Monárrez-Espino Joel, Laflamme Lucie, Elling Berty, Möller Jette
Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden.
Inj Prev. 2014 Apr;20(2):81-7. doi: 10.1136/injuryprev-2013-040762. Epub 2013 Jul 19.
This study investigated the relationship between the number of different medications dispensed (NDMD) to senior drivers and the risk of injurious road traffic crashes (RTCs).
A matched case-control study with data from various population-based national registers was conducted. Cases were drivers aged 50-80 years involved in a crash in Sweden between 2005 and 2009. Only the first non-alcohol-related RTC was studied. Controls were residents with a valid license who did not crash. Four controls were matched by sex, age (year and month of birth), and place of residence. Exposure to NDMD prior to the crash date was assessed using four time periods: 1-8, 1-15, 1-30 and 1-90 days. Conditional logistic regression was used and analyses adjusted for civil status, occupation and dispensation of medications affecting the cardiovascular or nervous systems (C/N).
ORs (95% CI) increased progressively with the NDMD. For 1-8 days the OR ranged from 1.15 (1.10 to 1.20) for 1-2 medications to 1.27 (1.13 to 1.42) for five or more medications. The magnitude of the effect declined gradually with longer exposure periods, but remained when five or more medications were used. Adjusting for C/N medications resulted in slightly higher effects; for 1-8 days it ranged from 1.16 (1.10 to 1.23) for 1-2 medications to 1.35 (1.17 to 1.56) for five or more, with similar trends by exposure period. The highest effects were seen for single crashes and for drivers aged 66-80 years.
The NDMD was linked to the likelihood of a senior driver being involved in an injurious RTC. The strength of the association steadily increased with increased NDMD, especially when medications were taken closer to the index date, or when more than five medications were dispensed.
本研究调查了向老年驾驶员配发的不同药物数量（NDMD）与道路交通事故（RTC）致伤风险之间的关系。
利用来自多个基于人群的国家登记处的数据进行了一项匹配病例对照研究。病例为2005年至2009年期间在瑞典发生车祸的50 - 80岁驾驶员。仅研究首次非酒精相关的RTC。对照为持有有效驾照且未发生车祸的居民。根据性别、年龄（出生年份和月份）及居住地点匹配了四名对照。在事故发生日期之前使用四个时间段评估NDMD暴露情况：1 - 8天、1 - 15天、1 - 30天和1 - 90天。使用条件逻辑回归，并针对婚姻状况、职业以及影响心血管或神经系统（C/N）的药物配给情况进行分析调整。
OR值（95%可信区间）随NDMD逐渐增加。对于1 - 8天，1 - 2种药物的OR值范围为1.15（1.10至1.20），五种或更多药物的OR值为1.27（1.13至1.42）。随着暴露时间延长，效应大小逐渐下降，但在使用五种或更多药物时仍存在。对C/N药物进行调整导致效应略高；对于1 - 8天，1 - 2种药物的OR值范围为1.16（1.10至1.23），五种或更多药物的OR值为1.35（1.17至1.56），不同暴露时间段有类似趋势。单次车祸以及66 - 80岁驾驶员的效应最高。
NDMD与老年驾驶员发生致伤性RTC的可能性相关。随着NDMD增加，关联强度稳步上升，尤其是在更接近索引日期服药时，或配发五种以上药物时。
