Risk of Culpable Traffic Accident by Frailty in Drivers with Advanced Age

초록

Background: Although older drivers has been increasing, medical screening of older drivers is not evidence based. Objectives: This study was conducted to evaluate the influence of the frailty measured from claims data on the risk of culpable traffic accident. Methods: Setting: We extracted the data of drivers who died of motor vehicle crashes (MVCs) during 2010–2014 from the Korean Traffic Accident Analysis System and linked it to the Korean National Health Insurance database. Main outcome measures: We calculated the responsibility score of an accident to quantify the driver's culpability using the responsibility analysis method, which will categorize drivers into culpable drivers (responsibility score < 12) or non-culpable driver (responsibility score ≧ 12). Exposures: Frailty score using ICD-10 codes was calculated to categorize driver's frailty into low risk (frailty score < 5), intermediate risk (frailty score 5 to 15), and high risk (frailty score ≧ 15). Statistical analysis: Logistic regression analysis was used to evaluate the influence of frailty on the culpability of drivers, adjusting for age, sex and medications which were known to be related to traffic accidents. Results: We found 8,881 deaths during the study period, among whom 8,828 were successfully linked to the national insurance data. Among them, 2,081 drivers were categorized into the culpable group and 6,747 into non-culpable group. The mean age of the participants was 48.9 (±17.7), and 8,169 (92.5%) were males. Culpable drivers had more frequent prescription of hypnotics, narcotics, muscle relaxants, and antispasmodics 1 year prior to the traffic accidents. When adjusted for demographic factors and medications, high frailty (odds ratio 1.224: 95% confidence interval 1.030–1.454) was significantly related to the culpable crashes. Interestingly, age older than 65 was protective against culpable accidents (0.995: 0.992–0.998). Conclusions: High frailty score measured using claims data was associated to the culpable traffic accident which could be attributed to the fault of driver. Methods to screen drivers with advanced age using frailty score will help preventing traffic accident related to aging of drivers.