American Journal of Epidemiology, Vol 152, Issue 5 424-431, Copyright © 2000 by Oxford University Press
G McGwin Jr, RV Sims, L Pulley and JM Roseman
Older drivers have elevated crash rates and are more likely to be injured
or die if they have a crash. Medical conditions and medications have been
hypothesized as determinants of crash involvement. This population-based
case-control study sought to identify medical conditions and medications
associated with risk of at-fault crashes among older drivers. A total of
901 drivers aged 65 years and older were selected in 1996 from Alabama
Department of Public Safety driving records: 244 at-fault drivers involved
in crashes; 182 not at-fault drivers involved in crashes; and 475 drivers
not involved in crashes were enrolled. Information on demographic factors,
chronic medical conditions, medications, driving habits, visual function,
and cognitive status was collected. Older drivers with heart disease (odds
ratio (OR) = 1.5, 95% confidence interval (CI): 1.0, 2.2) or stroke (OR =
1.9, 95% CI: 0.9, 3.9) were more likely to be involved in at-fault
automobile crashes. Arthritis was also associated with an increased risk
among females (OR =1.8, 95% CI: 1.1, 2.9). Use of nonsteroidal
antiinflammatory drugs (OR = 1.7, 95% CI 1.0, 2.6), angiotensin converting
enzyme inhibitors (OR = 1.6, 95 CI: 1.0, 2.7), and anticoagulants (OR =
2.6, 95% CI: 1.0, 73) was associated with an increased risk of at-fault
involvement in crashes. Benzodiazepine use (OR = 5.2, 95% CI: 0.9, 30.0)
was also associated with an increased risk. Calcium channel blockers (OR =
0.5, 95% CI: 0.2, 0.9) and vasodilators (OR = 0.3, 95% CI: 0.1, 1.0) were
associated with a reduced risk of crash involvement. The identification of
medical conditions and medications associated with risk of crashes is
important for enhancing the safety and mobility of older drivers.
ARTICLES
Relations among chronic medical conditions, medications, and automobile crashes in the elderly: a population-based case-control study
Department of Epidemiology and International Health, School of Public Health, University of Alabama at Birmingham, 35294-0009, USA. mcgwin@eyes.uab.edu
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