On a collision course: fatal motorcycle and bicycle accidents of adolescents in Finland from 2008 to 2019.

BACKGROUND: Transport injuries are a major cause of mortality among adolescents. Our aim was to evaluate the circumstances and trauma associated with fatal accidents involving adolescents and two-wheeled vehicles. METHODS: We analyzed retrospective data from the Finnish Crash Data Institute from 2008 to 2019 involving 10- to 24-year-old victims of fatal traffic accidents who were injured while riding a bicycle, moped or motorcycle. We collected data on patient characteristics, accident circumstances and possible treatment. These fatalities were compared with national mortality rates among the respective age groups. RESULTS: We identified 147 fatalities over the 12-year period involving 20 bicycle, 50 moped and 77 motorcycle riders. Most accidents involved males (n = 121, 82%). Less than half of vehicles were in good condition (46%); motorized vehicles were often illegally tuned (37%) or had tire problems (31%). Most of the accidents were collisions with another vehicle (n = 99, 67%) or other objects (n = 35, 24%). In 94% of cases, the Injury Severity Score was >25. Head injury was the most common cause of death (62%). Among 15-year-olds, every fifth death was due to accidents on two-wheeled vehicles. CONCLUSIONS: Fatal transport accidents among adolescents comprise several elements that should be incorporated into driver's education and in case of minors, also communicated to parents. These include the condition of the vehicle, proper helmet use and effects of speed on both control of the vehicle and the consequences of a possible collision.

Single-bicycle crashes in Finland - Characteristics and safety recommendations.

PROBLEM: Increasing the role of cycling is necessary to reduce physical inactivity. While promoting cycling, attention should also be given to traffic safety. Hence, a better understanding on the underlying factors and safety recommendations of cyclist crashes is needed. This study aims to increase knowledge on fatal single-bicycle crashes (SBCs), where other road users are not collided with. METHOD: Data from in-depth investigated fatal cyclist crashes in Finland is analyzed from 2010 to 2019. The study presents descriptive analysis of the characteristics, underlying factors, and safety recommendations of SBCs (n = 82) and other cyclist crashes (n = 151). Logistic regression analysis and chi-squared tests were performed to identify significant characteristics for SBCs. RESULTS: Fatal SBCs commonly involved people aged 60 or older, males, and cyclist not wearing a helmet. Cyclist's health issues influenced the crash in 62.2% of the SBCs. Compared to other cyclist crashes, health issues, alcohol, males, other crash locations than intersections, and weekends were highlighted in SBCs. Safety recommendations emphasized human factors, such as informing cyclist about underlying factors and the use of safety equipment. DISCUSSION: In addition to human factors, the safety recommendations included suggestions regarding the bicycle, the traffic environment, and traffic regulations. This highlights the need to focus on different safety improvement actions to reduce SBCs. This study identified key characteristics of SBCs, which may help traffic safety authorities address this road safety issue and ultimately help to promote cyclist safety. PRACTICAL APPLICATIONS: Cooperation between the actors including health care providers and the police is also proposed to address cyclists' health issues that contribute to SBCs.

Controlled register-based study of road traffic accidents in 12,651 Finnish cancer patients during 2013-2019.

BACKGROUND: Little controlled evidence exists on road traffic accident (RTA) risk among patients diagnosed with cancer, while clinicians are often requested to comment their ability to drive. The aim of this study was to evaluate RTA risk in a population-based cohort of cancer patients living in Southwest Finland. PATIENTS: All adult patients diagnosed with cancer in 2013-2019 were included. Acute appendectomy/cholecystectomy and actinic keratosis patients without cancer were selected from the same region as the control cohort. Participants were cross-referenced to a national driving licence database, yielding 12,651 cancer and 6334 control patients with a valid licence. Due to marked differences in their clinical presentation, the cancer cohort was divided into nine cancers of interest (breast, prostate, colorectal, lung, melanoma, head & neck, primary brain tumours, gynaecological and haematological malignancies). The nationwide law-regulated motor liability insurance registry was searched for all RTAs leading to injury with claims paid to not- or at-fault participants. At-fault drivers were verified based on sex and birth year. RESULTS: During a median follow-up of 34 months, 167 persons were at-fault drivers in RTAs leading to injury. Among the nine cancers of interest, RTA risk did not differ from the control cohort. Among cancer patients, multivariable regression suggested male sex and opioid use, but not advanced cancer stage or given systemic therapy, as the most influential risk factors for RTA. CONCLUSIONS: Cancer diagnosis itself was not associated with increased RTA risk, but other associated symptoms, medications, comorbidities or specific cancer subgroups may.

Crash risk of ESC-fitted passenger cars.

Objective: We examined both fatal and injury at-fault crashes of a population of passenger cars fitted with electronic stability control (ESC). Crash rates were calculated in relation to both registration years and mileage. Crash rates were also calculated for a non-ESC car population and crash rate ratios were calculated to compare the crash risk between ESC-fitted and non-ESC-fitted passenger cars. Methods: Passenger car models with and without ESC were identified (ESC-equipped cars: 3,352,813 registration years; non-ESC-equipped: 5,839,946 registration years) and their vehicle information for the period 2009-2013, including mileage (ESC-equipped vehicles: 89.3 billion kilometers; non-ESC-equipped: 72.4 billion kilometers), was drawn from the national Vehicular and Driver Data Register. The registry of Finnish road accident investigation teams was accessed and all fatal at-fault crashes among the cars in the study populations (ESC 97; non-ESC 377) for the period 2009-2013 were analyzed. The motor insurance database includes at-fault crashes leading to injuries and was utilized for analyses (ESC: N = 8,827, non-ESC: N = 21,437). Crash rates and crash rate ratios were calculated to evaluate crash risk of both ESC-equipped and non-ESC-equipped passenger cars. Poisson regression was used to model crash involvement rate ratios both per registration year and per mileage for vehicles with ESC and without ESC, controlling for age and gender of the vehicle owner and vehicle mass. Results: Passenger cars fitted with ESC showed lower crash rates than non-ESC-equipped cars in all crash types studied. In general, the difference in crash rates between ESC-equipped and non-ESC-equipped vehicles was greater when the crashes were compared to the mileage rather than registration years. The mileage-proportional crash rate of ESC-equipped cars was 64% (95% confidence interval, 61%; 67%) lower in run-off-road crashes resulting in injury and as much as 82% (65%; 91%) lower in fatal run-off-road crashes when suicides and disease attacks were not taken into account. Conclusions: Our results show that modern passenger cars provide a significant crash risk reduction, which depends on both ESC and passive safety features introduced. Results also show that exposure evaluation in terms of registration years (or vehicle population) instead of true mileage can provide an overly pessimistic view of the crash risk.

Drivers' psychiatric disorders and fatal motor vehicle accidents in Finland.

Relatively little is known about fatal motor vehicle accidents (FMVA) involving drivers with psychiatric disorders. In this study of all drivers killed in FMVAs in Finland between 1990 and 2011, we aimed to study drivers' death rate trends in FMVAs, with special focus on drivers with a history of psychiatric disorders. Prevalence of drivers' hospital treated psychiatric disorders, and characteristics of drivers with psychiatric disorders were also studied. For the purpose of this study, three national registers were accessed. Drivers' hospital treated psychiatric disorders were screened in a five-year period prior to death. Drivers with (n = 425) and without (n = 3856) psychiatric disorders were compared, female and male drivers separately. The main outcome measure was any psychiatric disorder in drivers within the five-year timescale. Socio-demographic factors, use of intoxicants and medication at the time of death, recent adverse life events, and drivers' physical and emotional states were used as covariates in the statistical analyses. During the study period, death rates increased for females with psychiatric disorders, and decreased for females without psychiatric disorders. Death rates for males with psychiatric disorders decreased between the years 1990-2000 and 2007-2011, and increased between the years 2000-2007. Death rates decreased over the whole study period in males without psychiatric disorders. Alcohol related disorders and affective disorders were the most prevalent hospital treated psychiatric disorders among drivers involved in FMVAs. Use of medications at the time of death, and committing suicide in traffic both associated with being a driver with psychiatric disorders involved in FMVAs for both genders. As FMVAs involving drivers with psychiatric disorders have increased, a more focused and detailed evaluation of the driving performance of drivers with psychiatric disorders is recommended. These evaluations should also be extended to drivers with non-psychotic disorders.