Motor Vehicle Collision Involvement Research Articles

Risk of motor vehicle collisions and culpability among older drivers using cannabis: a meta‐analysis

AbstractBackgroundWhile the effects of cannabis use on driving have been established in younger populations, limited studies have investigated this association among older adults, who represent the fastest growing segment of drivers globally.MethodWe conducted a systematic review and meta‐analysis to evaluate the effect of THC exposure on (1) risk of motor vehicle collisions (MVC) and (2) risk of culpability (being responsible for the collision), among adults 50 years and older. Three reviewers screened 7,022 studies identified through MEDLINE, EMBASE, CENTRAL, and PsycINFO and published between inception and 2021. Odds Ratios (OR) were calculated with a random‐effects model using the Mantel‐Haenszel method in Review Manager 5.4.1. Heterogeneity was assessed using I2. An adapted version of the National Heart, Lung, and Blood Institute quality assessment tool was used to assess the quality of each study.Result7 cross‐sectional studies were included. Three studies were rated ‘Good’ quality, one rated ‘Fair’, and three rated ‘Poor’. Three of the included studies evaluated culpability (NTHC+ = 239 NTHC‐ = 4609) while four evaluated MVC risk (NTHC+ = 158, NTHC‐ = 6152). We found that the pooled risk of MVC was not significantly different between older drivers exposed to THC and those who were not (OR, 95% CI 1.15 [0.40, 3.31]; I2 = 72%). In the studies assessing driver culpability, THC exposure was not significantly associated with an increased risk of being culpable for MVC among adults over the age of 50 (OR, 95% CI 1.24 [0.95, 1.61]; I2 = 0%). A visual inspection of the funnel plots did not indicate any publication bias.ConclusionOur review found that THC exposure was not associated with MVC involvement nor with culpability. However, it would be an oversimplification to conclude that cannabis use does not pose a safety risk to older drivers. Rather, our results may reflect several methodological limitations of the studies included in this review. Due to the increasing prevalence of cannabis use worldwide, we are optimistic that future research will be able to address this research question using more objective methodologies.

Risk of Motor Vehicle Collisions and Culpability among Older Drivers Using Cannabis: A Meta-Analysis.

Limited studies have investigated the effects of cannabis use on driving among older adults, who represent the fastest growing segment of drivers globally. We conducted a systematic review and meta-analysis to evaluate the effects of delta-9-tetrahydrocannabinol (THC) exposure on risks of (1) motor vehicle collisions (MVC) and (2) culpability for MVCs among adults 50 years and older. Three reviewers screened 7022 studies identified through MEDLINE, EMBASE, CENTRAL, and PsycINFO. Odds Ratios (OR) were calculated using the Mantel-Haenszel method in Review Manager 5.4.1. Heterogeneity was assessed using I2. The National Heart, Lung, and Blood Institute tool was used to assess the quality of each study. Seven cross-sectional studies were included. Three studies evaluated culpability while four evaluated MVC. The pooled risk of MVC was not significantly different between THC-positive and THC-negative older drivers (OR, 95% CI 1.15 [0.40, 3.31]; I2 = 72%). In culpability studies, THC exposure was not significantly associated with an increased risk of being culpable for MVC among adults over the age of 50 (OR, 95% CI 1.24 [0.95, 1.61]; I2 = 0%). Inspection of funnel plots did not indicate publication bias. Our review found that THC exposure was not associated with MVC involvement nor with culpability for MVCs.

Vision Screening for Motor Vehicle Collision Involvement among Older Drivers

To evaluate the epidemiologic association between visual acuity and other measures of visual function and motor vehicle collisions (MVCs) as well as their performance as screening tests for MVCs. Prospective cohort study. A total of 2000 licensed drivers aged 70 years and older who resided in the environs of Jefferson County, Alabama. Visual acuity, contrast sensitivity, useful field of view, Motor-free Visual Perception Test, and visual field sensitivity were measured at a baseline visit. Study participants were followed for up to 4 years for the occurrence of MVC involvement. Area under the curve (AUC), sensitivity, and specificity were calculated to determine the screening performance of each visual function measure with respect to MVC occurrence. Poisson regression was used to estimate rate ratios (RRs) for the association between each visual function measure and MVC occurrence. Police-reported MVCs. For all visual function measures, the AUC values were only slightly higher than 0.50; additionally, none of the measures exhibited adequate values for both sensitivity and specificity (i.e., > 80%). For all visual function measures except visual acuity, there were statistically significant positive RRs for the association between vision impairment and MVC occurrence, although the magnitude of the associations was weak (i.e., < 2.0). The negative impact of involuntary driving cessation on mobility and the associated mental health implications likely outweigh the safety benefit of vision screening. Alternative approaches to improving older driver safety should be considered.

Motion perception as a risk factor for motor vehicle collision involvement in drivers ≥ 70 years

PurposeTo evaluate the relationship between visual function and a five-year history of motor vehicle collision rates in older adults. Motion perception impairment was explored as a risk factor for motor vehicle collisions for the first time in this study. Materials and methodsParticipants were licensed drivers ≥70 years old enrolled in the Alabama VIP Older Driver Study who underwent functional assessments for motion perception, distance visual acuity, contrast sensitivity, visual field sensitivity, and visual processing speed. Participants were recruited based on their being patients in an ophthalmology clinic in the year prior to enrollment or had participated in an earlier driving study. Crash reports were obtained from the Alabama Law Enforcement Agency for the 5 years prior to enrollment and mileage estimated using the Driving Habits Questionnaire. Crude and age-adjusted rate ratios (RRs) and 95 % confidence intervals (95 % CIs) were calculated using Poisson regression. Results159 participants enrolled with a mean age of 79 years. The age-adjusted crash rate was higher among those with worse motion perception (RR: 2.7, 95 % CI: 1.4−5.2), severe slowing in visual processing speed (RR: 3.6, 95 % CI: 1.5−8.5), and impaired peripheral visual field sensitivity (RR: 2.4, 95 % CI: 1.3−4.4). ConclusionsAmong a sample of older drivers, crash rates were higher for those with impaired motion perception, severely slowed visual processing speed, and impaired peripheral visual field sensitivity. The association between motion perception and crash risk in older drivers has not been previously reported. Prospective analysis of the Alabama VIP Older Driver Study will examine these risk factors for future collision involvement based on naturalistic driving data.

Aging, Obesity, and Motor Vehicle Collisions

Aging and obesity are two key areas of research as risk factors leading to motor vehicle collisions (MVCs). However, only a few studies identified obese older drivers as an at-risk population of MVC (i.e., older than 65 years old with Body Mass Index greater than 30 kg/m2). This paper aims to review the literature related to aging, obesity, and MVCs. Extensive literature searches were conducted, and the results are presented in a narrative review of the literature, in order to discuss the risk for involvement in MVC as well as the solutions for this population. Extrinsic factors are components of the “built environment” that decrease road safety for this population and poor fit of the vehicle through their inappropriate design for this population. The intrinsic factors are the autonomy and the health status of the driver. Health status are challenges associated with obesity and aging that increase the prevalence of being part in a MVC and that increase risk of morbidity and mortality during or following a collision. Finally, some prevention strategies are presented for consideration. There is a need to inform public policy makers on the additional risk factors associated with aging and obesity for MVCs.

Association between visual field impairment and involvement in motor vehicle collision among a sample of Japanese drivers

BackgroundThere is an expectation that the addition of visual field testing to driving licencing procedures may contribute to detecting unsafe drivers due to visual field (VF) impairment. However, previous research has been inconclusive as to the association between VF impairment and motor vehicle collision (MVC), and there are relatively fewer trials conducted outside the United States using a sample of general drivers compared to studies using eye clinic patients. PurposeTo investigate the association between ophthalmic indicators of VF impairment and involvement in at-fault MVC in the previous five years among a sample of middle-aged or older drivers. MethodDriving licence holders aged 40 years or over (N = 546) were administered a questionnaire survey and underwent a visual assessment at a driving licence examination centre in the suburbs of Tokyo. Of these participants, 458 were current drivers. Their response to the written questionnaire and ophthalmic indicators of VF impairment were subjected to multivariate logistic regression models to predict at-fault MVC. The analyses were done while adjusting for variables pertinent to driving habit, near-miss experience and perceived driving difficulties. We compared two different dependent variables separately: at-fault MVC based on police record and self-reports. ResultsAnalysis showed that ophthalmic indicators of binocular VF impairment such as Esterman score and Integrated Visual Field was not statistically significant in explaining at-fault MVC involvement. This was true both for predicting police-registered MVC and self-reported at-fault MVC. It was indicated that history of citation, presence of medical conditions and certain driving circumstances such as frequent night-time driving would increase risk of at-fault MVC in conjunction with the individual’s perception about driving difficulties. ConclusionThe results of this study were consistent with previous research in that ophthalmic VF impairment may not be directly associated with MVC involvement when VF impairment is not severe. However, a combination of at-risk driving behaviour (exposure to high-risk driving situations and certain near-miss experience), deterioration in health condition, and lack of insight into such circumstances would likely increase at-fault MVC risk.

General cognitive impairment as a risk factor for motor vehicle collision involvement: a prospective population-based study.

This study examined whether cognitive impairment and decline as assessed by a brief mental status screening test is associated with future crash risk in a cohort of older drivers. A three-year prospective study was conducted in a population-based sample of 2000 licensed drivers, aged 70 years and older. At the baseline visit, cognitive impairment was defined as <24 on the Mini Mental State Exam (MMSE). Decline was defined as those with a one-year change in MMSE scores in the lowest quartile (largest decrease). Motor vehicle collision involvement was obtained from the Alabama Department of Public Safety. Poisson regression was used to calculate crude and adjusted rate ratios (RR). There were 278 crashes during the follow-up period. Rates of crash involvement were higher for those with cognitive impairment (crude RR = 2.33) compared to those without impairment at baseline; adjustment for potential confounders namely age and visual processing speed attenuated this relationship (adjusted RR = 1.26, 95% confidence interval (CI) 0.65–2.44). Drivers who experienced a pronounced decline in estimated MMSE scores in one year were 1.64 (95% CI 1.04–2.57) times more likely to have a future at-fault crash, as compared to those whose scores did not decline. Evaluation of MMSE over time may provide important insight in an older driver’s future risk of at-fault crash involvement.

Relationship between Areas of Cognitive Functioning on the Mini-Mental State Examination and Crash Risk

Previous studies have suggested that the pattern of cognitive impairment in crash-involved older drivers is different from non-crash-involved older drivers. This study assessed the relationship between seven areas of cognitive functioning (orientation to time, orientation to place, registration, attention and calculation, recall, language, and visual construction) on the Mini-Mental State Examination (MMSE) collected at baseline and rates of future crash involvement in a prospective population-based sample of older drivers. Motor vehicle collision (MVC) involvement was obtained from the Alabama Department of Public Safety. Poisson regression was used to calculate crude and adjusted rate ratios (RR). Older drivers having difficulties in place orientation were more than 6 times (95% CI 1.90–19.86) more likely to be involved in a future crash (adjusted RR = 6.14, 95% confidence interval (CI) 1.90–19.86) and at-fault crash (adjusted RR = 6.39, 95% CI 1.51–27.10). Impairment in the other cognitive areas was not associated with higher rates of crash or at-fault crash involvement. The findings were validated in an independent sample of high-risk older drivers and a similar pattern of results was observed. Spatial orientation impairment can help identify older drivers who are more likely to crash in the future.

Motor Vehicle Collision Involvement among Persons with Hemianopia and Quadrantanopia.

Persons with homonymous quadrantanopia and hemianopia experience driving restrictions, yet there is little scientific evidence to support driving prohibition among persons with these conditions. This retrospective cohort study compares motor vehicle collision (MVC) rates among 27 current licensed drivers with hemianopic and quadrantanopic field defects, who were ≥6 months from the brain injury date with that of 27 age-matched drivers with normal visual fields. Information regarding all police-reported MVCs that occurred over a period of nine years was obtained. MVC rates per year and per mile travelled were calculated and compared using conditional Poisson regression. Drivers with hemianopia or quadrantanopia had more MVCs per mile driven compared to drivers with normal visual fields; specifically their overall MVC rate was 2.45-times (95% confidence interval (CI) 0.89–3.95) higher and their at-fault MVC rate was 2.64-times (95% CI 1.03–6.80) higher. This study indicates that drivers with hemianopia or quadrantanopia have elevated MVC rates. This is consistent with previous research despite studies showing wide individual variability from excellent to poor driving skills. Future research should focus on the functional and driving performance characteristics associated with superior driving skills and/or those that may be amenable to improvement via behavioral and/or engineering interventions.

The useful field of view assessment predicts simulated commercial motor vehicle driving safety

ABSTRACTObjective: The Useful Field of View (UFOV) assessment, a measure of visual speed of processing, has been shown to be a predictive measure of motor vehicle collision (MVC) involvement in an older adult population, but it remains unknown whether UFOV predicts commercial motor vehicle (CMV) driving safety during secondary task engagement. The purpose of this study is to determine whether the UFOV assessment predicts simulated MVCs in long-haul CMV drivers.Method: Fifty licensed CMV drivers (Mage = 39.80, SD = 8.38, 98% male, 56% Caucasian) were administered the 3-subtest version of the UFOV assessment, where lower scores measured in milliseconds indicated better performance. CMV drivers completed 4 simulated drives, each spanning approximately a 22.50-mile distance. Four secondary tasks were presented to participants in a counterbalanced order during the drives: (a) no secondary task, (b) cell phone conversation, (c) text messaging interaction, and (d) e-mailing interaction with an on-board dispatch device.Results: The selective attention subtest significantly predicted simulated MVCs regardless of secondary task. Each 20 ms slower on subtest 3 was associated with a 25% increase in the risk of an MVC in the simulated drive. The e-mail interaction secondary task significantly predicted simulated MVCs with a 4.14 times greater risk of an MVC compared to the no secondary task condition. Subtest 3, a measure of visual speed of processing, significantly predicted MVCs in the email interaction task. Each 20 ms slower on subtest 3 was associated with a 25% increase in the risk of an MVC during the email interaction task.Conclusions: The UFOV subtest 3 may be a promising measure to identify CMV drivers who may be at risk for MVCs or in need of cognitive training aimed at improving speed of processing. Subtest 3 may also identify CMV drivers who are particularly at risk when engaged in secondary tasks while driving.

Visual Risk Factors and Screening Tests for Motor Vehicle Collision Involvement: A Population-Based Study

Visual Risk Factors and Screening Tests for Motor Vehicle Collision Involvement: A Population-Based Study

Driving with pets and motor vehicle collision involvement among older drivers: A prospective population-based study

ObjectiveDistracted driving is a major cause of motor vehicle collision (MVC) involvement. Pets have been identified as potential distraction to drivers, particularly in the front. This type of distraction could be worse for those with impairment in the cognitive aspects of visual processing. The purpose of this study is to evaluate the association between driving with pets and rates of motor vehicle collision involvement in a cohort of older drivers. MethodsA three-year prospective study was conducted in a population-based sample of 2000 licensed drivers aged 70 years and older. At the baseline visit, a trained interviewer asked participants about pet ownership, whether they drive with pets, how frequently, and where the pet sits in the vehicle. Motor vehicle collision (MVC) involvement during the three-year study period was obtained from the Alabama Department of Public Safety. At-fault status was determined by the police officer who arrived on the scene. Participants were followed until the earliest of death, driving cessation, or end of the study period. Poisson regression was used to calculate crude and adjusted rate ratios (RR) examining the association between pet ownership, presence of a pet in a vehicle, frequency of driving with a pet, and location of the pet inside with vehicle with any and at-fault MVC involvement. We examined whether the associations differed by higher order visual processing impairment status, as measured by Useful Field of View, Trails B, and Motor-free Visual Perception Test. ResultsRates of crash involvement were similar for older adults who have ever driven with a pet compared to those who never drove with their pet (RR=1.15, 95% CI 0.76–1.75). Drivers who reported always or sometimes driving with their pet had higher MVC rates compared to pet owners who never drive with a pet, but this association was not statistically significant (RR=1.39, 95% CI 0.86–2.24). In terms of location, those reporting having a pet frequently ride in the front of the vehicle had similar rates of MVC involvement compared to those who did not drive with a pet in the front. A similar pattern of results was observed for at-fault MVCs. This association was not modified by visual processing impairment status. ConclusionThe current study demonstrates a positive but non-significant association between frequently driving with pets and MVC involvement. More research is needed, particularly on restraint use and whether the pet was in the car at the time of the crash, to help characterize the public safety benefit of regulations on driving with pets.

Association between Glaucoma and At–fault Motor Vehicle Collision Involvement among Older Drivers: A Population-based Study

To examine the association between glaucoma and motor vehicle collision (MVC) involvement among older drivers, including the role of visual field impairment that may underlie any association found. A retrospective, population-based study. A sample of 2000 licensed drivers aged ≥70 years who reside in north central Alabama. At-fault MVC involvement over the 5 years before enrollment was obtained from state records. Three aspects of visual function were measured: habitual binocular distance visual acuity, binocular contrast sensitivity (CS), and the binocular driving visual field constructed from combining the monocular visual fields of each eye. Poisson regression was used to calculate crude and adjusted rate ratios (RRs) and 95% confidence intervals (CIs). At-fault MVC involvement over the 5 years before enrollment. Drivers with glaucoma (n = 206) had a 1.65 times higher MVC rate (95% CI, 1.20-2.28; P = 0.002) compared with those without glaucoma after adjusting for age, and mental status. Among those with glaucoma, drivers with severe visual field loss had higher MVC rates (RR, 2.11; 95% CI, 1.09-4.09; P = 0.027), whereas no association was found among those with impaired visual acuity and CS. When the visual field was subdivided into 6 regions (upper, lower, left, and right visual fields; horizontal and vertical meridians), we found that impairment in the left, upper, or lower visual field was associated with higher MVC rates, and an impaired left visual field showed the highest RR (3.16; P = 0.001) compared with other regions. However, no association was found in deficits in the right side or along the horizontal or vertical meridian. A population-based study suggests that older drivers with glaucoma are more likely to have a history of at-fault MVC involvement than those without glaucoma. Impairment in the driving visual field in drivers with glaucoma seems to have an independent association with at-fault MVC involvement, whereas visual acuity and CS impairments do not.

Previous Driving Experience, but Not Vision, Is Associated With Motor Vehicle Collision Rate in Bioptic Drivers.

Bioptic telescopic spectacles (BTS) consist of a small telescope (or telescopes) mounted high in a pair of spectacle lenses. More than 40 states allow for some form of bioptic driving licensure for people with decreased central vision. The purpose of this study was to determine significant associations among previous driving experience, vision, and motor vehicle collisions (MVCs) for bioptic drivers in Ohio. We conducted a retrospective study of patients who received a vision examination and subsequently obtained bioptic licensure. We obtained driving records from the Ohio Bureau of Motor Vehicles in order to determine MVC involvement. Relationships among vision measures, age, sex, previous experience, and MVCs were investigated using time-to-event analysis and the Cox proportional hazards regression model. We identified 237 bioptic drivers (65% male). Age at initial exam ranged from 16 to 81 years, and mean visual acuity was approximately 20/120. The number of MVCs per driver ranged from 0 to 11, with 124 (52%) drivers having had at least one MVC. Visual acuity and contrast sensitivity were not significant predictors of MVC. Drivers without previous driving experience were significantly more likely to have been involved in an MVC (P < 0.001), and this association remained significant after adjusting for age and sex (P = 0.01). The rate of MVC per year decreased steadily over a 10-year period for drivers without previous experience. Previous nonbioptic driving experience, but not visual acuity or contrast sensitivity, was associated with yearly MVC rate in bioptic drivers.

Binocular Visual Field Impairment in Glaucoma and At-Fault Motor Vehicle Collisions

To evaluate the association between the binocular visual field defects in drivers with glaucoma and the risk of motor vehicle collision (MVC) involvement. A retrospective cohort study was conducted on 438 drivers with glaucoma aged 55 years or older using data from 1994 through 2000. Demographic, clinical, and driving characteristics were obtained from chart abstractions and patient survey. Binocular field measures were generated by combining data from the monocular (central 24-degree radius) fields whereby the binocular field measure was defined as the more sensitive point at each monocular field location. Measures included threshold (TH), total deviation (TD), and pattern deviation (PD); severe impairment in these measures was defined as falling into the worst quartile. MVC data were obtained from police records. Rate ratios (RR) and 95% confidence intervals (CI) were calculated. Drivers with severely impaired PD measures were twice as likely to have an at-fault MVC compared with those not severely impaired (RR, 2.13; 95% CI, 1.21-3.75); those with severely impaired TH (RR, 1.49; 95% CI, 0.81-2.74) and TD (RR, 1.50; 95% CI, 0.82-2.74) also had an increased rate of at-fault MVCs, although these were not significant. When the binocular central visual field was stratified into 9 regions, drivers with impaired TH, TD, or PD had similarly elevated MVC rates in all regions compared with those not severely impaired, though not all reached statistical significance. On the basis of clinical measures of visual field routinely used in the management of glaucoma, drivers with glaucoma with severe PD field defects in the binocular field have a higher rate of at-fault MVC compared with those with less impaired or unimpaired binocular visual fields.

The driving visual field and a history of motor vehicle collision involvement in older drivers: a population-based examination.

We designed a visual field test focused on the field utilized while driving to examine associations between field impairment and motor vehicle collision involvement in 2000 drivers aged 70 years or older. The "driving visual field test" involved measuring light sensitivity for 20 targets in each eye, extending 15° superiorly, 30° inferiorly, 60° temporally, and 30° nasally. The target locations were selected on the basis that they fell within the field region utilized when viewing through the windshield of a vehicle or viewing the dashboard while driving. Monocular fields were combined into a binocular field based on the more sensitive point from each eye. Severe impairment in the overall field or a region was defined as average sensitivity in the lowest quartile of sensitivity. At-fault collision involvement for 5 years prior to enrollment was obtained from state records. Poisson regression was used to calculate crude and adjusted rate ratios (RRs) examining the association between field impairment and at-fault collision involvement. Drivers with severe binocular field impairment in the overall driving visual field had a 40% increased rate of at-fault collision involvement (RR, 1.40; 95% confidence interval [CI]: 1.07-1.83). Impairment in the lower and left fields was associated with elevated collision rates (RR, 1.40; 95% CI: 1.07-1.82 and RR, 1.49; 95% CI: 1.15-1.92, respectively), whereas impairment in the upper and right field regions was not. Results suggest that older drivers with severe impairment in the lower or left region of the driving visual field are more likely to have a history of at-fault collision involvement.

PC-FACS

PC-FACS

Frequent Falling and Motor Vehicle Collision Involvement of Older Drivers

To examine the relationship between frequent falls in older drivers and motor vehicle collision (MVC) involvement. Cross-sectional. North central Alabama. Population-based sample of 2,000 licensed drivers aged 70 and older. Self-reported history of falling two or more times in the prior year was the main predictor. Outcomes were any MVC or at-fault MVC in the prior year. Approximately 9% of older drivers reported having fallen two or more times in the prior year. Logistic regression models indicated that frequent falling was associated with having any MVC (crude odds ratio (OR) = 1.53, 95% confidence interval (CI) = 0.77-3.02) and an at-fault MVC (OR = 2.21, 95% CI = 0.97-5.06). Adjustment for the potentially confounding effects of demographic, health, visual, and driving characteristics did not meaningfully affect the association with any MVC, whereas the association with at-fault MVC was weakened (adjusted OR = 2.03, 95% CI = 0.84-4.90). Frequent falling was associated with at-fault MVC involvement of older drivers, especially whites. History of falling can be used to identify individuals at risk of MVC involvement and to begin a dialogue about driver safety.

Temporal trends in the associations between age, sex and socioeconomic status after death from motor vehicle collisions in England and Wales: 1960–2009

ObjectiveTo determine the trend in the associations between socioeconomic status and gender with median age at death in England and Wales, from 1960 to 2009.MethodsAnnual cross-sectional studies of all registered...

Examining the association between age-related macular degeneration and motor vehicle collision involvement: a retrospective cohort study

BackgroundLittle is known about motor vehicle collision (MVC) risk in older drivers with age-related macular degeneration (AMD). The purpose of this study is to examine associations between MVC involvement and...