Karolinska Institutet, Department of Global Public Health, Solnavägen 1E, SE-11365 Stockholm, Sweden; Swedish Transport Agency, Department of Road and Rail, Isafjordsgatan 1, SE-16440 Kista, Sweden.
The Swedish National Road and Transport Research Institute (VTI), Olaus Magnus väg 37, SE-58195 Linköping, Sweden.
Accid Anal Prev. 2021 Dec;163:106434. doi: 10.1016/j.aap.2021.106434. Epub 2021 Oct 23.
Several medical conditions are known to impair sensory, cognitive and motor functions and are associated with road traffic crashes (RTC). For the drivers of today, we lack updated knowledge on how driving-impairing conditions are associated with RTCs, across all driving-impairing conditions in a given population. We aim to determine this among older drivers in Sweden.
A national, population register-based, matched case-control study comparing acknowledged driving-impairing health conditions among all older drivers (65 years or older) involved in an injurious RTC in the period 2011-2016 (n = 13,701) with those of controls: older drivers not involved in any RTC (n = 26,525) matched to the cases by age, sex and residential area. The medical conditions, extracted from the National Patient Register from 1997 up until date of RTC, were identified based on ICD-10 diagnosis codes and categorized into the 13 groups of medical conditions listed in the Swedish driver's license regulations. Conditional logistic regression was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals.
Unadjusted ORs for RTC were increased for all conditions. After taking the other 12 medical conditions into account, the ORs remained significant in 11 out of the 13. A strong association was found for the group "ADHD and autism spectrum disorders" (OR 2.79, CI 1.47-5.30), although with very low prevalence among cases (0.2%). Moderate associations were found for three conditions with a case prevalence between 1.3% and 8.5%: epilepsy and seizure disorders (OR 1.53, CI 1.25-1.89), substance abuse and dependence (OR 1.45, CI 1.29-1.63), psychological diseases and mental disorders (OR 1.28, CI 1.18-1.39) and for one condition with a case prevalence of 14.7%, diabetes (OR 1.28, CI 1.20-1.36).
In Sweden, in the current generation of older drivers, acknowledged driving-impairing medical conditions at the national and European levels remain a concern. After adjustment for one another, all but 2 of the conditions are associated with RTCs albeit to varying degrees and more pronounced in the age group 65-79 compared to 80 or older. To promote and sustain older people's mobility, addressing this issue will require a blend of interventions where, hopefully, technological and infrastructural innovations may help counteracting individual health-related shortcomings.
已知多种医学病症会损害感觉、认知和运动功能，并与道路交通事故（RTC）有关。对于当今的驾驶员，我们缺乏关于在特定人群中，所有导致驾驶能力下降的病症如何与 RTC 相关的最新知识。我们旨在在瑞典的老年驾驶员中确定这一点。
这是一项全国性的、基于人群登记的、匹配病例对照研究，比较了 2011 年至 2016 年期间参与伤害性 RTC 的所有老年驾驶员（65 岁或以上）（n=13701）和对照组中公认的驾驶能力下降健康状况：未参与任何 RTC 的老年驾驶员（n=26525）按年龄、性别和居住地区与病例相匹配。从 1997 年到 RTC 发生日期，从国家患者登记处提取的医疗条件是根据 ICD-10 诊断代码确定的，并分为瑞典驾照法规中列出的 13 组医疗条件。使用条件逻辑回归来估计未经调整和调整后的优势比（OR），置信区间为 95%。
未经调整的 RTC 比值比（OR）在所有情况下均增加。在考虑了其他 12 种医疗条件后，13 种中的 11 种 OR 仍然显著。在“ADHD 和自闭症谱系障碍”组中发现了很强的相关性（OR 2.79，CI 1.47-5.30），尽管病例中的患病率非常低（0.2%）。在三种患病率在 1.3%至 8.5%之间的病症中发现了中度相关性：癫痫和癫痫发作障碍（OR 1.53，CI 1.25-1.89）、物质滥用和依赖（OR 1.45，CI 1.29-1.63）、心理疾病和精神障碍（OR 1.28，CI 1.18-1.39）以及患病率为 14.7%的一种病症：糖尿病（OR 1.28，CI 1.20-1.36）。
在瑞典，在当前一代的老年驾驶员中，国家和欧洲层面公认的导致驾驶能力下降的医疗条件仍然令人担忧。在相互调整后，所有条件（除 2 种外）均与 RTC 相关，尽管程度不同，并且在 65-79 岁年龄组中比 80 岁或以上年龄组更为明显。为了促进和维持老年人的流动性，解决这个问题需要综合干预措施，希望技术和基础设施创新可以帮助克服个人健康相关的缺陷。
