Division of General Internal Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
Centre for Clinical Epidemiology & Evaluation, Vancouver, British Columbia, Canada.
BMJ Open. 2024 Jul 30;14(7):e080609. doi: 10.1136/bmjopen-2023-080609.
To examine the relationship between schizophrenia, antipsychotic medication adherence and driver responsibility for motor vehicle crash.
Retrospective observational cohort study using 20 years of population-based administrative health and driving data.
British Columbia, Canada.
Licensed drivers who were involved in a police-attended motor vehicle crash in British Columbia over a 17-year study interval (2000-16).
Incident schizophrenia was identified using hospitalisation and physician services data. Antipsychotic adherence was estimated using prescription fill data to calculate the 'medication possession ratio' (MPR) in the 30 days prior to crash.
We deemed drivers 'responsible' or 'non-responsible' for their crash by applying a validated scoring tool to police-reported crash data. We used logistic regression to evaluate the association between crash responsibility and exposures of interest.
Our cohort included 808 432 drivers involved in a police-attended crash and for whom crash responsibility could be established. In total, 1689 of the 2551 drivers with schizophrenia and 432 430 of the 805 881 drivers without schizophrenia were deemed responsible for their crash, corresponding to a significant association between schizophrenia and crash responsibility (66.2% vs 53.7%; adjusted OR (aOR), 1.67; 95% CI, 1.53 to 1.82; p<0.001). The magnitude of this association was modest relative to established crash risk factors (eg, learner license, age ≥65 years, impairment at time of crash). Among the 1833 drivers with schizophrenia, near-optimal antipsychotic adherence (MPR ≥0.8) in the 30 days prior to crash was not associated with lower crash responsibility (aOR, 1.04; 95% CI, 0.83 to 1.30; p=0.55).
Crash-involved drivers with schizophrenia are more likely to be responsible for their crash, but the magnitude of risk is similar to socially acceptable risk factors such as older age or possession of a learner license. Contemporary driving restrictions for individuals with schizophrenia appear to adequately mitigate road risks, suggesting more stringent driving restrictions are not warranted.
研究精神分裂症、抗精神病药物依从性与机动车事故驾驶员责任之间的关系。
使用基于人群的行政健康和驾驶数据进行回顾性观察队列研究，时间跨度为 20 年。
加拿大不列颠哥伦比亚省。
在不列颠哥伦比亚省参与警方处理的机动车事故的有照驾驶员，研究期间为 17 年（2000-16 年）。
通过住院和医生服务数据确定精神分裂症的发病情况。使用处方填写数据来估计抗精神病药物的依从性，以计算事故发生前 30 天的“药物占有比”（MPR）。
我们通过应用经过验证的评分工具来评估警察报告的事故数据，将驾驶员认定为“有责任”或“无责任”。我们使用逻辑回归来评估事故责任与感兴趣的暴露因素之间的关系。
我们的队列包括 808432 名参与警方处理的事故的驾驶员，其中 2551 名患有精神分裂症的驾驶员中有 1689 名和 805881 名未患精神分裂症的驾驶员中有 432430 名被认定为对事故负有责任，这表明精神分裂症与事故责任之间存在显著关联（66.2%对 53.7%；调整后的比值比（aOR），1.67；95%CI，1.53 至 1.82；p<0.001）。与已确立的事故风险因素（例如，学习驾照、年龄≥65 岁、事故发生时的损伤）相比，这种关联的程度相对较小。在 1833 名患有精神分裂症的驾驶员中，事故发生前 30 天近乎最佳的抗精神病药物依从性（MPR≥0.8）与较低的事故责任无关（aOR，1.04；95%CI，0.83 至 1.30；p=0.55）。
参与机动车事故的精神分裂症患者更有可能对其事故负责，但风险程度与年龄较大或持有学习驾照等社会可接受的风险因素相似。对精神分裂症患者的现行驾驶限制似乎足以减轻道路风险，表明不需要更严格的驾驶限制。
