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EPI 2670: Injury Epidemiology
Transportation Related Injuries
Thomas Songer, PhDUniversity of Pittsburgh
Types of Transportation
Top Ten Public Health Achievement
History of Crashes
0
5
10
15
20
25
USA Pennsylvania
Fatality Rate per 100 Million Vehicle Miles
Studying the Epidemiology of Injuries from Crashes
The Accident Triumvirate
• Environment
• Vehicle
• Driver
The Crash Sequence
• Pre-crash Period
• Crash Period
• Post-crash Period
The Haddon Matrixuse for planning, resource allocation, strategy identification
Human Vehicle Environment
Pre-event
Event
Post-event
How do we know what the impact of crashes are?
Surveillance:
Systematic, regular ascertainment of incidence using methods distinguished by their practicality, uniformity, and frequently their rapidity, rather than by complete accuracy.
Last, 1990
Definition of Crashes
• Police-reported crashes
• Fatal crashes
• Self-reported crashes
• Insurance-reported crashes
• Injury-producing crashes
• Property-damage producing crashes
Fatality Analysis Reporting System
Police Accident Reports State vehicle registration files State driver licensing files State Highway Department data Death certificates Coroner/Medical examiner reports Hospital medical records Emergency medical service reports
FARS
Fatality Analysis Reporting System
39,187 fatal motor vehicle crashes occurred in the United States in 2005, and 43,443 deaths occurred in these
crashes.
Fatal Crashes, 1975-2003
Persons Killed, United States, 1975-2003
38,000
39,000
40,000
41,000
42,000
43,000
44,000
91 92 93 94 95 96 97 98 99 0 1 2 3
Number % Speed % Alcohol Costs Related Related (millions)
1,562 16.1 32.9 $ 4,385
All figures are 1997
State of Pennsylvania Department of Transportation
Fatal Accidents in Pennsylvania
USA Crash Rates By Severity
6,279,000 total crashes
Fatal
Injury
PropertyDamage
per 100 million VMT
1.4
77
156
1999 FARS, GES
What are the descriptive factors related to crashes?
Human
Environmental
VehicularFailureDesignSpeed
AgeGenderExperience
AlcoholFatigue
Road Cond.TrafficWeather
0
1000
2000
3000
4000
5000
6000
Injury PropertyDamage
Driver Involvement Rates in Crashes by Gender and Crash Severity
1999 GES/FARS
per 100,000 licensed drivers
0
10
20
30
40
50
Fatal
Males Females
Crash Death Rates per 100,000 population by Age and Gender
0
10
20
30
40
50Males Females
1999 FARS
Motor Vehicle Crash Death Rates among Males by Country, 1980
0
10
20
30
40
50
60
70
0-4 15-24 35-44 55-64 75+
Rat
e pe
r 10
0,00
0 po
p.
USA France Japan GER UK
Age group
Percent of Drivers in Crashes with Alcohol Involvement by Age Group
0
5
10
15
20
25
30
35
40
16-20 21-24 25-34 35-44 45-54 55-64 65+
1999 GES/FARSAge (in years)
FatalInjury
Drivers Involved in Fatal Crashes by Previous Driving Record
Previous Crashes 14.8%Previous Suspensions 12.4%Previous DWI Convictions 3.4%Previous Speeding Convictions 21.0%Other Moving Violations 17.6%No Previous Convictions 57.3%
1999 FARS
Proportion of Vehicles Involved in Traffic Crashes
CarsOtherLarge TrucksBusLight TruckMotorcycle
1999 GES/FARS
Crash Rates by Type of Vehicle
0
5
10
15
20
25
Cars LightTrucks
LargeTrucks
Motor-cycles
1997 FARS
per 100 million vehicle miles traveled
Fatal Crashes
Crash Rates by Type of Vehicle
0
70
140
210
280
350
Cars LightTrucks
LargeTrucks
Motor-cycles
1997 GES
per 100 million vehicle miles traveled
Injury Property Damage
USA Crash Rates by Month
0
100
200
300
400
Total Property Damage Injury Severe/Fatal Injury
1999 GES/FARS
per 100 million vehicle miles traveled
Crash Rates by Road Type, 1997, Pennsylvania (per 100 million VMT)
0.45 0.39
1.51
2.4
0
1
2
3
Interstate Turnpike OtherState
Highway
LocalRoad
PennDOT
Crashes by Hour of Day, PA
0
2000
4000
6000
8000
10000
12000
6:00AM
9 12:00PM
3 6 9 12:00AM
3
Number
1997 PennDOT
Alcohol Involved Crashes by Time of Day
1999 GES,FARS
Number of Crashes
0
20,000
40,000
60,000
80,000
100,000
6-9 9-12 12-3 3-6 6-9 9-12 12-3 3-6
Morning Evening
Alcohol Related Crashes by Time of Day1999 GES,FARS
0
20
40
60
80
100
6-9 9-12 12-3 3-6 6-9 9-12 12-3 3-6
per
cen
t al
coh
ol r
elat
ed
Morning Evening
Property Damage Injury Fatal Injury
Crash Severity by Posted Speed Limit
1999 GES/FARS
Property Damage Injury Fatal Injury
0
5
10
15
20
25
30
35
40
15-30 35-40 45-50 55 60+
%
Research Issues
No Standard Definition of Crashes
• Police-reported crashes– under-reports non-fatal & less severe events
• Self-reported crashes– drivers with impairments may under-report
• Injury-producing crashes– does not include less severe events
• Property-damage producing crashes– under-reporting to insurance companies
Various sources suggest that about half the motor vehicle crashes in the
country are not reported to the police, the majority of these unreported
crashes involve only minor property damage and little personal injury.
General Underreporting of Accidents
Death Rates per 10,000 Vehicles Registered by Country
0 40 80 120 160 200
Australia
Indonesia
India
China
Ghana
Ethiopia
Bangladesh
Swaziland
Ecuador
Hong Kong
MMUCC
• Crash Date & Time
• Place
• Manner of Crash
• Weather Conditions
• Road Condition
• Vehicle Make
• VIN
Model Minimum Uniform Crash Criteria
• Total Occupants
• Seating Position
• Injury Status
• Seat Belt Use
• Alcohol Involvement
• Air bag Deployment
Important Data Elements
To measure benefits in terms of reducing death, disability, and medical costs, NHTSA determined that statewide data were needed that included all persons involved in police-
reported crashes --
those who were injured as well as those who were not injured.
CODES
Prevention of Injuries from Motor Vehicle Accidents
• Changes in Highway Design
• Changes in Vehicle Design
• Seat Belts
• Air Bags
• Speed Limits
• Changes in Licensing
Air Bags Work (except for a few)
- Up through December 1999, air bags have saved an estimated 4969 lives.
- In purely frontal crashes, air bags reduce car driver deaths by 26-32 percent.
- Since 1990, 175 deaths have been caused by airbags
