Accidents, assaults, and marital status

Individual characteristics associated with road traffic collisions and healthcare seeking in low- and middle-income countries and territories

Incidence of road traffic collisions (RTCs), types of users involved, and healthcare requirement afterwards are essential information for efficient policy making. We analysed individual-level data from nationally representative surveys conducted in low- or middle-income countries (LMICs) between 2008-2019. We describe the weighted incidence of non-fatal RTC in the past 12 months, type of road user involved, and incidence of traffic injuries requiring medical attention. Multivariable logistic regressions were done to evaluate associated sociodemographic and economic characteristics, and alcohol use. Data were included from 90,790 individuals from 15 countries or territories. The non-fatal RTC incidence in participants aged 24-65 years was 5.2% (95% CI: 4.6-5.9), with significant differences dependent on country income status. Drivers, passengers, pedestrians and cyclists composed 37.2%, 40.3%, 11.3% and 11.2% of RTCs, respectively. The distribution of road user type varied with country income status, with divers increasing and cyclists decreasing with increasing country income status. Type of road users involved in RTCs also varied by the age and sex of the person involved, with a greater proportion of males than females involved as drivers, and a reverse pattern for pedestrians. In multivariable analysis, RTC incidence was associated with younger age, male sex, being single, and having achieved higher levels of education; there was no association with alcohol use. In a sensitivity analysis including respondents aged 18-64 years, results were similar, however, there was an association of RTC incidence with alcohol use. The incidence of injuries requiring medical attention was 1.8% (1.6-2.1). In multivariable analyses, requiring medical attention was associated with younger age, male sex, and higher wealth quintile. We found remarkable heterogeneity in RTC incidence, the type of road users involved, and the requirement for medical attention after injuries depending on country income status and socio-demographic characteristics. Targeted data-informed approaches are needed to prevent and manage RTCs.

Some evidence for health-related marriage selection

OBJECTIVES

Married people live longer and are healthier than unmarried people. This can be explained in terms of marriage protection and marriage selection. The aim of the present study was to examine the direct effect of marriage selection on health status.

METHODS

Data were collected from the archives of the Lower Silesian Medical Center (DOLMED) in Wrocław, Poland. The sample consisted of 2,265 adult (never married or currently married) men. Subjects were assigned to categories for selected variables, including age, level of education, military category upon conscription, height, hearing acuity, and visual acuity. Military category, objective data gathered upon military conscription at age 18, was used to assess initial health status. To identify any relationships between marital status and health status, generalized linear models with binomially distributed dependent variable were used.

RESULTS

The never-married subjects were more likely to have been assigned to lower military categories, which indicates that their health status at age 18 was inferior to those conscripts who would later marry. Hearing acuity and visual acuity were generally worse in never-married subjects than in married subjects. Never-married subjects were also more likely to be short and less likely to be tall.

CONCLUSIONS

The results provide evidence for direct health-related marriage selection in men between 25 and 60 years of age. Poor health status reduces the likelihood of marriage.

Is a single item stress measure independently associated with subsequent severe injury: a prospective cohort study of 16,385 forest industry employees

Background

A previous review showed that high stress increases the risk of occupational injury by three- to five-fold. However, most of the prior studies have relied on short follow-ups. In this prospective cohort study we examined the effect of stress on recorded hospitalised injuries in an 8-year follow-up.

Methods

A total of 16,385 employees of a Finnish forest company responded to the questionnaire. Perceived stress was measured with a validated single-item measure, and analysed in relation recorded hospitalised injuries from 1986 to 2008. We used Cox proportional hazard regression models to examine the prospective associations between work stress, injuries and confounding factors.

Results

Highly stressed participants were approximately 40% more likely to be hospitalised due to injury over the follow-up period than participants with low stress. This association remained significant after adjustment for age, gender, marital status, occupational status, educational level, and physical work environment.

Conclusions

High stress is associated with an increased risk of severe injury.

The role of marital status in the association between benzodiazepines, psychotropics and injurious road traffic crashes: a register-based nationwide study of senior drivers in Sweden

BACKGROUND

Among senior drivers, benzodiazepines (BZDs) have a documented effect on the risk of road traffic crashes (RTCs). It remains unclear however if BZDs play the same role when considering marital status. Therefore, we aimed to investigate the role of marital status in the association between BZD use and injurious RTCs among senior drivers.

METHODS

Matched case-control study based on five national Swedish registers (n = 154 225). Cases comprised the first non-alcohol-related injurious RTC sustained by drivers aged 50-80 years from July 2005 to December 2009 and controls included registered residents with a valid license who did not crash during that period. Four controls were matched to each case by sex, age and place of residence. Conditional logistic regression analysis for injurious RTC was performed with adjustment for occupation and number of medications. The main exposure was dispensation of BZDs, alone or in combination with other psychotropic medications, 1-30 days prior to the crash date stratified by marital status.

RESULTS

BZD use, alone or in combination with other psychotropic medications, increased the risk of being involved in an RTC (BZD only: adjusted OR: 1.26, 95% CI: 1.17-1.36; BZDs and other psychotropics: adjusted OR: 1.25, 95% CI: 1.12-1.41). Compared to married drivers, those divorced (1.48, 1.43-1.53) and widowed (1.54; 1.45-1.63) had higher adjusted ORs. Marital status modified the association between BZDs and RTCs, particularly among younger male drivers.

CONCLUSIONS

Both BZDs and marital status independently affect the risk for senior drivers to be involved in an RTC. However, marital status plays a role in the association between BZD use and RTCs and this may have implications for targeting risk populations for RTCs among senior drivers.

The social side of accidental death

Mortality from unintentional injuries, or accidents, represents major and understudied causes of death in the United States. Epidemiological studies show social factors, such as socioeconomic and marital status, relate with accidental death. But social theories posit a central role for social statuses on mortality risk, stipulating greater relevance for causes of death that have been medically determined to be more preventable than others. These bodies of work are merged to examine deaths from unintentional injuries using 20years of nationally representative survey data, linked to prospective mortality. Results indicate that socially disadvantaged persons were significantly more likely to die from the most preventable and equally likely to die from the least preventable accidental deaths over the follow-up, compared to their more advantaged counterparts. This study extends our knowledge of the social contributors to a leading cause of death that may have substantial implications on overall disparities in length of life.

Zero-inflated models for regression analysis of count data: a study of growth and development

Poisson regression is widely used in medical studies, and can be extended to negative binomial regression to allow for heterogeneity. When there is an excess number of zero counts, a useful approach is to used a mixture model with a proportion P of subjects not at risk, and a proportion of 1--P at-risk subjects who take on outcome values following a Poisson or negative binomial distribution. Covariate effects can be incorporated into both components of the models. In child assessment, fine motor development is often measured by test items that involve a process of imitation and a process of fine motor exercise. One such developmental milestone is 'building a tower of cubes'. This study analyses the impact of foetal growth and postnatal somatic growth on this milestone, operationalized as the number of cubes and measured around the age of 22 months. It is shown that the two aspects of early growth may have different implications for imitation and fine motor dexterity. The usual approach of recording and analysing the milestone as a binary outcome, such as whether the child can build a tower of three cubes, may leave out important information.

Marital status and biological condition of Polish males

Strong evidence for marital differences in mortality has been demonstrated in a large number of countries. Married men and women have lower death rates than unmarried individuals within each adult age group. Additionally, married persons tend to be healthier as compared to unmarried. In the literature two explanations for this patterning have been proposed. .The health selection hypothesis. suggested that disabled or less healthy people are not as likely to get married as the healthy ones. In .the social causation hypothesis ., marriage yields health benefits through emotional and social support which may act as a buffer against the effects of life stress. In this study, .the social causation hypothesis. is supported.