Risk of 30-day mortality and its association with alcohol concentration level among driver victims of motor vehicle crashes: comparison of population- and hospital-based designs

Abstract

BackgroundAlthough blood alcohol concentration (BAC) is undoubtedly associated with increased risk of injury among driver victims involved in motor vehicle crashes (MVCs), some studies noted that high BAC was associated with reduced risk of mortality after injury. In addition, most of the previous studies included only injured patients admitted, which may lead to potential selection bias arising from exclusion of those with minor injury and those who died at the accident scene of MVC.MethodThe population-based design included 2586 driver victims with BAC equivalent >0 and 10 307 matched controls (BAC equivalent =0) selected from the Police-reported Traffic Accident Registry from 1 July to 31 December 2016 in Taiwan. The hospital-based design comprised a subset sample, which included 517 driver victims with BAC equivalent >0 and 662 with BAC equivalent =0 hospitalised on the same day the MVCs occurred. Conditional logistic regression models with adjustment for potential confounders were used to estimate the ORs and 95% CIs of 30-day mortality associated with BAC equivalent level.ResultsIn the population-based design, a positive dose–gradient relationship was observed between BAC equivalent level and 30-day mortality, with a covariate-adjusted OR of 3.77 (95% CI 1.84 to 7.72), 6.19 (95% CI 3.13 to 12.26) and 7.75 (95% CI 4.51 to 13.32) for low, moderate and high BAC equivalent levels, respectively. By contrast, the hospital-based design revealed no significant association between 30-day mortality and alcohol concentration regardless of the BAC equivalent level.ConclusionThe association between BAC equivalent level and short-term mortality could have been overlooked in hospital-based studies that excluded MVC-related deaths outside hospital settings.

Maternal outcomes in association with motor vehicle crashes during pregnancy: a nationwide population-based retrospective study

“…Hospital records might also preclude those MVCs that result in immediate death. 9 Thus, there is a potential selection bias for the studies entirely based on the MVC data reported to the hospital.…”

“…Also, using hospitalisation data following MVCs may result in an over- or under-representation of severe injuries, because women involved in minor injuries may not present themselves to hospitals. Hospital records might also preclude those MVCs that result in immediate death 9. Thus, there is a potential selection bias for the studies entirely based on the MVC data reported to the hospital.…”

Type 2 diabetes mellitus increases the severity of non-fatal injuries, but not the risk of fatal injuries, among driver victims of motor vehicle crashes in Taiwan

“…The PTAR is managed by the National Police Agency of Taiwan. After a road traffic crash is made known to the police department, certified police accident investigators examine the accident scene and complete accident reports, which contain information relevant to the MVC [ 11 , 12 ]. NHI medical claims are retrieved from Taiwan’s NHI program; this program is implemented and supervised by the National Health Insurance Administration, which also performs quarterly expert reviews on random samples of medical claims to ensure their accuracy [ 13 ].…”

“…The aim of this population-based cohort study was to examine whether type 2 diabetes is associated with a greater severity of injury among driver victims of MVCs. [11,12]. NHI medical claims are retrieved from Taiwan's NHI program, which is implemented and supervised by the National Health Insurance Administration that also performs quarterly expert reviews on random samples of medical claims to ensure the accuracy of such claims [13].…”

“…Second, the study cohort (i.e., driver victims) was retrieved from PTAR, which is a populationbased registry that covers nearly all road traffic crashes, including those without injury. An analyses that is limited to the comparison between driver victims with and without diabetes in hospital settings is likely to be subject to referral bias because driver victims who require treatment after MVC tend to exhibit smaller variability in injury severity [12] Nonetheless, the police-reported road traffic crash data could under-report some minor motor vehicle collisions, which involve no injury or property damage or loss [36]. Third, this study interlinked among PTAR, NHI medical claims, and TDR, considerably reducing the likelihood of incomplete information due to follow-up loss.…”