纤维肌痛与后续机动车碰撞事故风险

Fibromyalgia and the Risk of a Subsequent Motor Vehicle Crash.

作者信息

Redelmeier Donald A, Zung Jeremy D, Thiruchelvam Deva, Tibshirani Robert J

机构信息

From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA.D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University.

出版信息

J Rheumatol. 2015 Aug;42(8):1502-10. doi: 10.3899/jrheum.141315. Epub 2015 May 15.

DOI:10.3899/jrheum.141315

PMID:25979716

Abstract

OBJECTIVE

Motor vehicle crashes are a widespread contributor to mortality and morbidity, sometimes related to medically unfit motorists. We tested whether patients diagnosed with fibromyalgia (FM) have an increased risk of a subsequent serious motor vehicle crash.

METHODS

We conducted a population-based self-matched longitudinal cohort analysis to estimate the incidence rate ratio of crashes among patients diagnosed with FM relative to the population norm in Ontario, Canada. We included adults diagnosed from April 1, 2006, to March 31, 2012, excluding individuals younger than 18 years, living outside Ontario, lacking valid identifiers, or having only a single visit for the diagnosis. The primary outcome was an emergency department visit as a driver involved in a motor vehicle crash.

RESULTS

The patients (n = 137,631) accounted for 738 crashes during the first year of followup after diagnosis, equal to an incidence rate ratio of 2.44 compared with the population norm (95% CI 2.27-2.63, p < 0.001). The crash rate was more than twice the population norm for those with a new or a persistent diagnosis. The increased risk included patients with diverse characteristics, approached the rate observed among other patients diagnosed with alcoholism, and was mitigated among those who received dedicated FM care or a physician warning for driving safety.

CONCLUSION

A diagnosis of FM is associated with an increased risk of a subsequent motor vehicle crash that might justify medical interventions for traffic safety.

摘要

目的

机动车碰撞事故是导致死亡和发病的一个普遍因素，有时与身体状况不适合驾车的驾驶者有关。我们测试了被诊断为纤维肌痛（FM）的患者随后发生严重机动车碰撞事故的风险是否增加。

方法

我们进行了一项基于人群的自我匹配纵向队列分析，以估计加拿大安大略省被诊断为FM的患者与人群标准相比的碰撞事故发病率比。我们纳入了2006年4月1日至2012年3月31日期间被诊断的成年人，排除了年龄小于18岁、居住在安大略省外、缺乏有效标识符或仅因诊断就诊一次的个体。主要结局是作为机动车碰撞事故驾驶员前往急诊科就诊。

结果

患者（n = 137,631）在诊断后的第一年随访期间发生了738起碰撞事故，与人群标准相比，发病率比为2.44（95%CI 2.27 - 2.63，p < 0.001）。对于新诊断或持续诊断的患者，碰撞率是人群标准的两倍多。增加的风险包括具有不同特征的患者，接近在其他被诊断为酒精中毒的患者中观察到的比率，并且在接受专门的FM护理或医生关于驾驶安全警告的患者中有所减轻。