Visual and medical risk factors for motor vehicle collision involvement among older drivers

Abstract

Aims-To identify visual and medical risk factors for motor vehicle collisions (MVCs).Methods-Data from four cohorts of older drivers from three states were pooled (n=3,158). Health information was collected at baseline, and MVC data were obtained prospectively. Cox proportional hazards regression was used to estimate rate ratios (RRs) and 95% confidence intervals (CIs) for associations between medical characteristics and MVCs.Results-A total of 363 MVCs were observed during the study period (1990-1997), of which 145 were at-fault and 62 were injurious. Falls and impaired useful field of view (UFOV 1 ) were positively associated with overall MVCs. At-fault MVCs were also positively associated with falls and UFOV impairment, and inversely with cancer. Injurious MVCs were positively associated with arthritis and neurological disease, and inversely with hypertension.Conclusions-These findings show similarities and differences across the risk factors for all, atfault, and injurious MVCs, and point to the need for verification and possible interventions. Licensing:The Corresponding Author has the right to grant on behalf of all authors and does grant on behalf of all authors, an exclusive licence (or non exclusive for government employees) on a worldwide basis to the BMJ Publishing Group Ltd to permit this article (if accepted) to be published in BJO and any other BMJPGL products and sublicences such use and exploit all subsidiary rights, as set out in our licence (http://bjo.bmj.com/ifora/licence.pdf). Competing interests: None declared.Patient consent: All patients signed an informed consent form approved by each institution's respective institutional review board. NIH Public Access MATERIALS AND METHODS Study DesignThis study involves the analysis of pooled data from four cohorts of older drivers (n=3,158) from three different states (Kentucky, Maryland, Alabama). Study ParticipantsAlabama Cohort I-This cohort has been described elsewhere (8). In brief, subjects were identified by the Alabama Department of Public Safety and enrolled in 1990 for a case-control study on visual and medical risk factors for MVC involvement. The sample was age-stratified to include equal numbers of drivers in each half decade from 55 to 85+ years old, and was about evenly split between those who had and had not been involved in a MVC five years prior to enrollment. The final sample (n=306) was followed prospectively for police-reported MVCs through 1996.Alabama Cohort II-A description of this cohort is available elsewhere (9); briefly, this cohort was assembled in 1994-1995 to investigate the association between mobility and cataract. It was comprised of one group with and one without cataract. Subjects were recruited from ten ophthalmology practices and two optometry clinics in Birmingham through a medical record review of patients seen in the past year. Study participants (n=385; 274 with cataract) were followed prospectively for police reported MVCs until February, 1997.Kentucky Cohort-A description of this cohort has been...

The Impact of Depression on Driver Performance

“…Both case-control studies and prospective cohort studies have often been limited by failure to control for driving exposure or mileage (e.g., Selzer et al 1968;Selzer and Vinokur 1975), low response rates or sample sizes (e.g., Hilton et al 2009;Sagberg 2006;Sims et al 2000), neglecting less serious collisions (e.g., Koepsell et al 1994;Wilk 2007, 2012;Margolis et al 2002;Marottoli et al 1994), possible underreporting of both collisions and psychiatric conditions due to reliance on selfreport (e.g., Cross et al 2009;Mann et al 2010;Sagberg 2006;Wickens et al 2013), and the use of numerous statistical tests that may have resulted in some associations occurring by chance alone (e.g., Koepsell et al 1994;Sims et al 2000). Perhaps due in part to these limitations, the results of these studies have been inconsistent; however, there does appear to be some evidence that depression is associated with increased collision risk.…”

Sensory System Changes

“…65 " The useful field of view becomes smaller in older adults when distractions are present, making visual search less efficient. Cross and colleagues 160 report that a greater than 35% reduction in UVOF is significantly associated with an increased rate of motor vehicle collisions (MVCs) in a three-state cohort of older drivers. This same study found that there was no association between visual acuity and contrast sensitivity in older adults and MVC involvement.…”

Road safety in an aging population: risk factors, assessment, interventions, and future directions

“…However, studies using a range of sample sizes and methodologies have found only a weak relationship between VA and crash risk (Hofstetter, 1976;Gresset and Meyer, 1994;Marottoli, 1998;Ivers et al, 1999) or no association (Keeffe et al, 2002;Rubin et al, 2007;Cross et al, 2009). High-contrast static VA is unlikely to represent the normal-driving environment that includes both static and moving objects of different sizes and contrast levels.…”