Estimating seat belt effectiveness using matched-pair cohort methods

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Accident Analysis & Prevention (Impact Factor: 1.87). 02/2003; 35(1):143-9. DOI: 10.1016/S0001-4575(01)00087-2
Source: PubMed


Using US data for 1986-1998 fatal crashes, we employed matched-pair analysis methods to estimate that the relative risk of death among belted compared with unbelted occupants was 0.39 (95% confidence interval (CI) 0.37-0.41). This differs from relative risk estimates of about 0.55 in studies that used crash data collected prior to 1986. Using 1975-1998 data, we examined and rejected three theories that might explain the difference between our estimate and older estimates: (1) differences in the analysis methods; (2) changes related to car model year; (3) changes in crash characteristics over time. A fourth theory, that the introduction of seat belt laws would induce some survivors to claim belt use when they were not restrained, could explain part of the difference in our estimate and older estimates; but even in states without seat belt laws, from 1986 through 1998, the relative risk estimate was 0.45 (95% CI 0.39-0.52). All of the difference between our estimate and older estimates could be explained by some misclassification of seat belt use. Relative risk estimates would move away from 1, toward their true value, if misclassification of both the belted and unbelted decreased over time, or if the degree of misclassification remained constant, as the prevalence of belt use increased. We conclude that estimates of seat belt effects based upon data prior to 1986 may be biased toward 1 by misclassification.

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    • "Seatbelts protect drivers and passengers by holding people in the vehicle during a crash including rollovers and reducing the likelihood of people to hit the hard surfaces in the vehicle (Evans, 1990). Experimental and empirical research examining the effectiveness of seat belt use on fatalities reveals that seat belts are important driving devices which save lives and reduce the risk of fatal injury to drivers and passengers (Evans, 1991Evans, , 1996Cohen & Einav, 2003;Cummings et al., 2003). For example, in a study,Evans (1986)found that seatbelts are overall 41% effecting in preventing fatalities for drivers and right front passengers. "

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    • "In some cases, pairs can share characteristics that are unmeasurable (e.g. Cummings et al., 2003b; Martin and Lenguerrand, 2008; Viano et al., 2008), and a more classic example of this would be twin studies. Similarly to the latter, this study in fact constructs a dataset with observations of inherently matched pairs, because each pair of drivers originates from the same accident and experienced the same weather, the same crash location, the same road geometry, etc. "
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    ABSTRACT: This study seeks to inspect the nonparametric characteristics connecting the age of the driver to the relative risk of being an at-fault vehicle, in order to discover a more precise and smooth pattern of age impact, which has commonly been neglected in past studies. Records of drivers in two-vehicle rear-end collisions are selected from the general estimates system (GES) 2011 dataset. These extracted observations in fact constitute inherently matched driver pairs under certain matching variables including weather conditions, pavement conditions and road geometry design characteristics that are shared by pairs of drivers in rear-end accidents. The introduced data structure is able to guarantee that the variance of the response variable will not depend on the matching variables and hence provides a high power of statistical modeling. The estimation results exhibit a smooth cubic spline function for examining the nonlinear relationship between the age of the driver and the log odds of being at fault in a rear-end accident. The results are presented with respect to the main effect of age, the interaction effect between age and sex, and the effects of age under different scenarios of pre-crash actions by the leading vehicle. Compared to the conventional specification in which age is categorized into several predefined groups, the proposed method is more flexible and able to produce quantitatively explicit results. First, it confirms the U-shaped pattern of the age effect, and further shows that the risks of young and old drivers change rapidly with age. Second, the interaction effects between age and sex show that female and male drivers behave differently in rear-end accidents. Third, it is found that the pattern of age impact varies according to the type of pre-crash actions exhibited by the leading vehicle.
    Full-text · Article · Jun 2014 · Accident; analysis and prevention
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    • "By understanding pediatric head and neck biological and mechanical properties, better safety measures can be developed to reduce pediatric injury. The use of passenger restraint systems has been shown to significantly decrease the risk of injury and death to all motor vehicle occupants (Cummings et al. 2003;Houston et al. 1996;McGwin et al. 2003;NHTSA 2007b), including children (Elliott et al. 2006;Halman et al. 2002;Javouhey et al. 2006;NHTSA 2007a;Valent et al. 2002). Engineering advancements to motor vehicle restraint systems and passenger compartments provide a direct means to further reduce pediatric MVC injuries. "
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    ABSTRACT: Objective: During dynamic injury scenarios, such as motor vehicle crashes, neck biomechanics contribute to head excursion and acceleration, influencing head injuries. One important tool in understanding head and neck dynamics is computational modeling. However, realistic and stable muscle activations for major muscles are required to realize meaningful kinematic responses. The objective was to determine cervical muscle activation states for 6-year-old, 10-year-old, and adult 50th percentile male computational head and neck models. Currently, pediatric models including muscle activations are unable to maintain the head in an equilibrium position, forcing models to begin from nonphysiologic conditions. Recent work has realized a stationary initial geometry and cervical muscle activations by first optimizing responses against gravity. Accordingly, our goal was to apply these methods to Duke University's head-neck model validated using living muscle response and pediatric cadaveric data. Methods: Activation schemes maintaining an upright, stable head for 22 muscle pairs were found using LS-OPT. Two optimization problems were investigated: a relaxed state, which minimized muscle fatigue, and a tensed activation state, which maximized total muscle force. The model's biofidelity was evaluated by the kinematic response to gravitational and frontal impact loading conditions. Model sensitivity and uncertainty analyses were performed to assess important parameters for pediatric muscle response. Sensitivity analysis was conducted using multiple activation time histories. These included constant activations and an optimal muscle activation time history, which varied the activation level of flexor and extensor groups, and activation initiation and termination times. Results: Relaxed muscle activations decreased with increasing age, maintaining upright posture primarily through extensor activation. Tensed musculature maintained upright posture through coactivation of flexors and extensors, producing up to 32 times the force of the relaxed state. Without muscle activation, the models fell into flexion due to gravitational loading. Relaxed musculature produced 28.6-35.8 N of force to the head, whereas tensed musculature produced 450-1023 N. Pediatric model stiffnesses were most sensitive to muscle physiological cross-sectional area. Conclusions: Though muscular loads were not large enough to cause vertebral compressive failure, they would provide a prestressed state that could protect the vertebrae during tensile loading but might exacerbate risk during compressive loading. For example, in the 10-year-old, a load of 602 N was produced, though estimated compressive failure tolerance is only 2.8 kN. Including muscles and time-variant activation schemes is vital for producing biofidelic models because both vary by age. The pediatric activations developed represent physiologically appropriate sets of initial conditions and are based on validated adult cadaveric data.
    Preview · Article · Nov 2013 · Traffic Injury Prevention
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