The driver's role in fatal two-car crashes: a paired "case-control" study.

This population-based study examines drivers' characteristics associated with driving errors that resulted in fatal motor vehicle crashes. Routinely collected data from the Fatal Accident Reporting System were used to assess whether a driver initiated the crash (case) or was passively involved (control) in 6,506 two-car collisions (81% of 7,993 eligible events). A paired comparison of cases and controls avoided confounding by environmental factors, exposure to traffic, and differences in case fatality. The strongest predictor of crash initiation is alcohol (odds ratio (OR) = 11.5; 95% confidence interval (CI) 9.57-13.9). Odds ratios are elevated even at the lowest blood alcohol concentration levels and increase dramatically as alcohol levels rise. Drivers aged 40-49 years are least likely to initiate crashes; odds ratios rise in a U-shaped manner to 3.35 in teenagers (95% CI 2.72-4.13) and to 22.1 in drivers over 80 years (95% CI 14.2-34.5). Other risk factors for initiating a fatal crash are the following: not wearing a seat belt (OR = 1.54; 95% CI 1.35-1.75), driving without a valid driver's license (OR = 2.16; 95% CI 1.72-2.73), and having had a crash within the last year (OR = 1.21; 95% CI 1.07-1.38). Driving errors leading to fatal crashes do not occur at random, but are associated with specific driver characteristics. The risk factors for crash initiation among crash-involved drivers are similar to risk factors for crash involvement found in other studies. These findings suggest that driving errors often explain high rates of crash involvement, invite further use of crash initiation in traffic injury research, and underscore the value of population-based registries for analytic epidemiology.