Research Article: Prescription medicine use by pedestrians and the risk of injurious road traffic crashes: A case-crossover study

Date Published: July 18, 2017

Publisher: Public Library of Science

Author(s): Mélanie Née, Marta Avalos, Audrey Luxcey, Benjamin Contrand, Louis-Rachid Salmi, Annie Fourrier-Réglat, Blandine Gadegbeku, Emmanuel Lagarde, Ludivine Orriols, Donald A. Redelmeier

Abstract: BackgroundWhile some medicinal drugs have been found to affect driving ability, no study has investigated whether a relationship exists between these medicines and crashes involving pedestrians. The aim of this study was to explore the association between the use of medicinal drugs and the risk of being involved in a road traffic crash as a pedestrian.Methods and findingsData from 3 French nationwide databases were matched. We used the case-crossover design to control for time-invariant factors by using each case as its own control. To perform multivariable analysis and limit false-positive results, we implemented a bootstrap version of Lasso. To avoid the effect of unmeasured time-varying factors, we varied the length of the washout period from 30 to 119 days before the crash. The matching procedure led to the inclusion of 16,458 pedestrians involved in an injurious road traffic crash from 1 July 2005 to 31 December 2011. We found 48 medicine classes with a positive association with the risk of crash, with median odds ratios ranging from 1.12 to 2.98. Among these, benzodiazepines and benzodiazepine-related drugs, antihistamines, and anti-inflammatory and antirheumatic drugs were among the 10 medicines most consumed by the 16,458 pedestrians. Study limitations included slight overrepresentation of pedestrians injured in more severe crashes, lack of information about self-medication and the use of over-the-counter drugs, and lack of data on amount of walking.ConclusionsTherapeutic classes already identified as impacting the ability to drive, such as benzodiazepines and antihistamines, are also associated with an increased risk of pedestrians being involved in a road traffic crash. This study on pedestrians highlights the necessity of improving awareness of the effect of these medicines on this category of road user.

Partial Text: Walking is rightly being promoted for its benefits for physical and mental health and for the environment. This comes, however, with a caveat: pedestrians are among the most vulnerable road users [1]. The World Health Organization’s 2013 global status report on road traffic safety revealed that pedestrians account for 22% of the world’s road traffic deaths [2].

We extracted and matched data from 3 French nationwide databases: the national healthcare insurance database, police reports, and the police national database of injurious crashes. Drivers were included by means of their national healthcare ID number, extracted from police reports by an automatic procedure. This national ID number was used to link pedestrians to medicine reimbursement data around the crash date. Police reports were matched to records in the injurious crashes database by a probabilistic linkage method [24].

National ID number, sex, and date of birth of individuals involved in a traffic crash were extracted for 215,032 of the 439,518 police reports of traffic crashes from 1 July 2005 to 31 December 2011. Among these, 186,636 (86.8%) were matched with a corresponding record in the police national database of injurious crashes. The linkage failed for national ID numbers corresponding to road users involved in a crash but not captured in the police national injurious crashes database and for individuals not involved in the crash (e.g., witnesses).

The analysis of 16,458 pedestrians involved in a road crash between 1 July 2005 and 31 December 2011, among which 6,584 were included in the analyses, identified 48 medicine classes associated with an increased risk for pedestrians of being involved in an injurious road traffic crash. Among them, the 10 most consumed medicines included benzodiazepines and benzodiazepine-related drugs, antihistamines, and anti-inflammatory and antirheumatic drugs.

Source:

http://doi.org/10.1371/journal.pmed.1002347

 

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