocular vision problems are related to their rate and severity in terms of the number of victims.

Recent studies do not agree on the possible relationship between medical conditions and traffic safety; most of them do not control for exposure factors. In this study, we estimate the effect of binocular vision problems on taxi drivers' distributions of crashes (frequency). Moreover, given a crash, we estimate the effect of binocular vision problems on the distributions of the number of victims per crash (dead or injured). Our data and models permit the simultaneous consideration of many variables: age, medical condition, exposure factors measured by distance driven and time behind the wheel, qualitative risk factors, other characteristics of the driver, and crash circumstances in the models for the number of victims. Results show that taxi drivers have a large average number of crashes per year, larger for those with binocular vision problems compared with healthy ones, but not more severe in terms of the number of victims. The driver's past record (number of crashes and demerit points in the previous year) is a significant predictor of the number of crashes. Age is associated significantly with the number and the severity of crashes with older drivers having a better record than the youngest group (30 years old or less).

Medical conditions and the severity of commercial motor vehicle drivers' road accidents.

In this research we studied the association between commercial motor vehicle drivers' medical conditions and crash severity. Some aspects of medical condition were considered. To our knowledge, no study has ever isolated this association. The severity of a crash was measured by the total number of victims (injured and dead). We estimated nonlinear regression models (specifically, Poisson and negative binomial) which incorporated, simultaneously, information on drivers' characteristics, crash circumstances and health status, in order to isolate the association between health status and crash severity. Our results show that crashes of truck drivers with binocular vision problems and bus drivers with hypertension are more severe than those of healthy drivers. No other medical condition considered in this study was significantly associated with crash severity. Many variables describing crash circumstances were also significant.

Medical conditions, risk exposure, and truck drivers' accidents: an analysis with count data regression models.

Recent studies do not agree on the possible relationship between medical conditions and traffic safety; most of them do not control for exposure factors. This problem has become more pertinent for scientific studies because of litigation that showed that present regulations about access to driver permits might contravene human rights legislation. In our study, we estimate the effect of different medical conditions on truck drivers' distributions of accidents. Our data and our models permit simultaneous control for age; medical conditions; exposure factors measured by hours, kilometer, and qualitative factors; and other characteristics of truck drivers. Our results show that diabetic truck drivers of the permit class for straight trucks have more accidents than drivers in good health. No other studied medical condition has a significant effect on individual accident distributions. Many risk exposure variables are also significant. The effect of age is discussed in detail.

[Diabetes and road safety]. / Diabète et sécurité routière.

The purpose of this study is to analyse the driving habits of a group of diabetic individuals, insulin and noninsulin treated, compared with the driving habits of an equivalent group of individuals in good health. Specific attention is given to the evaluation and management of stress related to driving. The analysis relies mainly upon the answers of 307 persons of both sex on a questionnaire regarding their driving habits and concerning twenty more or less risky behaviors. The diabetic subjects were sampled among the patients of an endocrinology clinic, and the pilot group (in good health) was gathered among the patients from the clinic of a general practitioner. The subjects were aged between 25 and 65. All were in possession of a driving licence and had a driving experience of over two years. The results show, on one hand, that the evaluation of stress related to a risky behavior is associated to the taking of risk at the wheel, and on the other hand, that compared with the other subjects in the study the diabetic subjects had a lesser tendency to taking risks in driving. The subjects avoided the behaviors they judged risky. Beside avoiding dangerous road behaviors, the latter brought special attention to food and relaxation needs and they showed a great alertness towards climatic and road conditions. Finally, they are especially careful in preventing and curing hypoglycaemic states.

Neck injuries among belted and unbelted occupants of the front seat of cars.

This article, part of a recently completed research project on safety belts, presents results on neck injuries. A total of 3927 injured front-seat occupants (drivers and passengers) involved in two-car crashes were studied. Among them, 725 sustained neck sprains (ICD-9 code 847.0); some of them may have sustained other injuries as well. The more serious injuries to the cervical spine were more prevalent among the unbelted occupants. Neck sprains were relatively more numerous among belted occupants compared with unbelted ones, with a relative risk estimate of 1.68. Similar results hold also for subsets of the data on different types of collisions; the relative risks ranged from 1.39 to 2.42. A log linear model was constructed for the odds ratio (neck sprain vs. no neck sprain) taking into account the following factors: (1) seatbelt use, (2) direction of impact, (3) authorized speed limit, and (4) vehicle weight. The resulting relative risk estimate (belted vs. unbelted) became 1.58. The results raise questions about seatbelts and their protection against neck sprains.

Exposure for different license categories through a phone survey: validity and feasibility studies.

This paper presents: (i) an operational definition of risk exposure, (ii) a questionnaire developed to measure exposure, (iii) validity studies of estimates of the distance traveled and time spent driving for different permit holder categories, and (iv) a feasibility study for a telephone survey on exposure. Results show that long-distance truck drivers from one company studied estimated accurately their distance driven on the last worked day; Montreal Urban Community Transport Commission bus drivers estimated well their time behind the wheel; while a convenience sample of private car drivers (coworkers and friends) estimated well their previous week distance and time on the road. Phone surveys appear to be an efficient and cost-effective method for risk exposure data collection.

The effects of age and experience on accidents with injuries: should the licensing age be raised?

In Canadian Provinces and in several states of the United States the minimal legal age to drive a motor vehicle is 16 years old and in some, it is 15. The excess mortality and morbidity registered by 15 to 24-year-old drivers is well known. Several studies have reported that accident rates decrease with experience, but the effect of the age of new drivers has not been well documented. The objective is to study injury accident rates in terms of the age and experience factors. The data sources are computer files of the Government Insurance Corporation (Société de l'assurance automobile du Québec), which covers all Quebec drivers. For each driver, the file contains birth date, sex, year and month of first license, involvement in accidents, and other parameters. The yearly rates (1970-1984) of new permits per age last birthday and sex show an increase over time, particularly for 16-year-old men. For the period 1979-1984, injury accident involvement rates were computed for all Quebec drivers by age, sex, and driving experience. An experienced driver has been defined as a person who has been licensed for at least one year. The results show, for experienced as well as inexperienced young men (16-18), a high injury accident rate that decreases with age. For women, the rates are much lower and decrease more gradually than for men. This study does not take into account the kilometers driven. Since young drivers (16-18) have the highest accident rates, the question of regulating access to first licensing for such drivers must be examined as a possible strategy for injury prevention.

[Exposure to the risk of traffic accidents, a fundamental epidemiological parameter, and one difficult to measure]. / L'exposition au risque d'accident de la route, un paramètre épidémiologique fondamental et difficile à mesurer.

This is a review of the literature dealing with exposure to the risk of traffic accidents. We present the principal definitions of this concept, the different measures of risk exposure, indicators of the risk of traffic accidents, and the advantages and disadvantages of the methods used for the collection of data. The validity of the measure of exposure to risk is analyzed as well. We conclude that while distance travelled is the principal measure of exposure to risk accepted by the research community, it is necessary to use a composite measure which also takes into account the risk associated with the driver.

[Impact of diabetes mellitus on driving safety]. / L'impact du diabète sucré sur la sécurité routière.

Driving ability is controlled by specific regulations. Therefore disabled individuals or those with certain chronic diseases may be affected by these regulations. These latter are based on assumption that the existence and the nature of certain diseases may cause particular hazard; and this could be prevented by introducing certain driving regulations. This hypothesis has not been tested properly, considering the proposed and suspected risk factors. Diabetes mellitus is a good example of the interested medical condition in this field. Review of the literature do not provide adequate information to allow us to conclude whether the insulin treated diabetic person is at higher risk to develop traffic accident, compared with non diabetic individual; and there is no definite explanation whether hypoglycaemia play a causative role in the etiology of traffic accident among insulin treated diabetics. Perhaps the lack of knowledge in this field is due to use of non-standardized methodologies and small sample size studies which make the comparisons difficult. The existing regulations in different countries are based on empirical knowledge and common sense. This often leads to conflictual situations and apparently discriminatory decisions regarding diabetics. Further comparative and prospective studies are needed.

[3-wheeled and 4-wheeled all-terrain vehicles: unstable and dangerous vehicles]. / Les trimotos et les quadrimotos: des véhicules instables et dangereux.

We present the results of a questionnaire completed by 526 victims of accidents involving three- and four-wheeled all-terrain vehicles. All victims were treated at the emergency departments of 10 regional hospitals in Quebec. In 70% of cases, the vehicles overturned. Two thirds of victims were injured in accidents without collision, typically involving overturns on level ground or hills. We suggest accident reconstruction research as a means of identifying engineering solutions as one element in an injury control approach.

Characteristics of three- and four-wheeled all-terrain vehicle accidents in Quebec.

During a seven-month survey from May to November 1985, 624 victims injured from three- or four-wheeled all-terrain vehicles (ATVs) were observed in the emergency rooms of 10 regional hospitals in Quebec. A total of 1,100 injuries were identified, including 3 fatal and 104 serious to critical injuries (AIS greater than or equal to 3). These injuries were to the lower limb (29%), the upper limb (28%), the head, neck, and face (26%), and the thorax, abdomen, and pelvis (18%). Close to one-half (45%) of the victims were 19 years old and less; 54% reported wearing helmets. Ten percent of the victims were hospitalized for an average period of 8 days. In 70% of the cases, the vehicle overturned: half of these vehicles turned on the side, 27% toward the back, and 19% flipped forward. Two-thirds of persons injured were involved in accidents in which no external objects were hit by the vehicle; these accidents typically involved vehicle overturns, both on hills and on level ground. Ninety-five percent of the vehicles were in good mechanical condition. The use of these vehicles presents a danger whether used by a child or an adult, by an experienced or an inexperienced rider. The average user may not be aware that three- and four-wheel ATVs demand considerable skill and caution. We suggest the use of accident reconstruction studies for possible engineering solutions.

Mandatory driver training and road safety: the Quebec experience.

In January 1983, the Quebec Government made driver training courses mandatory for any person seeking a first driver's license. Using accident and licensure data over a five-year period, we conducted an evaluation of the impact of the enactment of mandatory driver training on: the risk of accident for newly licensed drivers; the mortality and morbidity of these accidents; the number of new drivers; and the mean age of licensure. Results of our time series analyses show that this legislation had no appreciable effect on the risk of accident or on the mortality/morbidity rate per accident for newly licensed drivers aged 18 and over. However, since 1983, the number of women under 18 years of age getting their first driver's license has increased by 20 per cent, and their mean age has decreased from over 18 to under 18. Mandatory driver training may have increased the numbers and risks of accidents for young, primarily female, drivers.