The development and application of a proxy measure of alcohol-related traffic crashes for rural communities.

CONTEXT: To date, no studies have adequately examined whether community-level, rather than individual-level, characteristics, are associated with high rates of alcohol-related traffic crashes (ARTC). OBJECTIVE: This study aims to identify a proxy measure of ARTC most appropriate to rural communities in New South Wales (NSW), Australia, and to identify community characteristics that predict higher rates of ARTC. METHODS: ARTC (2001-2007) incident data from 20 rural communities in NSW were obtained. Cost data were applied to take account of ARTCs of different severity. RESULTS: The method used to define a proxy measure of ARTCs for NSW generally was found to be inadequate when applied to local communities within NSW: specifically, two time periods were found to be alcohol-related for local communities only and seven time periods were found to be non-alcohol-related for local communities only. Applying a community-specific proxy measure of ARTCs to 20 communities identified substantial variation in ARTC cost-ratios, ranging from 1.20 to 0.15. Higher cost-ratios were statistically significantly predicted by the proportion of residents who were male and less than 25 years. CONCLUSIONS: Proxy measures of ARTCs represent an ideal method of utilising routinely collected data to identify specific types of ARTCs that are most relevant to a defined community, identify community-specific factors associated with higher rates of ARTCs and measure the impact of interventions tailored to those risk factors. Such measures ought to be community-specific because these results suggest national or provincial-level definitions are not necessarily directly applicable to local communities. These results show substantial variability between communities in their rates of ARTC and identify communities with higher proportions of young males as being at increased risk.

Comparing the cost of alcohol-related traffic crashes in rural and urban environments.

CONTEXT: Existing studies have identified that, although to a lesser extent than individual factors such as males and young people, rural (compared to urban) communities represent a disproportionately high-risk of alcohol-related traffic crashes (ARTCs). To date, however, few studies have attempted to apply different costs to alcohol crashes of different severity, to provide more precise, and practically useful, data on which to base public health policy and intervention decisions. OBJECTIVE: The aim of this study is to quantify the per capita prevalence and differential costs of alcohol crashes of different levels of severity to determine the extent to which urban and rural geographical areas may differ in the costs attributable to ARTCs. DESIGN: A cross-sectional analysis of alcohol-related traffic crash and costs data from 2001 to 2007. SETTING AND PARTICIPANTS: Data from New South Wales, Australia. MAIN OUTCOME MEASURES: Modified routinely collected traffic accident data to which costs relevant to alcohol crashes of different severity are applied. RESULTS: Although the rate per 10,000 population of alcohol-related crashes is 1.5 times higher in rural, relative to urban, communities, the attributable cost is four times higher, which largely reflects that rural alcohol-fatalities are seven to eight times more prevalent and costly. CONCLUSIONS: Given that per capita alcohol-related fatal crashes in rural areas account for a disproportionately large proportion of the harms and costs associated with alcohol-related traffic crashes, the cost-effectiveness of public health interventions and public policy initiatives should consider the relative extent of ARTC-harm in rural versus urban communities.