Emmanuel Lagarde

PW 1635 Chronic medical conditions and the risk of road traffic crash in older drivers: results from the gazel cohort

The number of elderly drivers is rapidly increasing. Older people have an increased frailty and an associated increase in injury susceptibility. Furthermore, driver’s conditions are important factors when assessing fitness to safe driving. The ageing of the population therefore leads to the question of the contribution of chronic medical factors to road traffic crashes involvement among elderly drivers. The GAZEL cohort includes past employees of the electricity and gas French company, who volunteered to participate in a multi-purpose health-related research cohort. Since 1989, participants have been followed up using administrative data and yearly self-administered questionnaires. The study sample consisted in 13u2009891 participants who were active drivers during the period 2007–2015. Data on road traffic crashes, relevant confounders (age, alcohol consumption, family status and gender) and medical conditions were collected. We will fit a generalized estimating equations model (GEE) after multiple imputation in order to identify medical conditions which are associated with increased odds of road traffic crashes involvement among elderly drivers. To date, this is the largest study of its kind of people aged 60 years or over in France. Prevention could benefit from the evaluation of fitness to drive according to the status of these conditions. However, our study suggests a better understanding of the driving behavior adaptation among older drivers is necessary to apply sensible policies.

PA 05-3-0690 Mavie-lab sports: a mhealth for injury prevention and risk management in sport

Computational advances in smart-phone technology and the development of expert systems has been an opportunity to devise the MAVIE-Lab an innovative Mobile Health Application (mHealth) for primary prevention of Home, Leisure and Sport Injuries (HLIs). Here, we present MAVIE-Lab Sports, the first module of the application focused on sports injuries. MAVIE-Lab was developed in the framework of the MAVIE project. A large web-based cohort launched with the objective of prospectively collecting data related to HLIs. A sample size of 26u2009000 volunteers have been already enrolled in this cohort and the ultimate goal is to recruit 1u200900u2009000 participants in France. As a first step, the MAVIE-Lab will be available for MAVIE volunteer’s only. MAVIE-Lab Sports is a decision support system (DSS) aimed to enable the self-management the potential risk of injury and to facilitate the choice of preventive measures. The App first allows participants to compare the overall injury risk between different sports. It then provides an estimation of their personal injury risk. Finally, the user is invited to experiment their potential risk change when opting for a set of proposed behavioral changes, protective devices, equipment or sport practice environments. The MAVIE-Lab algorithms were developed using detailed MAVIE cohort data related to participant’s health, demographics, training practices and the occurrence of injuries, there causes, consequences and severity. The model was constructed to predict the injury risk using probabilistic reasoning and graphical modelling through Bayesian Networks. This approach combines qualitative and quantitative modelling, allowing the combination of MAVIE data evidences and prior expert’s information about risk, protection factors and causal relations between them.

Emotional reactivity: Beware its involvement in traffic accidents

BACKGROUNDnReducing risk attributable to traffic accidents is a public health challenge. Research into risk factors in the area is now moving towards identification of the psychological factors involved, particularly emotional states. The aim of this study was to evaluate the link between emotional reactivity and responsibility in road traffic accidents. We hypothesized that the more ones emotional reactivity is disturbed, the greater the likelihood of being responsible for a traffic accident.nnnMETHODSnThis case-control study was based on a sample of 955 drivers injured in a motor vehicle crash. Responsibility levels were determined with a standardized method adapted from the quantitative Robertson and Drummer crash responsibility instrument. Emotional reactivity was assessed with the MATHYS.nnnRESULTSnHierarchical cluster analysis discriminated four distinctive drivers emotional reactivity profiles: basic emotional reactivity (54%), mild emotional hyper-reactivity (29%), emotional hyper-reactivity (11%) and emotional hypo-reactivity (6%). Drivers who demonstrated emotional hypo-reactivity had a 2.3-fold greater risk of being responsible for a traffic accident than those with basic emotional reactivity.nnnCONCLUSIONnDrivers responsibility in traffic accidents depends on their emotional status. The latter can change the ability of drivers, modifying their behavior and thus increasing their propensity to exhibit risk behavior and to cause traffic accidents.

Road hazard perception of high risk sites in voluntary Pakistani drivers

Introduction Road traffic crashes (RTCs) tend to concentrate on certain road sites. Our hypothesis is that these sites are not perceived as dangerous by drivers. Objective To compare the hazard perception of sites involved in RTCs to those not involved in RTCs. Methods Study settings were two interurban road-sections. Cases were sites involved in at least three police reported RTCs over 3 years. Matched control sites of same length were randomly selected on the same road. Video films of 26 case and 26 control sites were shown to 100 randomly chosen voluntary Pakistani drivers. Participants reported their perceived road hazardousness on a Likert scale (1 certainly safe to 4 certainly dangerous) and preferred speed. Ability to discriminate cases and controls was assessed by area under receiver operating curve (AUC). The inter-observer reliability among driver ratings was assessed by intra-class correlation coefficient (ICC). Results On average, participants rated 19.9% of case and 10.2% of control sites as certainly dangerous. They rated 36.8% of case and 47.5% of control sites as certainly safe. Out of 100 participants, nine were able to discriminate between high risk and control sites (0.66 ≤ AUC ≤ 0.71; p≤0.04). A high agreement among drivers was observed for ranking all sites (ICC=0.98; 95% CI 0.97 to 0.99). Conclusion Results were compatible with our hypothesis. Further work will focus on evaluating factors associated with the level of discrimination to orient preventive measures in resource limited settings.

Burden and factors associated with work-zone crashes on an interurban highway in Pakistan

Introduction Highway work zones (HWZ) may lead to an increased road traffic crash (RTC) risk. Little is known about such crashes in low-income countries (LICs). Objective To assess burden and factors associated with HWZ crashes on a highway in Pakistan. Methods Police reported crashes occurring on Karachi-Hala road-section from Jan 2006 to Dec 2008 were included in this study. We compared crash and death risk between work and normal traffic zones for a 50-km-long road-section for which data was available on work zone dates and average daily traffic. Crash locations were described for a further 146-km-long section on which we assessed factors associated with HWZ crashes. Results Of 180 crashes, 27 (15%) occurred in HWZs accounting for 30.8% of road fatalities (N=91). HWZ exposition was one-sixth of the whole traffic exposition on the selected road section. Rates were higher in HWZ compared to other parts of the road for crash (RR)=2.28, (95% CI 1.14 to 4.56), attributable risk (AR)=18.5%) and death (RR=4.56, 95% CI 2.05 to 10.16, AR=39.0%). Opposite-direction (adjusted OR (aOR)=8.01, 95% CI 2.34 to 27.68) and RTCs on wet surfaces (aOR=10.43, 95% CI 1.38 to 79.15) were significantly associated with HWZ crashes. Conclusion These results indicate that traffic separation in work-zones should be prioritised to reduce the increased burden of crashes in LICs.

Prescribed medicines and the risk of road traffic crashes: results of a French registry-based study

Background There is a growing concern over the impact of medicines on the risk of road traffic crashes. The French Health Products Safety Agency established a classification of medicines affecting driving abilities, using a labelling system with 4 levels of risk. Objective To investigate the association between prescribed medicine use and the risk of road traffic crashes, providing risk and attributable fraction estimates, with particular focus on the French labelling system. Methods We matched data from three exhaustive nation-wide databases: the database on medicine reimbursing, police reports and the database of injurious crashes. Drivers involved in an injurious crash in France, from July 2005 to May 2008, and identified by their national healthcare number were included. We studied prescribed medicines grouped according to the four levels of the French classification (level 0 to level 3). We performed a responsibility and a case-crossover analysis. Results 72 685 drivers were included. The results showed an increased risk of being responsible for a crash for users of medicines of level 2 (OR=1.31 [1.24 to 1.40]) and level 3 (OR=1.25 [1.12 to 1.40]). The fractions of road traffic crashes attributable to levels 2 and 3 medicine use were 2.9% (2.3–3.4%) and 0.6% (0.3–0.8%) respectively. Conclusion Users of level 2 and 3 medicines are at increased risk of experiencing a road traffic crash. Further studies are needed to evaluate the impact of the French labelling system.