G Model

AAP 1732 1–7

ARTICLE IN PRESS
Accident Analysis and Prevention xxx (2008) xxx–xxx

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Contents lists available at ScienceDirect

Accident Analysis and Prevention
journal homepage: www.elsevier.com/locate/aap

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Evelyn Vingilis a,∗ , Piotr Wilk b

a Population and Community Health Unit, Department of Family Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario London, Ontario, Canada N6A 5C1 b School of Nursing, Faculty of Health Sciences, London, Ontario, Canada N6A 5C1

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a b s t r a c t

Keywords: Motor vehicle injuries Risk factors Medicinal drugs Health Alcohol

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1. Introduction

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Article history: Received 31 January 2008 Received in revised form 9 April 2008 Accepted 28 June 2008

Objective: The purpose of this study was to examine the effects of health factors and substance use on subsequent motor vehicle collision (MVC) injuries of three different age groups, using the longitudinal dataset from the Canadian National Population Health Survey (NPHS) for the years 1994–2002. Methods: Path analysis technique was used to determine the relations between MVC injury and four risk factors: binge drinking; health status; distress; and medication use. The three demographic variables, age at ‘baseline’, sex, and immigration status were added into the model as control variables. Three age groups were examined: young = 12–29.9; middle-aged = 30–59.9 and old = 60–85 years of age. The total sample size was 16,093. Results: A lower percentage of males, older persons, immigrants, and non-binge drinkers reported a subsequent MVC injury, as did respondents reporting better health and lower distress scores. Medication use was associated with higher subsequent MVC injuries. Path analysis found that among younger individuals, the variable binge drinking, was the only significant risk factor associated with subsequent injuries. In contrast, among middle-aged individuals, the variable medication use, was the only statistically significant risk factor for subsequent injuries. No variables were significant risk factors of injuries for older individuals. Conclusions: Various demographic and risk factors were found to influence injuries among a nationally representative sample of Canadians. Reported binge drinking among young individuals and medication use among middle-aged individuals were found to be risk factors for subsequent MVC injury. These findings support the need for continued focus on alcohol, drugs and traffic safety. © 2008 Elsevier Ltd. All rights reserved.

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Motor vehicle collisions (MVCs) are a major cause of injuries in Canada, with recent Canadian data indicating that in 2005, 210,629 people were injured while 2923 persons died in MVCs (Transport Canada, 2007). Thus, injuries outnumber fatalities by over 70 times, making injuries a major economic burden. Interestingly, evidence indicates that MVC fatalities and injuries differ in patterns and trends. For example, the age and sex patterns of MVC injuries have been found to differ substantively from fatalities (National Highway Traffic Safety Administration, 2005; Roberts et al., 2007; Transport Canada, 2005). These differences and high economic burden support the need for research on MVC injuries. However, despite the high number of injuries due to MVCs, information is more limited

∗ Corresponding author. Tel.: +1 519 8585063x2. E-mail address: evingili@uwo.ca (E. Vingilis). 0001-4575/$ – see front matter © 2008 Elsevier Ltd. All rights reserved. doi:10.1016/j.aap.2008.06.020

on risk factors of MVC injuries, particularly among large representative samples. Three main sources of data on MVC injuries include: (1) clinical, (2) official police, and (3) social survey data (Gelles, 2000; Roberts et al., 2007), although the majority of studies on MVC injuries are based on clinical samples (emergency room or hospitalization data) (Cherpitel, 1988; Longo et al., 2000; Meropol et al., 1995; Stoduto et al., 1993; Tavris et al., 2001) or on police collision reports (AbdelAty and Abdelwahab, 2000; Ulfarsson and Mannering, 2004; Valent et al., 2002; Zhang et al., 2000). Because studies using clinical and police data are based on administrative databases, the risk factors that can be examined are limited to trauma- or collision-related variables and some available demographics. Studies based on social surveys can examine a wider range of risk factors. However, because MVC injuries are rare events and thus surveys to examine MVC injuries require large sample sizes, few population-based survey studies have been conducted. Those that have been conducted, have often focused on subpopulations, such as adolescent or elderly

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The effects of health status, distress, alcohol and medicinal drug use on subsequent motor vehicle injuries

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Please cite this article in press as: Vingilis, E., Wilk, P., The effects of health status, distress, alcohol and medicinal drug use on subsequent motor vehicle injuries. Accid. Anal. Prev. (2008), doi:10.1016/j.aap.2008.06.020

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. However. The limitation is that not all potential risk factors of subsequent MVC injuries are available in the survey instrument. 1995. use of health services. distress and those who reported using two or more medications. Ellinwood and Heatherly. A major critique of self-report surveys is the presumption that self-report data are subject to poor recall of events. 2004.020 UN CO RR EC TE DP RO OF . Since age has been found to play an important role in explaining the relationship between risk factors and MVC injury (e.. and psychotropic medication use (Alvarez et al. persons with poor health. binge drinking more common among younger persons. certain health problems. and medications can cause impairment which could increase susceptibility for MVC injuries. 2004. Moreover. such as fragility. 2007). such as MVCs.. most studies used cross-sectional surveys. They found high concordance between self-report and official data. we hypothesized that different risk factors would affect different age groups. 1999). using the longitudinal NPHS sample for the years 1994–2002 (Vinglis and Wilk. 1998). 2001. For example. Koepsell et al.. the rates by age were not linear. 1993). based on Transport Canada’s Traffic Accident Information Database (TRAID) for Canadian provinces and territories (Roberts et al. Singleton et al. the literature on variables that increased exposure (e. Amoros et al. McKinnon et al. (2008). The bivariate analyses found that a higher percentage of females and younger persons reported MVC injuries as did binge drinkers. have been criticized for potentially having biased samples. and prospective nature of the survey. namely that 117 118 119 120 121 122 123 124 125 126 127 128 129 130 131 132 133 134 135 136 137 138 139 140 141 142 143 144 145 146 147 148 149 150 151 152 153 154 155 156 157 158 159 160 161 162 163 164 165 166 167 168 169 170 171 172 173 174 175 176 177 178 179 Please cite this article in press as: Vingilis. In the first wave of the NPHS (1994–1995). 2004). Vaa et al. Begg et al. making it impossible to assess whether the factors that correlated with the outcome measures precede or follow the outcome measures (Chipman. Multiple logistic regression analysis found that health status and medication use were associated with MVC injury. and 2002–2003 (Cycle 5)) are available for analyses (Statistics Canada.. alcohol and certain health problems. 2. Vingilis. stratified..0% for persons in the 30–59 age categories. excluding people living on Native reserves.5% for persons in the under 30 age categories. 2004. E. Injury rates for 1994–1996 for both datasets were compared for males and females for seven age groups. that have been found to affect MVC injuries. we conducted an initial study to compare the NPHS self-reported MVC injury rates with police collision reports of MVC injury rates.5–1. is good (Schwarz and Oyserman. The effects of health status. The NPHS longitudinal follow-up sample includes 17. 1999. Chipman. 19. distress. using a two-staged.g... Vingilis and MacDonald. Kaufman et al. 2004. between . Lagarde et al. These variables could affect exposure. The National Population Health Survey The NPHS is a longitudinal. The survey focuses on health and injury status.. using the longitudinal dataset from the Canadian National Population Health Survey (NPHS). 1983). 1993. psychosocial factors. 1968. 2003. All three data sources are subject to validity problems. In 1994 (Time 1).06. The risk factors used in this study were based on our previous research findings. to be passengers with drinking drivers. 1995. P. Mock et al. 1997. gender) and/or susceptibility (e. 2000. 2000–2001 (Cycle 4). 1998–1999 (Cycle 3). Vinglis and Wilk. health status. Risk factors affecting MVC injuries can be conceptualized as mechanisms through which certain factors can cause injuries.. 2001.600 households were selected from across Canada. Fife et al. the NPHS does not include information on whether the respondent was injured as a driver or passenger or on kilometres driven per year. included control variables of age. no significant differences were found between males and females when the two datasets were compared for any of the age categories.. 2005). for example. 2002. and ... the analyses may not have been sensitive enough to assess risk factors that are typically associated with certain age groups... the sample was created by first selecting households and then within each household randomly choosing one member 12 years of age or older to be interviewed every 2 years. as age was used as a continuous variable..2008. variables such as. national survey database is the representativeness and generalizability of the sample.g.. For example. Elvik and Mysen. In a subsequent study. 2004). Research has shown that binge or heavy drinkers are more likely to drive impaired. Sudman and Bradburn. 2003. 2002). Aptel et al. and socio-demographic information (Statistics Canada. biennial study of Canadians. lifestyles. Selzer et al. 1974. such as clinical or police data. Anal. However. Sagberg.. 2001.g. distress.. Five waves of data collected over an 8-year period (measured in 1994–1995 (Cycle 1). males drive more than females and therefore are at greater risk of being involved in a MVC (Chipman et al. Overall. 2003. as not all persons injured are reported to the police or present to hospitals (e. 1994. Alsop and Langley. The purpose of this study was to examine the effects of risk factors on subsequent MVC injuries..G Model AAP 1732 1–7 ARTICLE IN PRESS E. Relevant variables available in the survey. sex.. Hu et al. Tavris et al. Moreover. Moreover. Accid. Kypri et al. 2001. 1989. 1997.. 1992. immigration status and four risk factors of binge drinking. Zhang et al. can possibly potentiate injury and thus also increase susceptibility for MVC injuries (Li et al.276 longitudinal respondents who have completed at least the general component of the questionnaire in Time 1. or active duty army personnel (Begg et al. and to not wear seatbelts (Chipman. 2003. Cherpitel. particularly beyond a 2-month window (Jenkins et al. 2006. Bell et al.aap. Van Beurden et al. 2000). Moreover.. 2002.5% or lower for the older age categories. 2000... 2004. A medication use by binge drinking interaction effect was found with an increased probability of MVC injury among individuals taking more medication and binge drinking. 1999. Both datasets indicated prevalence rates of over 1. 1999). a major value of the survey is the availability of health-related variables that have not typically been examined as potential risk factors of MVC injuries. younger persons are more likely to engage in binge drinking activities (Naimi et al. 2007).. Meuleners et al. P. 1999.. and some remote areas in Ontario and Quebec. medication use more common among older persons). 1995). In order to assess whether the self-reported injury rates in the NPHS were a valid measure of MVC injury rates in Canada.. Braver and Trempel.. random sampling procedure based on the Canadian Labour Force survey. Begg et al. the “two downstream mechanisms” to affect injuries: (1) differential exposure and (2) differential susceptibility.. Langley and McLoughlin. Serdula et al. 2002. Additionally. binge drinking. we examined predictors of subsequent MVC injuries.. military bases. doi:10. 2007. 2006. distress.. Wilk. 2005). (1999) assessed the validity of self-report of MVCs and serious injuries among young adults in comparison with clinical and police data sources. 1984. Selzer and Vinokur. Walsh et al. 1985. alcohol and medicinal drug use on subsequent motor vehicle injuries... 2007). McLeod et al. although their study was based on a small sample of young adults...g. Broyles et al. Official.. binge drinking) to MVC injury and on the availability of the measures within the survey. The strength of the longitudinal. although various studies have found that memory for salient events. Prev. institutions. 2006). the probability of MVC injury by age demonstrated a curvilinear trend with highest probability for respondents under 30 years of age and lowest for respondents over 60 years of age. Bell et al. while older persons are more likely to be using medications (Furu et al..1016/j. The conceptual framework of Laflamme and Diderichsen (2000) was used to identify at the individual level. administrative datasets. Moreover. 1996–1997 (Cycle 2). The study found the datasets to be “strikingly similar in their reports of injury trends” (Roberts et al. Wilk / Accident Analysis and Prevention xxx (2008) xxx–xxx 2 52 53 54 55 56 57 58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 79 80 81 82 83 84 85 86 87 88 89 90 91 92 93 94 95 96 97 98 99 100 101 102 103 104 105 106 107 108 109 110 111 112 113 114 115 116 drivers.

there is 2-year lag between the time of the report of MVC injury and the measurement of the risk factors. 2002. Health status. Distress.3.. codeine. The original variables were recoded into a binary variable. including direct and indirect effects (although. Binge drinking. The index ranged from 0 to 24 with higher scores indicating greater distress. The items asked respondents to indicate the frequency of times in the previous month when the respondent felt nervous. 1998–1999 (Cycle 3)..1... morphine. three age groups were identified: (1) ‘young individuals’—those between the ages of 12 and 29. Multiple group analysis Binge drinking can start in early adolescence (Chassin et al. and a goodness-of-fit statistic is calculated. Immigrant status was coded as 1 = ‘immigrant’ and 0 = ‘born in Canada’.020 UN . Kaufman et al. worthless. as with other regression techniques. Vingilis. Sex and Immigration status. Path analysis is a statistical technique that is an extension of the regression model and is used to examine “causal” relationships between two or more variables.. DP RO 274 275 276 277 278 279 280 281 282 283 284 285 286 287 288 CO RR 289 290 291 292 293 294 295 296 297 298 299 Please cite this article in press as: Vingilis. Thus.3. 1 = ‘one medication’.. 2003. The four risk factors were measured at the ‘baseline’ (a wave previous to the cycle when the MVC injury was recorded)..06. Various studies have documented highest rates of self-reported. did you have any injuries that were serious enough to limit your normal activities?” Participants who answered “yes” were then asked. Direct and indirect effects were specified from the control variables of Sex and Immigration status. 2000–2001 (Cycle 4). Control variables. and Immigration status. 1997). 1988). 2002. Anal.. 3 = ‘good’.aap. Hill et al. not causation of variables per se). Wilk / Accident Analysis and Prevention xxx (2008) xxx–xxx 3 239 240 241 242 243 244 245 246 247 248 249 250 180 181 182 183 184 185 186 187 188 189 190 191 192 193 194 195 196 3. fair or poor? The question was coded as 1 = ‘poor’. with the highest prevalence continuing into the late 20s (Naimi et al. 2000).. Wilk. with 19% of men and 23% of women reporting using five or more prescription medications in the past week. Distress. Path analysis 251 252 253 254 255 256 257 258 259 260 261 262 263 264 265 266 267 268 269 270 271 272 273 EC 212 213 214 215 216 217 218 219 220 221 222 223 224 225 226 227 228 229 230 231 232 233 234 235 236 237 238 Sociodemographic variables: included age. (2005) write “heavy drinking occasions are particularly important for this group [adolescents] and young adults” (p. Kaufman et al. antidepressants. P. and Medication use are hypothesized as differential risk factors of subsequent MVC injury of different age groups. using standardized data or a correlation matrix as input. Medication use: included pain relievers. 12 years of age through adolescence and young adulthood) (Chassin et al. E. sad. The survey did not query on the type of transportation accident or if the respondent was a driver or passenger in the accident. Dependent variable The dependent variable was derived from the outcomes of two questions: “In the past 12 months.. 1997).1016/j. morbidity and mortality (Vingilis et al. Age was coded continuously from 12 to 85 years of age. 2007). Sex was coded as a categorical variable with 1 = ‘male’. score 7 and above on a 24 point scale indicates that a participant is distressed where 1 = ‘yes’ and 0 = ‘no’.79 (Wade and Cairney. Binge drinking: was assessed using a derived frequency measure of consumption of five or more alcoholic beverages in one sitting in the past 12 months to assess frequency of bingeing behaviour. tranquillizers. 4 = ‘very good’. “What happened?” Participants who cited a “transportation accident” as the cause of their injuries were coded as 1 (indicating an MVC) and all others were coded as a zero. 2007. that is. Measures 3. the oldest are most likely to use multiple medications. hopeless.e. 2000.3. restless. path analysis was used. Moreover. (2008). (2002) found that 44% of men and 57% of women 65 years of age and older reported using five or more medications in the preceding week. would you say your health is excellent.. the technique examines correlation. This question has been found to be one of the best predictors of health care utilization. In this model. 2002). and 2002–2003 (Cycle 5). 2003.G Model AAP 1732 1–7 ARTICLE IN PRESS E.2008. Independent variables 197 198 199 200 201 202 203 204 205 206 207 208 209 210 TE 211 Because Laflamme and Diderichsen’s (2000) two downstream “causal” mechanisms for injuries framed the conceptualization of the relations between the four risk factors and subsequent MVC injury. Prev.g. which measure the extent of effect of one variable on another in the path model controlling for other prior variables. sex and immigrant status. The three demographic variables. Indeed. were measured at Cycle 1 (1994–1995) whereas Age was measured at ‘baseline’. Binge drinking. (2) ‘middle-aged individuals’—those between the ages of 30 OF binge drinking would be a risk factor for the younger respondents and health status and medication use would be risk factors for older respondents. 2007). If there were repeated events (more than one MVC injury). Sex. very good. Hill et al. and Medication use on MVC injuries. or that everything in life was an effort.2.. Health status. A regression is conducted for the dependent (endogenous) variable in the model on other (endogenous or exogenous) variables that the model identifies as influencing the dependent variable. Binge drinking. only the first event was taken into account.. while the 60-year olds and older show the highest proportion of medication use (Furu et al. Naimi et al. 1997. The effects of health status. Transport Canada. The original variables were added together to form a single score which was coded as 0 = ‘no medication’. The dependent variable was included for the years 1996–1997 (Cycle 2). 3. P. For example. whereas variables of Health status and Medication use are assumed to be measured on a continuous scale.2. path coefficients are partial regression coefficients. 0 = ‘not injured’. Health status: was assessed by a single question that asks: in general. doi:10. 2004). Rehm et al.. and sleeping pills in the past month. distress.9. to MVC injury whereas the control variable Age at ‘baseline’ had only indirect effect on MVC injury through the four risk factors. Age at ‘baseline’. Accid. good. 569). binge drinking for younger persons (e. The path coefficient is a standardized regression coefficient (beta) indicating the direct effect of an independent variable on a dependent variable in the path model. 2000). The variables of MVC injury. 2 = ‘two medications’ and 3 = ‘three medications or more’. 2002. Psychological distress: is a composite of six items included in the NPHS that is a subset of a generalized distress scale (Composite International Diagnostic Interview (CIDI)) developed at the University of Michigan (Robins et al. alcohol and medicinal drug use on subsequent motor vehicle injuries. Based on these studies and the differential injury rates for different age groups found from the NHPS and Transport Canada’s traffic collision statistics (Roberts et al. 5 = ‘excellent’.1. when the model has two or more causal variables. 2 = ‘fair’. Model We created a path model based on previous research to assess the relative importance of the four risk factors.. 0 = ‘female’. Demerol. 3. Previous research has indicated an internal consistency of this six-item subscale to be ˛ = 0. were added into the model as control variables. i. Serdula et al. Yet. Wechsler et al. 1 = ‘injured’. with 1 = ‘yes’ and 0 = ‘no’. 3. 3. and Distress are binary. The regression weights predicted by the model are compared with the observed correlation matrix for the variables.. medication use shows the reverse trend with highest use among those 60 years and older (Furu et al.

7 3. 2006). Results 302 303 304 305 306 307 308 309 310 311 312 313 314 315 316 317 318 319 320 321 322 323 324 325 326 327 328 329 330 OF Immigration status Born in Canada Immigrant 550.705 Percentage (%) 3.8 6..9 2.8 2.935 348. In our analysis. with a path coefficient of 0.4 2.5 2.957 653. was the only significant risk factor of MVC injuries.5 2.8 3.8 6.020 UN .G Model AAP 1732 1–7 ARTICLE IN PRESS E.9 years old). Wilk.9 3.1016/j.812 Use of sleeping pills No Yes Use of medications 0 1 2 3 607.1 2.500 113.9 years of age = 36.1 2.851.3 2.e.145 21. Table 2 presents the estimates of path coefficients. based on participant’s age at ‘baseline’ were: 12–29.093.3% and 60–85 years of age = 16. where class membership for the categorical latent variable representing a subpopulation is known.3. was the only statistically significant contributor to the outcome variable MVC injuries (path coefficient = 0.509 suggests that.aap.845 TE 331 332 333 334 335 336 337 338 339 340 341 342 343 344 345 346 347 348 349 350 351 352 353 354 355 356 357 358 359 360 The distribution of the sample by the three age groups. i.’ A maximum likelihood estimator with robust standard errors (MLR) employing a numerical integration algorithm (Monte Carlo integration) was used. and morphine No 570. 2006).569 24. while drivers aged 60–69 drove about 33% less distance and 19% less time than drivers 25–59 years of age.040 613. Discussion Frequency of having 5 or more drinks Never <Once/month Once/month 2–3 times/month Once/week >Once/week Self perceived health Poor Fair Good Very good Excellent Use of pain relievers No Yes Use of tranquillizers No Yes Use of antidepressants No Yes Use of codeine. A logit weight of 0.967 164. an increase in the number of medications used by one.9 2. In contrast.2 4. Anal. except for 134 cases that either had missing data points on the exogenous variables and/or on all the endogenous variables.9 1.5%.9 years of age = 47.9 30–59.3 3. (2008). when compared to individuals who did not engage in such a behaviour.992 250. 3.553 40.9 who engaged in binge drinking were 2.610 40.1%.7 6. We addressed the issue of missing data explicitly by modelling the missing data as a function of observed covariates and observed outcomes (missing at random (MAR) assumption). among middle-aged individuals.6 2.326 95.5 3. Among younger individuals. However. P. Among the older drivers.9 60–85 Total Gender Female Male 288.818 287. in examining the three age groups.523 365. where population membership is not known but is inferred from the data (Muthén and Muthén. Multiple-group path analysis is a special case of a mixture model. The MLR standard errors are computed using a sandwich estimator. standard errors. distress. Table 1 shows the weighted frequencies and percentages of those who did and did not report a subsequent MVC injury between 1996 and 2002.643 Yes 61. and ‘older individuals. and the corresponding odds ratios for the three age groups. Moreover. Vingilis.3 2.06.9. were used to conduct the statistical analysis.770 23. E.341 times more likely to experience a subsequent MVC injury.8 3.8 4.e.009 338. The effects of health status.688 591. we were able to retain most of the cases with missing values.862 40. Chipman et al. For example.501 21.363 481. the variable Medication use. Accid. alcohol and medicinal drug use on subsequent motor vehicle injuries. older and immigrant persons reporting a subsequent MVC injury. 4.4 2.5 5.2008.. the variable Binge drinking. Evidence suggests that both younger and older persons drive less. Analysis Mixture modelling techniques..886 167. EC DP Distress No Yes RO 5. offered in Mplus 4 (Muthén and Muthén. Listwise deletion for all cases with the missing data points would reduce the available sample by 2821 cases.6 2. Estimation was conducted using the sampling weights that were calculated by post-stratifying the Cycle 1 stripped weight to the 1994–1995 population estimates. 30–59.6 6.4 2.3.049 CO RR 361 The findings of this study provide important information on risk factors for subsequent MVC injuries among a nationally representative sample of Canadians. class membership corresponds to the three age groups.615 168.747 167.851 suggests that individuals between the ages of 12 and 29.515 103. In the end.704 323.509). indicating lower percentage of males.878 58. persons aged 60–85 have the lowest percentage of reported MVC injuries (i.415 464. as did respondents reporting better health and lower distress scores. a lower percentage of non-binge drinkers reported a subsequent MVC injury. among individuals between the ages of 30 and 59. no variables were significant risk factors of MVC injuries. A logit weight of 0. younger persons are more exposed as pas- 362 363 364 365 366 367 368 369 370 371 372 373 Please cite this article in press as: Vingilis. (1992) found that drivers under 20 years of age drove approximately 23% less in distance and time. Medication use was associated with higher subsequent MVC injuries.8 4 300 301 and 59.4 5.9.664 times. ‘middle-aged individuals’. Overall. Wilk / Accident Analysis and Prevention xxx (2008) xxx–xxx Table 1 Weighted frequencies and percentages of respondents’ reported involvement in subsequent MVC injuries by demographic and risk factors from the Canadian National Population Health Survey Number Age 12–29. Prev.791 18. Demerol. P.5 2. and (3) ‘older individuals’—those between the ages of 60 and 85.6 3. which could reflect a complex interplay of exposure and susceptibility differences.767 18.1 2. Three times the percentage of respondents indicating use of two or more medications reported subsequent MVC injuries.0 3. one third the percentage of MVC injuries compared to 12–29. based on 1996 Census counts by age group and sex within each province. doi:10.9 2. increases the odds of experiencing MVC injury 1.259 35. ‘young individuals’. Mixture modelling analysis refers to models with categorical latent variables that represent subpopulations. The total sample size (all individuals between the ages of 12 and 85 in the data set) was 16.276 141. compared to respondents indicating no medication use.

362 Odds ratios 0.953 1.509 −0.364 0. For example. the higher crash rate of elderly drivers was argued to be an artifact of the different nature of driving undertaken by elderly drivers.. 2002)..84 for passengers riding with drivers aged 20–24 and 1.295 −0. 2004. Thus. these findings do confirm the role of heavy drinking in MVC injuries. 2004).1% of the entire sample. Passenger belt use also decreased among adolescents as the number of passengers in the vehicle increased.. that older drivers had daytime risks comparable to 25-year olds. compared to other age groups (Jelalian et al. 1998. Jonah. if they do crash.591 0. E. P. per se. −1.67 for 25–29year olds.165 2. decreased driver belt use with increasing number of passengers. in the analyses of risk factors among the three age groups.222 −0.481 0.217 0.171 4. given that the elderly are much less likely to drive at night or on highways compared to other age groups. whether the respondent was a driver or passenger.. Health status was also found to be associated with MVC injuries with poor health and distress associated with subsequent MVC injuries. When the data were subjected to path analyses with age. or possibly because elderly drivers tend to reduce or stop driving because of health and vision problems (Ball et al. 2000).098 0.555 −0. or the medical conditions for which the medications are being used.710 −0.. the study is limited in the variables that could be included. particularly when driving with peer passengers (Petridou et al.. and immigration status as control variables. they may be susceptible to a greater probability of mortality for a given crash.490 0. Chipman et al. such as speeding. possibly by increasing susceptibility to injuries. to not wear seat belts. and to engage in other risky driving behaviours. As this study was based on secondary data analyses of a pre-constructed population-based survey. they may be driving less as they also reported the lowest percentage of MVC injuries. Williams and Shabanova. showing a higher percentage of MVC injury. Thus. Moreover. This has been reflected in injury rates. 1997.9 years.G Model AAP 1732 1–7 ARTICLE IN PRESS E.. This could be due to the above mentioned reasons of sample size and mortality susceptibility.53 for 20–24-year olds and 1. In particular. while medication use was a significant risk factor for those aged 30–59. whereby young persons show higher mortality and injury for MVCs. These findings are incongruent with some other studies that have found a higher crash rate in regard to vehicle kilometre travelled (Braver and Trempel..249 0.354 0.853 −0. and medication use. 0. particularly for the under-30 age cohort.631 0. rate ratios were 5.208 0.aap.2008. rate ratios were 3. previous research has shown that young persons are more exposed as drivers and passengers. Yet. etc. 2005).424 1.209 0. 2000). For all other age groups.519.797 1. Interestingly. For example. (2006) found that fragility was a contributing factor to serious injury risk for older drivers.332 −0.72 for 16–19-year olds. although it is not possible to assess whether the medication use. Keall and Frith (2004) found in their case-control study.124 −0.418 S. Alcohol and various medications have been found in experimental and other studies to cause impairment in driving skills and thus could increase susceptibility to MVC injuries among drivers (Vingilis and MacDonald.173 0. with driver belt use lowest when adolescent drivers were driving with passengers in their 20s. others have suggested that the higher MVC risk among older drivers found in various studies is due to the different nature of driving of many elderly drivers. Wilk / Accident Analysis and Prevention xxx (2008) xxx–xxx 5 414 415 416 417 418 419 420 421 422 423 424 425 426 427 428 429 430 431 432 433 434 435 436 437 438 439 440 441 442 443 444 445 446 447 448 449 450 451 452 453 454 455 456 457 458 459 460 461 462 463 464 465 466 467 468 469 470 471 472 473 474 475 476 477 478 Table 2 Path analysis results for risk factors for subsequent MVC injury by age group Variables 12–29. Rudman et al.258 0. 1998. reinforcing the need to engage in impaired driving interventions for this age cohort. while older persons are more exposed as drivers. Young persons are also more susceptible to MVC injuries.695 1. was not available.851 −0. However.199 0. but not significant. Wilk. Consistent with other studies (Broyles et al. Simons-Morton et al. This may explain some of the difference found between MVC mortality and injury trends.576 1. Additionally. Demerol and morphine.198 0.148 0. while the night-time risks were at the same low level as any other age groups. 1990. while elderly persons show higher mortality but lower injury for MVCs.477 0. type of collision injury.889 0. The effects of health status. information on driving exposure.378 −0.835 1.618 2.180 0. to drive faster than other drivers. the study is limited in its RO OF .829 1. although. Powell et al.. as information on whether the respondents were passengers or drivers in their “transportation accidents” was not available to us. to leave less distance between their vehicles and the vehicles in front of them. as young persons who had ridden with impaired drivers were more likely to drink.048 0. binge drinking passengers are more likely to ride with drinking drivers who could crash (Jelalian et al.685 0.231 0. with binge drinking. and highest when they were driving with passengers over 30 years of age (Williams and Shabanova.577 0. It is important to point out some limitations of this study. Accid.. doi:10. there may be a complex interplay of exposure and susceptibility with the elderly driving less per capita. Thus..863 0. The bivariate analyses showed that all risk factors significantly influenced MVC injuries. but not adults. young persons were found to engage in higher levels of binge drinking and a greater percentage of females reported MVC injuries compared to males. (2008).099 −0.519 Significant predictor. 2.9 years Male Immigration Alcohol bingeing* Health status Distress Medication use 30–59.020 UN CO RR EC TE DP 374 sengers. 2. Prev.147 −0. The unique finding regarding the lack of risk factors found to influence subsequent MVC injuries among the older respondents may be a statistical power issue as the older age group comprised only 16. P. alcohol and medicinal drug use on subsequent motor vehicle injuries./S. 375 376 377 378 379 380 381 382 383 384 385 386 387 388 389 390 391 392 393 394 395 396 397 398 399 400 401 402 403 404 405 406 407 408 409 410 411 412 413 Please cite this article in press as: Vingilis. Meuleners et al. Singleton et al.883 0. as were the risks of elderly drivers’ highway driving. adolescents. Anal. sex. except drivers older than 75 years of age injuring themselves. 1998. distress.202 −0.308 −0.9 years Male Immigration Alcohol bingeing Health status Distress Medication use* 60–85 years Male Immigration Alcohol bingeing Health status Distress Medication use * Logit weights −0. 2002).808 −1. 2002) and passengers since.. increases susceptibility of MVC injuries..194 0. Thus.1016/j.173 0.307 Est.81 for passengers riding with drivers aged 25–29. Hakamies-Blomqvist and Wahlstrom. However. to drink and drive themselves.292 0.E. but not for the older persons as was hypothesized. However.906 0.126 −1. codeine.341 0. drivers and passengers had rate ratios of ≤1.532 1. some of this nationally representative sample of elderly may not be driving and among those who do.344 0.118 −0.06.841 1. Naimi et al. specifically use of antidepressants.599 0. Braver and Trempel (2004) found that for non-fatal driver injuries.664 0. 2003. although we can only speculate on the differences found with the NPHS data.394 0. 2006). while for non-fatal passenger injuries.30 for passengers riding with drivers aged 16–19. 2003. 1989.. medication use and health status were not associated with significantly increased MVC injury risk. only binge drinking was a significant predictor for those aged 12–29. Langley and McLoughlin.9 years as hypothesized. 2002.626 −0. This small sample of older individuals involved in MVC injuries could explain why the odds ratio for medication use predicting injuries was 1. For example.633 1.411 0.E. only one hypothesis was confirmed.862 1. this study suggests that medication use is a risk factor for middle-aged persons and not older persons.146 0. Vingilis.

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