Use of psychotropic medication and risk of road traffic crashes: a registry-based case–control study in Denmark, 1996–2018

Olesen, Anne Vingaard; Madsen, Jens Ingemann; Nielsen, Jimmi

doi:10.1007/s00213-022-06146-0

Cited by 10 publications

(5 citation statements)

References 27 publications

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“…A recent study, however, found increased odds of vehicular crashes for individuals treated with stimulants. 41 Research supports that although drivers with ADHD who do not take medication may experience more inattention and impatience than drivers with ADHD who take medication, those taking methylphenidate committed a similar number of driving errors as those without ADHD or a history of taking relevant stimulant medications during on-road driving tests. 42 …”

Section: Discussionmentioning

confidence: 91%

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

Liu,

Chihuri,

Mielenz

et al. 2023

JAMA Netw Open

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ImportanceSymptoms 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.ObjectiveTo examine the prevalence of ADHD and the association between ADHD and crash risk among older adult drivers.Design, Setting, and ParticipantsThis 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.ExposureLifetime 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 MeasuresThe 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.ResultsOf 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 RelevanceAs 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.

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Section: Discussionmentioning

confidence: 91%

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

Liu,

Chihuri,

Mielenz

et al. 2023

JAMA Netw Open

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“…These findings are consistent with previous studies published in the literature that found associations with motor vehicle crashes and antidepressants 44 , 45 and sedatives and hypnotics. 46 , 47 Other medications that have been implicated in the literature include anticonvulsants, muscle relaxants, and anticholinergic drugs. These were either not found to be associated with driving impairment in our study or the prevalence of the drug was too small to study (eg, opioids or muscle relaxants).…”

Section: Resultsmentioning

confidence: 99%

Medication and Road Test Performance Among Cognitively Healthy Older Adults

Carr,

Beyene,

Doherty

et al. 2023

JAMA Netw Open

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ImportanceOlder adults are increasingly prescribed medications that have adverse effects. Prior studies have found a higher risk of motor vehicle crashes to be associated with certain medication use.ObjectiveTo determine whether specific medication classes were associated with performance decline as assessed by a standardized road test in a community sample of cognitively healthy older adults, to evaluate additional associations of poor road test performance with comorbid medical conditions and demographic characteristics, and to test the hypothesis that specific medication classes (ie, antidepressants, benzodiazepines, sedatives or hypnotics, anticholinergics, antihistamines, and nonsteroidal anti-inflammatory drugs or acetaminophen) would be associated with an increase in risk of impaired driving performance over time.Design, Setting, and ParticipantsThis was a prospective cohort study of 198 cognitively healthy adults 65 years and older with a valid driver’s license who were followed up annually, with rolling enrollment. Data were collected from participants in St Louis, Missouri, and neighboring Illinois who were enrolled in the Knight Alzheimer’s Disease Research Center. Data were collected from August 28, 2012, to March 14, 2023, and analyzed from April 1 to 25, 2023. Participants with healthy cognition, defined as a Clinical Dementia Rating score of 0 at baseline and subsequent visits, who had available clinical, neuropsychological, road tests, and self-reported medication data were included.ExposurePotentially driver-impairing medication use.Main Outcomes and MeasuresThe primary outcome measure was performance on the Washington University Road Test (pass or marginal/fail). Multivariable Cox proportional hazards models were used to evaluate associations between potentially driver-impairing medication use and road test performance.ResultsOf the 198 included adults (mean [SD] baseline age, 72.6 [4.6] years; 87 female [43.9%]), 70 (35%) received a marginal/fail rating on the road test over a mean (SD) follow-up of 5.70 (2.45) years. Any use of antidepressants (adjusted hazard ratio [aHR], 2.68; 95% CI, 1.69-4.71), serotonin and norepinephrine reuptake inhibitors (aHR, 2.68; 95% CI, 1.54-4.64), sedatives or hypnotics (aHR, 2.70; 95% CI, 1.40-5.19), or nonsteroidal anti-inflammatory drugs (aHR, 2.72; 95% CI, 1.31-5.63) was associated with an increase in risk of receiving a marginal/fail rating on the road test compared with control individuals. Conversely, participants taking lipid-lowering agents had a lower risk of receiving a marginal/fail rating compared to control individuals. There were no statistically significant associations found between anticholinergic or antihistamines and poor performance.Conclusions and RelevanceIn this prospective cohort study, specific medication classes were associated with an increase in risk of poor road test performance over time. Clinicians should consider this information and counsel patients accordingly when prescribing these medications.

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“…General discussion about the interpretation of PM toxicology results and about stability and artifacts has been provided by Druid and Skopp (2022) and by Skopp (2022), respectively. Since case–control studies devoted to fatal drowning with drugs are generally lacking (Kevrekidis et al, 2021), results obtained from epidemiological and experimental road traffic studies (Brunnauer et al, 2021; Hayley et al, 2016; Movig et al, 2004; Olesen et al, 2022; Simmons et al, 2022) could be cautiously applied to the interpretation of drowning cases.…”

Section: Requirements For Pm Toxicology Analysismentioning

confidence: 99%

Role of postmortem toxicology in drowning investigations

Ojanperä,

Kriikku

2023

WIREs Forensic Science

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Drowning is the third most common cause of unintentional injury death worldwide. In forensic medicine, drowning refers to an event in which the victim dies due to liquid penetrating into the airways or due to submersion in a liquid. Medico‐legal examination of bodies found in water is a challenging task. Establishing proper cause and manner of death requires the joint efforts of the police, medical examiner, and representatives of postmortem toxicology. Information of the circumstances, the victim's individual characteristics and medical background, together with postmortem findings is required. The presence of alcohol and drugs revealed by postmortem toxicology can give insight into the decedent's medical history, drug abuse history, and possible impairment at the time of death. There is ample epidemiological research indicating that alcohol is the most important single contributing factor for fatal drowning, while hypno‐sedative medicines and illicit drugs, especially amphetamines, also appear to pose a risk. Evidence shows that alcohol can be produced postmortem in a submerged body by microbial contamination and fermentation, and this phenomenon is even more significant the higher the water temperature and the longer the submersion time. The reliability of the blood alcohol concentration obtained can be verified in many ways, for example by comparing the ratios of blood, vitreous and urine alcohol concentrations with reference values, or by testing for non‐oxidative ethanol metabolites, the presence of which suggests antemortem alcohol ingestion. Compared to alcohol postmortem changes, very little is known about the long‐term stability of drugs in bodies found in water.This article is categorized under: Toxicology > Analytical Toxicology > Post‐Mortem

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Use of psychotropic medication and risk of road traffic crashes: a registry-based case–control study in Denmark, 1996–2018

Cited by 10 publications

References 27 publications

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

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

Medication and Road Test Performance Among Cognitively Healthy Older Adults

Role of postmortem toxicology in drowning investigations

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