Motor vehicle crash fatalities by race/ethnicity in Arizona, 1990-96

Investigating transportation safety in disadvantaged communities by integrating crash and Environmental Justice data

Recent efforts to identify disadvantaged communities (DACs) on a census tract level have evoked possibilities of attaining transportation justice and vision zero goals in these areas. To identify DACs, the United States Department of Transportation (USDOT) has developed six comprehensive indicators: economy, environment, equity, health, resilience, and transportation access. The indicators are used to explore the associations between DACs (in 71,728 census tracts) and five years of fatal crashes, providing a comprehensive understanding of safety risks. Specifically, using data on DACs and linking it with census and crash data, this study aims to understand the complex connections between safety (captured through fatal crashes) and disadvantages that communities confront due to a convergence of multiple challenges and burdens using Zero-Hurdle Negative Binomial models. The results reveal that health, resilience, and transportation-disadvantaged tracts are associated with more fatal crashes. The study also found the presence of a higher percentage of the population with bachelor's degrees and increased use of public transportation are correlated with fewer fatal crashes. Also, a higher fatal crash rate is observed in disadvantaged census tracts where a high proportion of the Hawaiian or other Pacific Islander, and American Indian or Alaska Native populations live. This implies that targeted interventions can be explored further in tracts that show high correlations with fatal crashes. The findings contribute to traffic safety by highlighting the risks in DACs, which can help design and implement traffic safety interventions. The insights gained from this study can inform decision-making and help to guide the development of more equitable traffic safety programs in disadvantaged communities.

Motor Vehicle Crash Risk in Older Adult Drivers With Attention-Deficit/Hyperactivity Disorder

Importance

Symptoms of attention-deficit/hyperactivity disorder (ADHD), such as inattentiveness and impulsivity, could affect daily functioning and driving performance throughout the life span. Previous research on ADHD and driving safety is largely limited to adolescents and young adults.

Objective

To examine the prevalence of ADHD and the association between ADHD and crash risk among older adult drivers.

Design, Setting, and Participants

This prospective cohort study collected data from primary care clinics and residential communities in 5 US sites (Ann Arbor, Michigan; Baltimore, Maryland; Cooperstown, New York; Denver, Colorado; and San Diego, California) between July 6, 2015, and March 31, 2019. Participants were active drivers aged 65 to 79 years at baseline enrolled in the Longitudinal Research on Aging Drivers project who were studied for up to 44 months through in-vehicle data recording devices and annual assessments. The data analysis was performed between July 15, 2022, and August 14, 2023.

Exposure

Lifetime ADHD based on an affirmative response to the question of whether the participant had ever had ADHD or had ever been told by a physician or other health professional that he or she had ADHD.

Main Outcomes and Measures

The main outcomes were hard-braking events defined as maneuvers with deceleration rates of 0.4g or greater, self-reported traffic ticket events, and self-reported vehicular crashes. Multivariable negative binomial modeling was used to estimate adjusted incidence rate ratios (aIRRs) and 95% CIs of outcomes according to exposure status.

Results

Of the 2832 drivers studied, 1500 (53.0%) were women and 1332 (47.0%) were men with a mean (SD) age of 71 (4) years. The lifetime prevalence of ADHD in the study sample was 2.6%. Older adult drivers with ADHD had significantly higher incidence rates of hard-braking events per 1000 miles than those without ADHD (1.35 [95% CI, 1.30-1.41] vs 1.15 [95% CI, 1.14-1.16]), as well as self-reported traffic ticket events per 1 million miles (22.47 [95% CI, 16.06-31.45] vs 9.74 [95% CI, 8.99-10.55]) and self-reported vehicular crashes per 1 million miles (27.10 [95% CI, 19.95-36.80] vs 13.50 [95% CI, 12.61-14.46]). With adjustment for baseline characteristics, ADHD was associated with a significant 7% increased risk of hard-braking events (aIRR, 1.07; 95% CI, 1.02-1.12), a 102% increased risk of self-reported traffic ticket events (aIRR, 2.02; 95% CI, 1.42-2.88), and a 74% increased risk of self-reported vehicular crashes (aIRR, 1.74; 95% CI, 1.26-2.40).

Conclusions and Relevance

As observed in this prospective cohort study, older adult drivers with ADHD may be at a significantly elevated crash risk compared with their counterparts without ADHD. These findings suggest that effective interventions to improve the diagnosis and clinical management of ADHD among older adults are warranted to promote safe mobility and healthy aging.

Injury in Children with Developmental Disorders: A 1:1 Nested Case-Control Study Using Multiple Datasets in Taiwan

Although past studies have identified predictors related to child injuries with developmental disorders, national-level research in Asia is limited. The objective of this study was to explore the risk factors for child injuries with developmental disorders in Taiwan using a national-level integrated database for the period between 2004-2015 (The Maternal and Child Health Database, National Health Insurance Research Database, Census Registry, and Indigenous Household Registration). Children younger than 12 years old who had records of visiting the ER or being hospitalized due to injury or without injury were included in this study. A 1:1 nested case-control study (injury vs. noninjury) to examine the risk factors for child injury with developmental disorder was performed. A total of 2,167,930 children were enrolled. The risk factors were associated with repeated ER visits or hospitalization: being indigenous (adjusted odds ratio [AOR]: 1.51; CI: 1.45-1.57); having a developmental disorder (AOR: 1.74; CI: 1.70-1.78); and having parents with illicit drug use (AOR: 1.48; CI: 1.32-1.66), alcohol abuse (AOR: 1.21; CI: 1.07-1.37), or a history of mental illness (AOR: 1.43; CI: 1.41-1.46). Being indigenous, having developmental disorders, and having parents with history of illicit drug use, alcohol abuse, or mental illness were predictors related to injuries in children.

Racial/Ethnic and Gender Differences in Risk of Injury and Life-Course Drinking Patterns: Data from US National Alcohol Surveys

AIMS

To estimate risk of injury associated with frequency of drinking and heavy drinking (5+ drinks on occasion) by gender and race/ethnicity in the US population.

METHODS

Data were from a merged sample of two National Alcohol Surveys (telephone and web-based) (2014-2015 and 2019-2020) on 16,639 respondents, and analyzed using Cox proportional hazards models with age as the timescale in a retrospective cohort design. Life-course drinking was determined by age of onset and questions on any drinking and heavy drinking by decade of life. The outcome measure was having had an injury from a serious accident at a certainage.

RESULTS

Frequent heavy drinking (5+ daily, weekly and monthly) was significantly predictive of injury with hazard ratios (HRs) of 2.40, 1.81 and 1.50, respectively, while frequent light drinking (alcohol at least weekly and 5+ yearly or less) was also significant for women (HR = 1.73). For White respondents, 5+ at least weekly was significant for both men (HR = 1.74) and women (HR = 2.42). Among Hispanic respondents, 5+ at least weekly and 5+ monthly were both significant for men (HR = 2.81 and 2.49, respectively) and women (HR = 2.81 and 3.48, respectively). Among Black women, risk was significant for 5+ monthly (HR = 2.90) and for any alcohol ≥ weekly (HR = 2.72), but neither frequency of any drinking or 5+ was significant for Blackmen.

CONCLUSIONS

Data suggest a greater risk of injury from a serious accident for frequent heavy drinkers among all White and Hispanic respondents, and Black women, but not for Blackmen.

Motorcycle-related head and neck injuries: increased risk among ethnic minorities

Background

Ethnic disparities have been associated with injury and mortality. The impact of ethnicity on head and neck injury (HNI), traumatic brain injury (TBI), in-hospital mortality and resource utilization following a motorcycle crash (MCC) is undetermined. This study explored the influence of ethnicity in these aspects and the effect of helmet use on HNI and TBI following a MCC.

Methods

The National Trauma Registry provided hospitalization data on motorcycle riders and passengers between 2008 and 2017. Ethnicity was classified as Jews or Arabs, the two major ethnic groups in Israel. Univariate followed by multivariable logistic models were applied to examine ethnic disparities. Mediation effect was tested by structural equation modeling.

Results

Among 6073 MCC casualties, Arabs had increased odds of HNI (OR = 1.37,95% CI = 1.12–1.65) and TBI (OR = 1.51,95%CI = 1.12–1.99), and a six-fold decreased odds of helmet use (OR = 0.16,95%CI = 0.12–0.22). The HNI and TBI associations with ethnicity were mediated by helmet use. Arabs had significantly higher odds for admission to intensive care unit (OR = 1.36,95%CI = 1.00–1.83), and lower odds for ambulance evacuation (OR = 0.73,95%CI = 0.61–0.89) and discharge to rehabilitation (OR = 0.55,95%CI = 0.39–0.7). In-hospital mortality was not associated with ethnicity.

Conclusions

Helmet non-use is an important etiologic factor associated with motorcycle-related HNI and TBI among Arabs. While in Israel, ethnic equality exists in in-hospital health care, disparities in ambulance and rehabilitation utilization was found. Intervention programs should target the Arab population and focus on helmet compliance.

Identifying a gap in drowning prevention: high-risk populations

INTRODUCTION

Some populations have been less susceptible to reductions in drowning than others. It has been hypothesised that this is due to prevention strategies failing to account for the influence of social determinants (such as ethnicity, socioeconomic status). Populations such as ethnic minorities have been over-represented in injury statistics, however this is not well explored in drowning. This study aims to identify high-risk populations for drowning, risk factors and prevention strategies.

METHODS

A literature review undertaken systematically using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses approach was conducted of peer-reviewed literature in English, published between 1990 and 2018 from high-income countries. Search terms included drowning, water safety, ethnic minority, migrant, and culturally diverse.

RESULTS

In total, 35 articles were included. High-risk populations identified were: ethnic minorities, First Nations/Aboriginal people, migrants and rural residents. Over half (51%) focused on children (0-18 years). Risk factors included social determinants, swimming ability and knowledge, attitudes and behaviour. Four intervention studies were found; two focused on upskilling adults from high-risk populations to increase employment opportunities within the aquatic industry; an evaluation of a 10-year rock fishing safety education project and a learn-to-swim programme for minority children. Proposed prevention strategies included education, practical skills, research, policy and engagement.

DISCUSSION

Limited literature exists pertaining to drowning among adults from high-risk populations. There is a need to increase the sophistication of drowning prevention strategies addressing the disparities in drowning from a culturally appropriate perspective. Acknowledging the role of the social determinants of health in drowning prevention is essential in order to improve drowning outcomes for high-risk populations globally.

Ethnic variations in falls and road traffic injuries resulting in hospitalisation or death in Scotland: the Scottish Health and Ethnicity Linkage Study

Objectives

To investigate ethnic differences in falls and road traffic injuries (RTIs) in Scotland.

Study design

A retrospective cohort of 4.62 million people, linking the Scottish Census 2001, with self-reported ethnicity, to hospitalisation and death records for 2001–2013.

Methods

We selected cases with International Classification of Diseases–10 diagnostic codes for falls and RTIs. Using Poisson regression, age-adjusted risk ratios (RRs, multiplied by 100 as percentages) and 95% confidence intervals (CIs) were calculated by sex for 10 ethnic groups with the White Scottish as reference. We further adjusted for country of birth and socio-economic status (SES).

Results

During about 49 million person-years, there were 275,995 hospitalisations or deaths from fall-related injuries and 43,875 from RTIs. Compared with the White Scottish, RRs for falls were higher in most White and Mixed groups, e.g., White Irish males (RR: 131; 95% CI: 122–140) and Mixed females (126; 112–143), but lower in Pakistani males (72; 64–81) and females (72; 63–82) and African females (79; 63–99). For RTIs, RRs were higher in other White British males (161; 147–176) and females (156; 138–176) and other White males (119; 104–137) and females (143; 121–169) and lower in Pakistani females (74; 57–98). The ethnic variations differed by road user type, with few cases among non-White motorcyclists and non-White female cyclists. The RRs were minimally altered by adjustment for country of birth or SES.

Conclusion

We found important ethnic variations in injuries owing to falls and RTIs, with generally lower risks in non-White groups. Culturally related differences in behaviour offer the most plausible explanation, including variations in alcohol use. The findings do not point to the need for new interventions in Scotland at present. However, as the ethnic mix of each country is unique, other countries could benefit from similar data linkage-based research.

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Ethnic inequalities in injuries are demonstrated in Scotland based on a large sample size and a fine ethnic granularity.

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White minority ethnic groups had the highest risks of fall-related injuries in Scotland.

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Fall-related injuries were the least likely in the Pakistani population.

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Ethnic differences in road traffic injuries varied by the type of road user.

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Ethnic differences in injuries were not explained by socio-economic status or country of birth.

A geographically weighted regression to estimate the comprehensive cost of traffic crashes at a zonal level

Global road safety records demonstrate spatial variation of comprehensive cost of traffic crashes across countries. To the best of our knowledge, no study has explored the variation of this matter at a local geographical level. This study proposes a method to estimate the comprehensive crash cost at the zonal level by using person-injury cost. The current metric of road safety attributes safety to the location of the crash, which makes it challenging to assign the crash cost to home-location of the individuals who were involved in traffic crashes. To overcome this limitation, we defined Home-Based Approach crash frequency as the expected number of crashes by severity that road users who live in a certain geographic area have during a specified period. Using crash data from Tennessee, we assign those involved in traffic crashes to the census tract corresponding to their home address. The average Comprehensive Crash Cost at the Zonal Level (CCCAZ) for the period of the study was $18.2 million (2018 dollars). Poisson and Geographically Weighted Poisson Regression (GWPR) models were used to analyzing the data. The GWPR model was more suitable compared to the global model to address spatial heterogeneity. Findings indicate population of people over 60-years-old, the proportion of residents that use non-motorized transportation, household income, population density, household size, and metropolitan indicator have a negative association with CCCAZ. Alternatively, VMT, vehicle per capita, percent educated over 25-year-old, population under 16-year-old, and proportion of non-white races and individuals who use a motorcycle as their commute mode have a positive association with CCCAZ. Findings are discussed in line with road safety literature.

Achieving ethnic equality in the Israel trauma healthcare system: the case of the elderly population

Objective

To determine if ethnic disparities exist with regard to the risk of injury and injury outcomes among elderly hospitalized casualties in Israel.

Methods

A retrospective study based on data from the Israeli National Trauma Registry between 2008 and 2017. Data included demographic, injury and hospitalization characteristics. Descriptive statistics and adjusted logistic regression were used to examine the differences between Jewish and Arab casualties, aged 65 and older.

Result

The study included 96,795 casualties. The proportion of elderly hospitalized casualties was 2.8 times greater than their proportion in the population (3.1 times greater among Jews and 2.1 times among Arabs). In comparison to Arabs, Jews suffered from a greater percentage of head injuries (10.5 and 8.9%, respectively for Jews and Arabs p < .001), but fewer extremity injuries (46.7% vs. 48.0% respectively for Jews and Arabs p < .05). Among severe/critical casualties and among casualties with severe head injuries, Arabs were more likely to be transported to the hospital in a private car (27% vs. 21% respectively for Arabs and Jews p < .001; 30.5% vs. 23.3% respectively for Arabs and Jews p < .001). Logistic regression analysis, adjusted for age, gender, injury severity, type of injury, type of trauma center and year of admission, shows that Jews, relative to Arabs, were more likely to be hospitalized for more than seven days, admitted to the intensive care unit (ICU) and to be discharged to a rehabilitation center (OR: 1.3, 1.3 and 2.4 respectively). No differences regarding surgery (OR: 0.95) or in-hospital mortality (OR: 0.99) were found.

Conclusions

Ethnic disparities between Jewish and Arab hospitalized casualties were observed with regard to hospital stay, ICU admission and rehabilitation transfer. However, no differences were found with regard to mortality and surgery. While the reported disparities may be due in part by cultural differences and accessibility, health policy decision makers should aim to reduce the gaps by optimizing the accessibility of ambulance and rehabilitation services as well as increasing awareness regarding the availability of these medical services among the Arab population.

Are low income and minority households more likely to die from traffic-related crashes?

An analysis of motor vehicle mortality is conducted using data from the Census Bureau's National Longitudinal Mortality Study for 1980, 1990, and 2000. The likelihood of being a motor vehicle crash fatality is compared to all other causes of death and not dying within the six year follow up period of the data. Using a multinomial logistic regression, mortality associations with the socioeconomics and demographics of individuals is examined. No association is found with a greater likelihood of being a motor vehicle mortality, based on family income, ethnicity, or race. Those living in rural areas, are unemployed or disabled, and residents of southern states are more likely to be a motor-vehicle fatality. These results conflict with those of many ecological studies that assume lower income neighborhoods (and their residents) are more likely to die due to motor-vehicle crashes.

Characteristics and circumstances of injuries vary with ethnicity of different population groups living in the same country

OBJECTIVE

To examine whether characteristics and circumstances of injuries are related to ethnicity.

DESIGN

The study was based on the Israeli National Trauma Registry data for patients hospitalized between 2008 and 2011. Data included demographics, injury, hospital resource utilization characteristics and outcome at discharge. Univariate analysis followed by logistic regression models were undertaken to examine the relationship between injury and ethnicity.

RESULTS

The study included 116,946 subjects; 1% were Ethiopian Born Israelis (EBI), 11% Israelis born in the Former Soviet Union (FSUBI) and 88% the remaining Israelis (RI). EBI were injured more on street or at work place and had higher rates of penetrating and severe injuries. However, FSUBI were mostly injured at home, and had higher rates of fall injuries and hip fracture. Adjusted analysis showed that EBI and FSUBI were more likely to be hospitalized because of violence-related injuries compared with RI but less likely because of road traffic injuries. Undergoing surgery and referral for rehabilitation were greater among FSUBI, while admission to intensive care unit was greater among EBI.

CONCLUSION

Targeted intervention programmes need to be developed for immigrants of different countries of origin in accordance with the identified characteristics.

Racial/Ethnic Disparities in Rates of Traumatic Injury in Arizona, 2011-2012

OBJECTIVE

The purpose of this study was to compare the rates of traumatic injury among five racial/ethnic groups in Arizona and to identify which mechanisms and intents of traumatic injury were predominant in each group.

METHODS

We obtained 2011 and 2012 data on traumatic injury from Arizona's trauma registry and data on mortality from Arizona's death registry. We calculated location- and age-adjusted rates (aRs) of traumatic injury and rates of mortality per 100,000 Arizona residents and rate ratios (RRs) for each racial/ethnic group. We also calculated race/ethnicity specific aRs and RRs by mechanism of injury, intent of injury, and alcohol use.

RESULTS

We analyzed data on 58,034 cases of traumatic injury. After adjusting for age and location, American Indians/Alaska Natives (AI/ANs) had the highest overall rate of traumatic injury (n = 6,287; aR = 729) and Asian Americans/Pacific Islanders had the lowest overall rate of traumatic injury (n = 553; aR = 141). By intent, AI/ANs had the highest rate of homicide/assault-related traumatic injury (n = 2,170; aR = 221) and by mechanism, non-Hispanic black/African American people had the highest rate of firearm-related traumatic injury (n = 265; aR = 40). In 2011-2012, 8,868 deaths in Arizona were related to traumatic injury. AI/ANs had the highest adjusted mortality rate (n = 716; aR = 95).

CONCLUSION

Racial/ethnic disparities in traumatic injuries persisted after adjusting for age and injury location. Understanding how these disparities differ by mechanism, intent, and alcohol use may lead to the development of more effective initiatives to prevent traumatic injury.

Relationship of Usual Volume and Heavy Consumption to Risk of Alcohol-Related Injury: Racial/Ethnic Disparities in Four U.S. National Alcohol Surveys

OBJECTIVE

National population data on racial/ethnic disparities and risk of alcohol-related injury are scarce. Alcohol-related injury and drinking patterns are examined in a sample of respondents from four (1995, 2000, 2005, 2010) U.S. National Alcohol Surveys using risk function analysis.

METHOD

Self-reported consumption of 15,476 current drinkers was assessed as the average number of drinks consumed monthly and, separately, the frequency of consuming five or more drinks in a day (5+ days) in the last year. Alcohol-related injury was defined as drinking within 6 hours before the event. Risk curves were defined, separately for Whites, Blacks, and Hispanics, using fractional polynomial regression.

RESULTS

Risk was greatest for Hispanics to 110 drinks per month (3-4 drinks per day) and above 240 drinks per month, whereas risk was greatest for Whites between these levels. Blacks were at lower risk at all monthly volume levels when demographic and socioeconomic status characteristics were controlled for. Whites had the highest risk of an alcohol-related injury based on 5+ drinking days at all levels up to nearly daily 5+ drinking, whereas Blacks had the lowest risk at all levels of 5+ drinking.

CONCLUSIONS

A disparity in alcohol-related injury was found for Hispanics compared with Whites at the same average monthly volume of consumption at lower and higher volume levels, but not at the same number of 5+ drinking days, and a lower risk of alcohol-related injury was found for Blacks for both consumption measures when demographic and socioeconomic status characteristics were taken into account. Although exposure to hazards other than alcohol, which could account for some of the racial/ethnic disparity observed, was not taken into account, these mixed findings suggest this is an important area deserving future research attention.

Who are the traffic offenders among ethnic groups and why?

Marginalized populations, particularly ethnic minorities, are often at a higher risk of being involved in traffic crashes and committing traffic violations. Prominent explanations for this "ethnic traffic risk gap" include cultural and socioeconomic factors, usually measured at an aggregate level. In particular, it has been hypothesized that ethnic minorities commit traffic violations as a form of social resistance to what they perceive to be an oppressing regime. The current study examined the mechanisms underlying traffic violations at the individual level within a single ethnic minority, Israeli-Arabs. The study sample (n=231) included a group of known offenders (n=60) and non-offenders (n=171), all of which completed the Traffic Violation Questionnaire. The results show that offenders and non-offenders tended to have different types of occupations, although these did not translate into significant differences in level of income. Offenders reported significantly lower levels of trust in some hegemonic institutions (the police, government ministries) but not others (parliament, the juridical system). However, offenders displayed remarkably different daily activity patterns, including much higher exposure to traffic (3h/day vs. 0.75) and more complex trip patterns. Our results find little support for the social resistance hypothesis, as it fails to explain the differential treatment of hegemonic institutions. Daily activity patterns stand out as a central mechanism influencing the risk of violations. These results suggest policymakers should adopt a holistic approach for traffic safety interventions but avoid monolithic views of ethnic minorities which may lead to an inefficient use of resources.

Seat belt use to save face: impact on drivers' body region and nature of injury in motor vehicle crashes

BACKGROUND

Seat belt use is the single most effective way to save lives and reduce injuries in motor vehicle crashes. However, some case reports described seat belt use as a double-edged sword because some injuries are related to seat belt use in motor vehicle crashes. To comprehensively understand the effects of seat belt use, we systemically investigated the association between seat belt use and injuries based on anatomic body region and type of injury in drivers involved in motor vehicle crashes.

METHODS

The injury information was obtained by linking crash reports with hospital discharge data and categorized by using the diagnosis codes based on the Barell injury diagnosis matrix. A total of 10,479 drivers (≥15 years) in passenger vehicles involved in motor vehicle crashes from 2006 to 2011 were included in this study.

RESULTS

Seat belt use significantly reduced the proportions of traumatic brain injury (10.4% non-seat belt; 4.1% seat belt) and other head, face, and neck injury (29.3% non-seat belt; 16.6% seat belt) but increased the proportion of spine: thoracic to coccyx injury (17.9% non-seat belt; 35.5% seat belt). Although the proportion of spine: thoracic to coccyx injury was increased in drivers with seat belt use, the severity of injury was decreased, such as fracture (4.2% with seat belt use; 22.0% without seat belt use). Furthermore, the total medical charges decreased due to the change of injury profiles in drivers with seat belt use from a higher percentage of fractures (average cost for per case $26,352) to a higher percentage of sprains and/or strains ($1,897) with spine: thoracic to coccyx injury.

CONCLUSION

This study provide a comprehensive picture for understanding the protective effect of seat belt use on injuries based on anatomic body region and type of injury in drivers involved in motor vehicle crashes.

Revisiting exposure: fatal and non-fatal traffic injury risk across different populations of travelers in Wisconsin, 2001-2009

Comparing the injury risk of different travel modes requires using a travel-based measure of exposure. In this study we quantify injury risk by travel mode, age, race/ethnicity, sex, and injury severity using three different travel-based exposure measures (person-trips, person-minutes of travel, and person-miles of travel) to learn how these metrics affect the characterization of risk across populations. We used a linked database of hospital and police records to identify non-fatal injuries (2001-2009), the Fatality Analysis Reporting System for fatalities (2001-2009), and the 2001 Wisconsin Add-On to the National Household Travel Survey for exposure measures. In Wisconsin, bicyclists and pedestrians have a moderately higher injury risk compared to motor vehicle occupants (adjusting for demographic factors), but the risk is much higher when exposure is measured in distance. Although the analysis did not control for socio-economic status (a likely confounder) it showed that American Indian and Black travelers in Wisconsin face higher transportation injury risk than White travelers (adjusting for sex and travel mode), across all three measures of exposure. Working with multiple metrics to form comprehensive injury risk profiles such as this one can inform decision making about how to prioritize investments in transportation injury prevention.

A single urban center experience with adult pedestrians struck by motor vehicles

BACKGROUND

Pedestrian-vehicle crashes are a significant problem in public health. Understanding contributing factors within a specific community helps recognize and target key intervention points.

METHODS

Trauma registry analysis included all of the patients treated at a Level I trauma center following pedestrian-motor vehicle collisions from January 1, 2000 to December 31, 2010. Variables examined included patient demographics, timing of collision, abbreviated injury scale score, injury severity score (ISS), hospital and intensive care unit (ICU) length of stay (LOS), and emergency department and hospital disposition.

RESULTS

A total of 945 pedestrians were reviewed within the study period. Average age was 46.4+/-19.4 years. One hundred seventy-seven (18.7%) patients were elderly and of the elderly group, 69 (39%) were 80 years of age or greater. The median ISS score was 12, average hospital LOS was 10.8 days and average ICU length of stay was 6.0+/-7.5 days. More elderly patients required admission to the ICU than the nonelderly (61.6% vs 40.2%; P<0.001), and more elderly patients required admission to a skilled nursing facility than nonelderly (42.1% vs. 9%; P< 0.001). The mortality rate for elderly patients was more than double that of nonelderly patients (20.9% vs 9.1%; P<0.001). Pedestrian-motor vehicle collisions occurred disproportionately between the hours of 6 PM and midnight (P< 0.0001).

CONCLUSION

Elderly patients struck by a motor vehicle have a mortality rate twice that of the nonelderly and a higher rate of discharge to a skilled nursing facility, despite having a similar injury severity score on admission. This highlights the need for aggressive prevention efforts targeted at the elderly population.

Racial/ethnic differences in alcohol-related suicide: a call for focus on unraveling paradoxes and understanding structural forces that shape alcohol-related health

A substantial proportion of injuries worldwide are attributable to alcohol consumption, and US estimates indicate that the drinking patterns of racial/ethnic groups vary considerably. The authors reviewed evidence from 19 publications regarding racial/ethnic differences in overall alcohol-attributable injury as well as percent blood alcohol content positivity for injury deaths in the United States. They found that Native Americans evidence higher rates of alcohol-attributable motor vehicle crash fatality, suicide, and falls compared with other racial/ethnic groups; conversely, Asians evidence lower rates of alcohol-attributable injury than other racial/ethnic groups. The rate of alcohol positivity and intoxication among Hispanics is disproportionately high relative to estimates of alcohol use. Black subgroups also evidence higher rates of alcohol positivity than would be expected given estimates of alcohol use, including for alcohol positivity among drivers of fatally injured black children and homicide. These findings highlight the continued need for public health focus on Native American populations with respect to alcohol consumption and injury. Further, the disparity in alcohol-attributable injury mortality among black and Hispanic groups relative to their reported rates of alcohol consumption is an overlooked area of research. The authors review potential social determinants of racial/ethnic disparities in alcohol-attributable injuries and identify directions for further research on these patterns.

Ethnicity and road traffic injuries: differences between Jewish and Arab children in Israel

OBJECTIVE

To examine the differences and characteristics of road traffic injuries (RTIs) among Jewish and Arab children, ages 0-17 years, in Israel.

DESIGN

A retrospective study based on data from the Israeli National Trauma Registry between 2001 and 2010. This study relates specifically to traffic-related hospitalizations among children ages 0-17 years. Data include demographic, injury, and hospitalization characteristics. Descriptive statistics and adjusted logistic regression were used to examine the differences of RTIs between the two ethnic groups.

RESULTS

A total of 18,884 children were included, of which Arab children comprised 38.2% of the total and 44.1% of the severely injured. Among Arab children 41.8% were pedestrians compared to 33.4% among Jewish children (p<0.0001). Arab children were younger, had more severe injuries and more traumatic brain injury (TBI) compared to Jewish children. Adjusted logistic regression analysis shows that the probability of an Arab child, relative to a Jewish child, to undergo surgical procedures was 1.2 (p<0.0001), to be hospitalized in intensive care units (ICUs) was 0.8 (p=0.003), and to be transferred to rehabilitation was 0.5 (p<0.0001). There was no significant difference in inpatient mortality between the two ethnic groups.

CONCLUSIONS

Arab children in Israel are more likely to be hospitalized due to road accidents in comparison to Jewish children. Intervention programs should focus on Arab children and their unique characteristics.

Disparity surveillance of nonfatal motor vehicle crash injuries

OBJECTIVE

The lack of race information for nonfatal motor vehicle crash injuries in the United States has limited the understanding of racial disparities in motor vehicle crashes (MVCs). In this article, we describe a pilot surveillance project in Nebraska that linked crash reports and driver's license records to investigate racial disparity among nonfatal MVC injuries.

METHODS

The project linked 43,157 severely and nonseverely injured drivers from crash reports between 2006 and 2010 to the corresponding state driver's license database so that drivers' race information from each MVC could be retrieved. A log rate model was used to examine the likelihood of MVC injuries by drivers' race along the dimensions of age, sex, and place of residence.

RESULTS

Black drivers had 31.6 and 87 percent more severe and nonsevere injuries, respectively, than white drivers. Rural residents were more likely than urban residents to have severe MVC injuries. Controlling for residence status, age, and sex did not alter the basic pattern that black drivers had higher rates of nonfatal MVC injuries.

CONCLUSIONS

The linkage approach provides an effective way to obtain additional information for MVC injury disparity surveillance. To reduce racial disparities in severe and nonsevere MVC injuries, race-sex-, race-age-, and race-location-specific interventions should be considered based on their significant contributions to disparity.

Acciphilia on the road: An analysis of severe collisions

INTRODUCTION

Although prior studies of road traffic accidents have found between-group differences in risk, little attention has been given to the encounter between drivers involved in severe collisions.

METHOD

The present study empirically evaluates two different possible causes of "social accidents," which are defined as collisions between two or more drivers where some faulty social interaction might be assumed, and which are the most prevalent cause of road injuries. The analyses use merged Israeli collision records from 1983 to 2004 with data from two national censuses, thus providing an unprecedented empirical basis to study the social foundations of car accidents. The data are used to adjudicate between two alternative hypotheses: the heterogeneity hypothesis (socially different drivers tend to collide) versus the homogeneity hypothesis (socially similar drivers tend to collide).

RESULTS

Multivariate analyses provide preliminary support for the latter hypothesis. Given an accident, there are more collisions among drivers from the same broad educational group, and the factors that influence this correlation are independent of geography. The paper thus leads to the idea that severe collisions reflect a sociological or ecological process that is akin to acciphilia.

IMPACT ON INDUSTRY

The preliminary findings suggest that variation between drivers may be preferable to similarity, since apparently there is a greater tendency toward collisions between similar drivers.

The role of race/ethnicity in alcohol-attributable injury in the United States

A substantial proportion of injuries worldwide are attributable to alcohol consumption, and US estimates indicate that the drinking patterns of racial/ethnic groups vary considerably. The authors reviewed evidence from 19 publications regarding racial/ethnic differences in overall alcohol-attributable injury as well as percent blood alcohol content positivity for injury deaths in the United States. They found that Native Americans evidence higher rates of alcohol-attributable motor vehicle crash fatality, suicide, and falls compared with other racial/ethnic groups; conversely, Asians evidence lower rates of alcohol-attributable injury than other racial/ethnic groups. The rate of alcohol positivity and intoxication among Hispanics is disproportionately high relative to estimates of alcohol use. Black subgroups also evidence higher rates of alcohol positivity than would be expected given estimates of alcohol use, including for alcohol positivity among drivers of fatally injured black children and homicide. These findings highlight the continued need for public health focus on Native American populations with respect to alcohol consumption and injury. Further, the disparity in alcohol-attributable injury mortality among black and Hispanic groups relative to their reported rates of alcohol consumption is an overlooked area of research. The authors review potential social determinants of racial/ethnic disparities in alcohol-attributable injuries and identify directions for further research on these patterns.

Evaluation of criteria for developing traffic safety materials for Latinos

This quantitative study assessed the validity of guidelines that identified four key characteristics of culturally appropriate Spanish-language traffic safety materials: language, translation, formative evaluation, and credible source material. From a sample of 190, the authors randomly selected 12 Spanish-language educational materials for analysis by 15 experts. Hypotheses included that the experts would rate materials with more of the key characteristics as more effective (likely to affect behavioral change) and rate materials originally developed in Spanish and those that utilized formative evaluation (e.g., pilot tests, focus groups) as more culturally appropriate. Although results revealed a weak association between the number of key characteristics in a material and the rating of its effectiveness, reviewers rated materials originally created in Spanish and those utilizing formative evaluation as significantly more culturally appropriate. The findings and methodology demonstrated important implications for developers and evaluators of any health-related materials for Spanish speakers and other population groups.

Who by accident? The social morphology of car accidents

Prior studies in the sociology of accidents have shown that different social groups have different rates of accident involvement. This study extends those studies by implementing Bourdieu's relational perspective of social space to systematically explore the homology between drivers' social characteristics and their involvement in specific types of motor vehicle accident. Using a large database that merges official Israeli road-accident records with socioeconomic data from two censuses, this research maps the social order of road accidents through multiple correspondence analysis. Extending prior studies, the results show that different social groups indeed tend to be involved in motor vehicle accidents of different types and severity. For example, we find that drivers from low socioeconomic backgrounds are overinvolved in severe accidents with fatal outcomes. The new findings reported here shed light on the social regularity of road accidents and expose new facets in the social organization of death.

Ethnicity, age, and trends in alcohol-related driver fatalities in the United States

OBJECTIVE

To evaluate the 8-year ethnic-specific declining trend in the proportion of alcohol-impaired driver deaths in the United States.

METHODS

We used the Fatality Analysis Reporting System (FARS), which is a census of all fatal motor vehicle collisions occurring in public properties in all 50 states, the District of Columbia, and Puerto Rico since 1975. For this study we only focused on driver fatalities. Data on ethnicity were not included in the FARS database until 1999, limiting the analysis to the years 1999-2006.

RESULTS

The proportion of alcohol-impaired driver deaths was higher among males compared to females, with Hispanics constituting the highest proportion in all age groups. During the past 8 years, only the decline in the proportion of alcohol-impaired driver deaths among male Hispanics 16-20 years old and male Whites 21-64 years old were significant. We were not able to identify any significant declining trend in the corresponding proportions among other age groups, or among female drivers, regardless of their age category.

CONCLUSION

Though existing strategies have seemed to be successful in preventing an uptrend in alcohol-related fatal collisions in the country, their effectiveness in decreasing such incidents has been limited. Future studies should identify the factors that might influence the effectiveness of current anti-drunk driver policies.

'Race' or place? Explaining ethnic variations in childhood pedestrian injury rates in London

There is a substantial literature on socio-economic inequalities in injury rates, but less on ethnic differences. Using police records of road injuries to examine the relationships between pedestrian injury, area deprivation and ethnicity we found that, in London, children categorised as 'Black' had higher injury rates than those categorised as 'White' or 'Asian', and that living in less deprived areas did not protect 'Black' children from higher risk. Ethnic differences in injury rates cannot be explained by minority ethnic status or area deprivation, but are likely to result from the complex ways in which ethnicity shapes local experiences of exposure to injury risk.

Inter-group differences in road-traffic crash involvement

This paper assesses group differences in severe and fatal road-traffic accidents by using a unique database that merges road-traffic records with the Israeli census data. The database traces, over a period of 9 years, a group of drivers that comprises 20% of the Israeli population and explores the probability of their being involved in an accident. This unique database enables the investigation of drivers' socioeconomic and demographic characteristics, while controlling for a variety of variables, such as estimated daily distance traveled and license type. Testing a previously published theoretical paper on the social bases of accidents, the findings expose significant group differences in estimated probabilities of being involved in severe and fatal accidents. For example, estimated probabilities of accident involvement are higher for males than for females, for non-Jewish drivers than for Jewish, and for drivers whose origins are in Africa and Asia than in America and Europe. Furthermore, the higher one's education and socioeconomic status, the lower is the probability of accident-involvement. The implications of the findings for developing road-safety programs and suggestions for future research are discussed.

Seat belt use among Hispanic ethnic subgroups of national origin

OBJECTIVE

Findings from over a dozen studies of Hispanic/white disparities in seat belt use have been inconsistent, variably revealing that seat belt use prevalence among Hispanics is higher, lower, or comparable to use among non-Hispanics. In contrast to previous studies, this study investigates disparities in seat belt use by Hispanic subgroups of national origin.

METHODS

Data from the US Fatality Analysis Reporting System were used to compare seat belt use among 60 758 non-Hispanic whites and 6879 Hispanics (Mexican American (MA), n = 5175; Central American/South American (CASA), n = 876; Puerto Rican (PR), n = 412; Cuban (CU), n = 416) killed in crashes from 1999-2003. Logistic regression was used to adjust for age, gender, seat belt law, seat position, urban/rural region, and income.

RESULTS

Overall adjusted odds ratios for seat belt use among Hispanic subgroups, relative to non-Hispanic whites, were 1.04 (95% confidence interval (CI) 0.85 to 1.28) for CUs, 1.17 (95% CI 0.95 to 1.44) for PRs, 1.33 (95% CI 1.25 to 1.42) for MAs, and 1.66 (95% CI 1.44 to 1.91) for CASAs. Relative to their non-Hispanic white counterparts, odds ratios among MA and CASA Hispanics were highest for men, younger age groups, drivers, primary law states, rural areas, and lower income quartiles.

CONCLUSION

Among all Hispanic subgroups, seat belt use was at least as prevalent as among non-Hispanic whites. In the CASA and MA subgroups, which have the most rapidly growing subpopulations of immigrants, seat belt use was significantly more common than among whites.

The social accident: a theoretical model and a research agenda for studying the influence of social and cultural characteristics on motor vehicle accidents

The paper develops a sociological model to explain collisions between two drivers or more. The "Social Accident" model presented here integrates empirical findings from prior studies and extant sociological theories. Sociological theory posits that social groups have unique cultural characteristics, which include a distinctive world view and ways of operating that influence its members. These cultural characteristics may cause drivers in different groups to interpret a given situation differently; therefore, they will make conflicting decisions that may possibly lead to road accidents. The proposed model may contribute to an understanding of the social mechanism related to interactions and communication among drivers by presenting new directions for understanding accidents and collisions. The paper concludes with suggestions for future research that will employ the model to assess its predictive and practical utility.

Predictors of seatbelt use in American Indian motor vehicle crash trauma victims on and off the reservation

OBJECTIVES

American Indians (AI's) have the lowest rate of seatbelt use in the nation, putting them at significant risk for motor vehicle crash (MVC) morbidity and mortality. This study compares seatbelt use in victims of level one trauma crashes presenting from on and off AI reservations. Predictors of seatbelt use were evaluated as well. We hypothesized that AI's in crashes on a reservation would have lower rates of seatbelt use, even compared to AI's in crashes from off the reservation.

METHODS

This is a retrospective cohort study of consecutive MVC victims presenting to a level one trauma facility in Phoenix, Arizona from July 2003 to June 2005. Inclusion criteria were age >11 and transported directly from the crash; struck pedestrians were excluded. Inter-facility transports were also excluded, as these patients would likely represent a sicker population, possibly introducing bias. Characteristics of those patients (sex, race, location of crash, alcohol and seatbelt use) were analyzed in univariate and multivariate logistic regression.

RESULTS

Data were collected on 2339 patients. Three hundred ninety-two were excluded, leaving 1947 (83%) available for analysis. AI's had lower rates of seatbelt use compared to all other races. Additionally, AI's on a reservation were less likely to wear seatbelts than those off a reservation (25.9% versus 42.7%). However, when tested in a multivariate analysis with alcohol as a covariate, race and location became insignificant. Low seatbelt use by AI's on the reservation was primarily associated with alcohol use.

CONCLUSION

In this analysis, alcohol, rather than race or location, is the overriding predictor of seatbelt use. This study compared patients that were in crashes, and only those triaged to a level one trauma facility. If we assume unbelted passengers are more severely injured, this would bias our results. The application of these data may help direct future public service efforts to increase seatbelt use in target populations.

Seat belt use among American Indians/Alaska Natives and non-Hispanic whites

BACKGROUND

Accidents (including motor vehicle injuries) are a leading cause of death among American Indians/Alaskan Natives (AI/AN). The purpose of this study was to examine geographic variation and the existence of a seat belt law on seat belt use among AI/AN and non-Hispanic whites (NHW).

METHODS

Self-reported seat belt behavior data from the 1997 and 2002 Behavioral Risk Factor Surveillance System were analyzed in 2006-2007 and were restricted to AI/AN (n=4,310 for 2002, and n=1,758 for 1997) and NHW (n=193,617 for 2002, and n=108,551 for 1997) aged 18 years and older.

RESULTS

Seat belt non-use varied significantly across geographic regions for both AI/AN and NHW. For example, AI/AN living in the Northern Plains (odds ratio [OR]=12.4, 95% confidence interval [CI]=6.5-23.7) and Alaska (OR=10.3, 95%CI=5.3-19.9) had significantly higher seat belt non-use compared to AI/AN living in the West. In addition, compared to those residing in urban areas, those living in rural areas were 60% more likely in NHW and 2.6 times more likely in AI/AN not to wear a seat belt. Both AI/AN and NHW living in states without primary seat belt laws were approximately twice as likely to report seat belt non-use in 2002 as those living in states with primary laws. In states with primary laws enacted between 1997 and 2002, AI/AN experienced greater decline in seat belt non-use than NHW.

CONCLUSIONS

Seat belt use among AI/AN and NHW varied significantly by region and urban-rural residency in 2002. Primary seat belt laws appear to help reduce regional and racial disparities in seat belt non-use.

A conceptual model of work and health disparities in the United States

Recent research in medicine and public health highlights differences in health related to race, ethnicity, socioeconomic status, and gender. These inequalities, often labeled "disparities," are pervasive and pertain to the major causes of morbidity, mortality, and lost life years. Often ignored in discussions of health disparities is the complex role of work, including not only occupational exposures and working conditions, but also benefits associated with work, effects of work on families and communities, and policies that determine where and how people work. The authors argue that work should be considered explicitly as a determinant of health disparities. Their conceptual model and empirical evidence, built on previous contributions, describe how work contributes to disparities in health on multiple levels. The examples focus on the United States, but many of the key conceptual features can also be applied to other countries. The model emphasizes behaviors and characteristics of institutions rather than individual workers. This approach avoids a focus on individual responsibility alone, which may lead to victim blaming and failure to emphasize policies and institutional factors that affect large populations and systematically create and maintain racial, gender, and socioeconomic disparities in health.

Children’s Use of Motor Vehicle Restraints: Maternal Psychological Distress, Maternal Motor Vehicle Restraint Practices, and Sociodemographics

OBJECTIVE

To determine the relative contribution of maternal psychological distress, maternal restraint use, and sociodemographic characteristics to the likelihood that a child would not be restrained in a motor vehicle.

METHODS

We examined data on 6251 children aged 0-17 years from the 1998 National Health Interview Survey. The level of children's motor vehicle restraint use (low vs high) was examined by maternal psychological distress and motor vehicle restraint use. Multivariate regression analyses were used to model the odds of children's low use of motor vehicle restraints, controlling for potential confounders.

RESULTS

According to maternal reports, more than 10% of children and nearly 13% of mothers reported low use of motor vehicle restraints. Multivariate analyses revealed that maternal use of restraints and psychological distress were both independently related to children's use of restraints, with maternal low use as the stronger correlate. Older children were more likely than younger children to be low users of motor vehicle restraints if the mother reported that she was a low user of restraints. Families with male children, black and Hispanic mothers, and 4 or more members reported lower use of restraints for their children.

CONCLUSIONS

Children's low use of motor vehicle restraints was associated with low levels of maternal motor vehicle restraint use and maternal psychological distress. Moreover, maternal motor vehicle restraint practices become increasingly important as children age. Health care providers should consider maternal motor vehicle restraint use, maternal psychological distress, and child age in addition to sociodemographics when assessing children's motor vehicle safety.

Stop sign violations: the role of race and ethnicity on fatal crashes

INTRODUCTION

In contrast to age, education, and gender, which have been studied more frequently, the role of race/ethnicity in shaping fatal stop sign running incidents has received relatively little attention. It has been shown that failing to follow traffic laws and regulations is a major cause of motor vehicle crashes (MVCs) in Latin America. Does this driving behavior in Latin America correspond to the Hispanic community in the United States? Are Hispanics more likely to be at-fault concerning stop sign crossing than other racial/ethnic groups in the United States?

METHOD

We took advantage of a 1990-1996 Fatality Analysis Reporting System (FARS) file with additional racial/ethnic information. Our file consisted of drivers who died in a MVC that occurred in an intersection where a stop sign was in place that involved one or more drivers with at least one of them failing to obey the traffic device. Descriptive statistics and logistic regressions were applied.

RESULTS

Overall, we found no direct difference between African-American, White, and Hispanic drivers regarding stop sign running. However, we found that race/ethnicity does play an indirect role on this problem through its impact on drinking and driving as well as its interaction with age and gender.

CONCLUSIONS

We found a picture that is much more complex than what the initial hypothesis postulated. Race/ethnicity seems to play a role in shaping fatal stop sign running incidents, but the mechanisms by which such a role is played are complex and not fully understood.

IMPACT ON INDUSTRY

The incidence and cost of fatal stop sign running crashes may be reduced if prevention policies targeting the most vulnerable groups could be developed.

Traumatic brain injury hospitalizations among American Indians/Alaska Natives

OBJECTIVES

To compare the incidence of nonfatal traumatic brain injury (TBI) hospitalization among American Indians/Alaska Natives (AI/AN) with that of other race groups and to assess alcohol and protective equipment (PE) use among those who sustained TBI related to a motor vehicle (MV) incident.

METHODS

Data were obtained from 13 states funded by the Centers for Disease Control and Prevention to conduct TBI surveillance from 1997 to 1999. Rates by race and by cause were calculated for the 13 states combined. Blood alcohol concentration (BAC) levels and PE use were compared between AI/AN and "other" races in a subgroup of these states.

RESULTS

Although not significantly different, AI/AN had the highest overall age-adjusted TBI hospitalization rate (71.5 per 100,000). Rates were significantly higher among AI/AN than among whites for ages 20 to 44 years (78.5 per 100,000 vs 54.7 per 100,000, P < .0001). MV incidents were the leading cause of TBI (40.1% of cases) among AI/AN, and AI/AN injured in MV incidents had higher BAC levels (65.7% > or = 0.08 g/dL vs 31.6% > or = 0.08 g/dL, P < .0001) and lower PE use (22.0% vs 40.4%, P < .0001) than the "other" race group.

CONCLUSION

AI/AN have high rates of TBI hospitalization compared with other races. High BAC levels and low use of PE in MV incidents appear to be associated with the higher rates in this population.

The Fatality Analysis Reporting System as a tool for investigating racial and ethnic determinants of motor vehicle crash fatalities

The Fatality Analysis Reporting System (FARS) is a Department of Transportation database in the public domain that contains detailed information about fatalities resulting from motor vehicle crashes on public roadways in the United States since 1975. However, data on race and Hispanic ethnicity were not collected by FARS until 1999. Since then, completeness of reported racial and ethnic information has varied from State to State. To assess utility of FARS for investigating race- and ethnicity-specific risk factors associated with motor vehicle crash mortality, we examined yearly national and State-specific reporting rates of race and Hispanic ethnicity for 168,863 motor vehicle crash fatalities from 1999 to 2002. In 1999, national reporting was 85% for race and 78% for Hispanic ethnicity. Over the 4-year study period, a significant linear increase in annual reporting for both race and Hispanic ethnicity was evident at the national level, as reporting by individual States improved over time. In 2002, national reporting rates reached 90% for race and 88% for Hispanic ethnicity. Our findings indicate that FARS has become a valuable resource for population-based studies of motor vehicle crash mortality disparities that exist among racial and ethnic subpopulations in the United States.

Fatal red light crashes: the role of race and ethnicity

There is an increasing number of motor vehicle crashes (MVCs) in the U.S. that occur at intersections. Noncompliance with traffic signals is one of the causes for such increase. In this study, we focused on Hispanic drivers. It has been shown that failing to follow traffic laws and regulations is a major cause of MVCs in Latin America. Does this driving behavior in Latin America correspond to the Hispanic community in the U.S.? Are U.S. Hispanics more likely to die in a red light incident? Are Hispanics more likely to be red light runners than other racial/ethnic groups in the U.S.? We answered these questions by taking advantage of a 1990-1996 Fatality Analysis Reporting System (FARS) file with additional racial/ethnic information. Overall, we found no differences between African-American, White, and Hispanic drivers regarding red light running. We found that drinking and driving was the most important factor for red light running. However, we found evidence that some Hispanic subgroups may be more vulnerable to red light running. One such subgroup is formed by Hispanics who have no valid driver license and no record of previous driver license suspension. This study is the first to apply national, archival data to document the relevance of race/ethnicity to the red light running problem, and we hope that it might serve as an incentive for more research on this area.

Population characteristics of traffic accident-related deaths in Japan and Ireland, 1950-2000

To compare epidemiological characteristics of traffic accidents in Japan and Ireland, we analyzed mortality and the negative effect on life expectancy between 1950 and 2000 and generated a multivariate model. The characteristics were similar in the two countries: The time trends showed an increase in mortality followed by a decrease. The mortality rates were about 13 and 5/100,000 for males and females, respectively, in 2000. Correlation coefficients for sex were over 0.9. Age distribution obeyed the natural logarithm regularity. The negative effect on life expectancy was about 0.34 year for males, and 0.13 year for females. The economic level was positively associated with mortality, whereas "number of vehicles owned" was associated negatively. In conclusion, we can take advantage of the broad consistencies in these two countries when we draw up an intervention strategy. Any preventive strategy should be directed to the young, particularly males.