PUBLIC HEALTH BRIEFS TABLE 3-Driver Manual Belt Use In Cars with Air Bags and In Cars with Manual Befts Only, by Make/Series
TABLE 4-Driver Manual Solt Use in Cars with Air Bags and in Cars with Manual Belts Only, by Model Year
Percent (N) Using Belts
Percent (N) Using Belts
Make/Series
Air Bag Cars
Manual Belt Cars
BMW 5,6,7 Series; M6 Chrysler LeBaron Sedan, Convertible Chrysler LeBaron Coupe Dodge Daytona Ford Tempo Lincoln Continental Acura Legend Volvo 740, 760
76 (96)
75 (88)
53 (103) 60 (57) 47 (66) 57 (46) 68 (90) 73 (166) 82 (133)
50 (142) 48 (31) 41 (39) 59 (282) 66 (77) 71 (348) 81 (325)
present, driver belt use was eight percentage points higher than passenger belt use in cars with driver side air bags and five percentage points higher in cars with manual belts only. If air bags reduced belt use, driver belt use in these air bag equipped cars would have been much lower relative to passenger use. Manual belt use rates were higher than average in this survey because the observations were restricted to late model cars and were concentrated in affluent areas in states with laws requiring belt use. All of these factors elevate seat belt use.3,4 Most of the nation's population (89 percent) is now covered by belt use laws; belt use rates in cars with and without air bags would be expected to be lower in the 14 remaining states without laws. Nevertheless, many drivers and right front
Model Year 1986 1987 1988 1989 1990
Air Bag Cars
Manual Belt Cars
63 (185) 65 (319) 67 (434) 66 (630) 67 (60)
63 (9781) 63(9696) 62 (8673) 64 (5994) 66 (79)
passengers observed were not using seat belts even though required by law to do so. An important goal is to increase seat belt use both in cars with and without air bags. ACKNOWLEDGMENTS This work was supported by the Insurance Institute for Highway Safety. The assistance of Michael A. Ciccone is gratefully acknowledged.
REFERENCES 1. US Dept of Transportation: Evaluation Plan; Federal Motor Vehicle Safety Standards; Passenger Car Front Seat Occupant Protection. Federal Register 1990; 55:1586-1591. 2. Williams AF, Wells JD, Lund AK, Teed N: Observed use of automatic seat belts in 1987 cars. Accident Anal Prev 1989; 21:427-433. 3. National Highway Traffic Safety Administration: Restraint System Usage in the Traffic Population, 1988 Annual Report. (DOT HS 807 447). Washington, DC: US Department of Transportation, 1989. 4. Lund AK: Voluntary seat belt use among US drivers: Geographic, socioeconomic and demographic variation. Accident Anal Prev 1986; 18:43-50.
Age, Sex, and Road-Use Patterns of Motor Vehicular Trauma in Rhode Island: A Population-Based Hospital Emergency Department Study IAN R.H. ROCKETT, PHD, MPH, ELLICE S. LIEBERMAN, MD, DRPH, WILLIAM H. HOLLINSHEAD, MD, MPH, SANDRA L. PUTNAM, PHD, AND HENRY C. THODE, PHD Abstract: Population-based hospital emergency department data on motor vehicle traffic trauma in Rhode Island, 1984-85, are analyzed by age, sex, and road-use status. Annualized rates of overall and severe trauma were 1,195 cases (95% confidence interval [CI] = 1,164, 1,225) and 102 cases (95% CI = 94, 111) per 100,000 population, respectively. Overall and severe rates peaked at ages 15-24 years. Male rate excesses were most pronounced for motorcycle and pedal cycle trauma. (Am J Public Health 1990; 80:15161518.)
From the Department of Health, Leisure, and Safety, and the Health Services Research Center, University ofTennessee, Knoxville; Department of Maternal and Child Health, Harvard School of Public Health, and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston; Division of Family Health, Rhode Island Department of Health; and the Injury Prevention and Analysis Group, Brookhaven National Laboratory. Address reprint requests to Ian R.H. Rockett, PhD, MPH, Department of Health, Leisure, and Safety, University of Tennessee, 1914 Andy Holt Avenue, Knoxville, TN 37996-2700. This paper, submitted to the Journal October 13, 1989, was revised and accepted for publication May 17, 1990.
© 1990 American Journal of Public Health 0090-0036/90$1.50
1516
Introduction Population-based data on nonfatal motor vehicular trauma are not collected routinely. In population-based studies, case selection has typically been restricted in terms of injury diagnoses, road-use status, and age ofpopulation. '-5 An exception is the Northeastern Ohio Trauma Study, in which a comprehensive sample of motor vehicular trauma cases was drawn from regionwide hospital emergency department records.6 Adopting a similar methodology, the Rhode Island Department of Health instituted a motor vehicular trauma surveillance system.7 This report documents patterns of motor vehicle traffic trauma rates for Rhode Island by age, sex, and road-use status. Methods Cases represent a 25 percent systematic sample of first encounter motor vehicle traffic trauma patients treated during 1984 and 1985 in the emergency departments of the 12 Rhode Island civilian, acute care, nonpsychiatric hospitals with an emergency facility. They include only Rhode Island patients and fatalities (on RI roads) with known age and sex, who were or could be assigned an ICD-9CM external cause of injury AJPH December 1990, Vol. 80, No. 12
PUBLIC HEALTH BRIEFS
code (E-code) within ranges E810-E816 and E818-E819. Additional information on the methodology is available elsewhere.7,8 Numerators in the overall rates represent annual averages estimated from emergency department cases weighted for the inverse of the sampling fraction. Severe cases were a combination of weighted hospital nonfatal admissions and total fatalities; their initial age groups were collapsed in order to address the small numbers. For both sets of rates, denominators are mid-period age- and sex-stratified population estimates that were based on the 1980 Census for Rhode Island9 and an official projection of the State population for
45-64. The highest rates in the motor vehicle occupant, motorcyclist and other/unspecified road-use categories were registered in the 15-24 age group. Rates peaked at 0-14 years in the pedal cyclist category. There was a bimodal distribution in the pedestrian category, with rates highest at the extreme ages. Males manifested an 80 percent greater risk of sustaining severe motor vehicular trauma than females. In the motorcyclist category, the overall relative risk for males was nine. Discussion
July 1, 1985.10
Results Overall Trauma Sample cases numbered 6,268; 92 percent involved Rhode Island residents, and constituted the focus of this report. The estimated 1984-85 average annual number of motor vehicular trauma cases among Rhode Island residents was 11,538, and the corresponding rate was 1,195 cases per 100,000 population (Table 1). Motor vehicle occupants contributed three-fourths of the cases. The estimated annualized motor vehicular trauma rate for males was 1,311 per 100,000 population, and that for females was 1,080. Irrespective of sex, the rates peaked at ages 15-19 years.* Although varying by sex, this age group also registered the highest rates in the motor vehicle occupant, motorcyclist, and other/unspecified road-use categories. Rates for the pedestrian, pedal cyclist and motorcyclist categories peaked at ages 5-9, 10-14, and 20-24 years, respectively. * Rates were lowest at the extremes of the age spectrum, and were 21 percent greater for males than females. Male predominance was most evident in the motorcyclist category, where the relative risk exceeded five. Severe Trauma The estimated annualized rate of severe trauma (fatalities and hospital admissions) was 103 per 100,000 population (Table 2); 64 percent were in the motor vehicle occupant category; pedestrian and motorcycle trauma cases together comprised almost 30 percent. Respective estimated rates for males and females were 133 and 74 per 100,000 population. Regardless of sex, the severe trauma rate reached a zenith at ages 15-24 years, and was lowest at ages 0-14 and *Detailed age-, and sex- and road-use-specific data pertaining to both overall and severe motor vehicular trauma are available from the first author upon request.
Overall trauma rates are probably underestimated here because cases involving individuals who refrained from seeking treatment or were self-treated and those treated in out-of-state hospitals or other health care facilities were outside the study population. Estimated severe trauma rates more closely approximate true rates than do the rates of overall trauma, since they are less likely to be influenced by differential discretionary care-seeking behavior among population sub-groups. Although the Rhode Island study is more recent than the Ohio study,6 comparisons are instructive. During the respective time frames of these two studies, neither population was covered by a motorcycle helmet law or by a universal seat belt use law. For every motor vehicle traffic trauma fatality among Rhode Island residents, there were an estimated 11 hospital admissions and 130 patients treated in hospital emergency departments. Respective figures for Northeastern Ohio were one, 11, and 137. Other remarkable similarities are apparent in patterns of overall trauma rates by age, sex, and road-use status as, for example, the excess rates for males and young adults. Severe trauma rates were not computed in the Ohio study. Experience from the two studies underscores the need for comprehensive E-coding of motor vehicular trauma in hospital records. Also essential in identifying high-risk populations, and designing, targeting, and evaluating appropriate interventions, is compilation and analysis of environmental and behavioral data, such as road configurations at trauma sites and motorist usage of safety devices, alcohol, and other drugs. Rhode Island was the second state in the nation to enact a child restraint use law. The current data were collected as the founding activity of a nascent injury control unit at the Rhode Island Department of Health with the expectation that they would be useful in advocacy for, and evaluation of, a universal seat belt use law. Unfortunately, Rhode Island remains in the minority of states without such a law. Ironically, absence of a law enabled the Rhode Island
TABLE 1-Number and Percentage of Resident Cases in a 25% Motor Vehicular Trauma Sample by Road-use Status for Persons Treated in Hospital Emergency Departments, and Associated Annualized Rates per 100,000 Population, Rhode Island, 1984-85
Sample
95%
Road-use Status
No.
%
Motor vehicle occupant Motorzed cyclist Pedal cyclist
4,319
74.9 5.5 1.9 4.7 13.0 100.0
Pedestran
Other/unspecified Total
AJPH December 1990, Vol. 80, No. 12
318 109 273 750
5,769
Rate
Confidence Interval
894 66 23 57 155
868, 921 59, 73 18, 27 50, 63 144, 166 1,164,1,225
1,195
1517
PUBLIC HEALTH BRIEFS TABLE 2-Number and Percentage of Resident Motor Vehicular Trauma Fatalities and Nonfatal Hospital Admissions by Road-use Status, and Associated Annualized Rates per 100,000 Population, Rhode Island, 1984-85
Road-use Status
Fatalities*
Admissionst
%t
Rate
95% Confidence Interval
Motor vehicle occupant Motorized cyclist Pedal cyclist Pedestrian Other/unspecified Total
84 18 4 50 21 177
295 61 10 67 18 451
63.8 13.2 2.2 16.1 4.7 100.0
65 14 2 16 5 103
58, 73 10, 17 1, 4 13, 20 3, 7 94,111
No.
'Fatalities represent a complete enumeration of residents who died due to motor vehicular trauma sustained on in-state public roads in 1984 or 1985. The data source is the Division of Vtal Statistics, Rhode Island Department of Heaith. tAdmissions derive from resident cases in a 25% sample for persons treated in hospital emergency departments for motor vehicular trauma. The 35 fatal emergency departnent cases are excluded. *Percentages are based on a combination of total fatalities and weighted nonfatal admissions. The weights are the inverse of the sampling fraction; four.
population to serve as an external control in an ongoing epidemiologic evaluation of the New York State law.8,1' The surveillance system which is described here provided data for an alcohol-related injury intervention study.12 Rhode Island has now established an Office of Injury Control and implemented a variety of interventions aimed at reducing both vehicular and nonvehicular trauma. E-coding by all hospitals is a top priority of the Office, and geographic study of trauma sites is also planned. Both seat belt and helmet use bills were introduced again in the 1990 session of the State Legislature by the Governor. ACKNOWLEDGMENTS The authors are deeply indebted to Carmel Doyle for her role as a medical records technician; Susan Wilkinson for conducting data validation; Eleanor Alger, Brenda Doyle, and Maureen Sullivan for contributions to the field work; John Migotsky and Bill Brinson for technical assistance; Dr. David Parker for editorial suggestions; Roberta Chevoya and Edward Martin for providing access to the vital records; and to the medical, administrative, and clerical staffs of all participating hospitals. This research was supported by the National Highway Traffic Safety Administration of the US Department of Transportation (Grant DTNH22-91-C05026).
REFERENCES 1. Annegers JF, Grabow JD, Kurland LT, et al: The incidence, causes and secular trends of head trauma in Olmstead County, Minnesota, 1953-1974. Neurology 1980; 30:912-919.
1518
2. Whitman S, Coonley-Hoganson R, Desai BT: Comparative head trauma experience in two socioeconomically different Chicago-area communities: A population study. Am J Epidemiol 1984; 119:570-580. 3. Kraus JF, Riggins RS, Franti CE: Some epidemiologic features of motorcycle collision injuries: I. Introduction, methods and factors associated with incidence. Am J Epidemiol 1975; 102:74-98. 4. Kraus JF, Franti CE, Riggins RS, et al: Incidence of traumatic spinal cord lesions. J Chronic Dis 1974; 23:471492. 5. Gallagher SS, Finison K, Guyer B, et al: The incidence of injuries among 87,000 Massachusetts children and adolescents: Results of the 1980-81 Statewide Childhood Injury Prevention Program surveillance system. Am J Public Health 1984; 74:1340-1347. 6. Barancik JI, Chatterjee BF, Greene-Cradden YC, et al: Motor vehicle trauma in Northeastern Ohio. I: Incidence and outcome by age, sex, and road-use category. Am J Epidemiol 1986; 123:846-861. 7. Rockett I, Hollinshead WH, Lieberman E: A statewide motor vehicle injury surveillance system. RI Med J 1986; 69:67-70. 8. Rockett IRH, Hollinshead WH, Lieberman ES: A preliminary assessment of change in motor vehicle trauma incidence and outcome: Rhode Island, 1984-85. Bull NY Acad Med 1988; 64:750-756. 9. US Department of Commerce: 1980 Census of Population. General Population Characteristics, Rhode Island. Washington, DC: Govt Printing Office, 1981. 10. Statewide Planning Program: Monthly Progress Report for October 1986. Providence, RI: Rhode Island Department of Administration, 1986. 11. Barancik JI, Kramer CF, Thode HC, Harris D: Epidemiology of motor vehicle injuries in Suffolk County, New York, before and after enactment of the New York State seat belt use law: Preliminary assessment of occurrence and severity. Bull NY Acad Med 1988; 64:742-749. 12. Putnam SL: Planning, development and process issues in the Rhode Island Alcohol-Related Injury Prevention Project. In: Giesbrecht N, Conley P, Denniston R, et al (eds): Research, Action and the Community: Experiences in the Prevention of Alcohol and other Drug Problems. OSAP Prevention Monograph-4. Rockville, MD; Office for Substance Abuse Prevention, DHHS Publication No. (ADM) 89-1651, 1990; 183-195.
AJPH December 1990, Vol. 80, No. 12
TABLE 4-Driver Manual Solt Use in Cars with Air Bags and in Cars with Manual Belts Only, by Model Year
Percent (N) Using Belts
Percent (N) Using Belts
Make/Series
Air Bag Cars
Manual Belt Cars
BMW 5,6,7 Series; M6 Chrysler LeBaron Sedan, Convertible Chrysler LeBaron Coupe Dodge Daytona Ford Tempo Lincoln Continental Acura Legend Volvo 740, 760
76 (96)
75 (88)
53 (103) 60 (57) 47 (66) 57 (46) 68 (90) 73 (166) 82 (133)
50 (142) 48 (31) 41 (39) 59 (282) 66 (77) 71 (348) 81 (325)
present, driver belt use was eight percentage points higher than passenger belt use in cars with driver side air bags and five percentage points higher in cars with manual belts only. If air bags reduced belt use, driver belt use in these air bag equipped cars would have been much lower relative to passenger use. Manual belt use rates were higher than average in this survey because the observations were restricted to late model cars and were concentrated in affluent areas in states with laws requiring belt use. All of these factors elevate seat belt use.3,4 Most of the nation's population (89 percent) is now covered by belt use laws; belt use rates in cars with and without air bags would be expected to be lower in the 14 remaining states without laws. Nevertheless, many drivers and right front
Model Year 1986 1987 1988 1989 1990
Air Bag Cars
Manual Belt Cars
63 (185) 65 (319) 67 (434) 66 (630) 67 (60)
63 (9781) 63(9696) 62 (8673) 64 (5994) 66 (79)
passengers observed were not using seat belts even though required by law to do so. An important goal is to increase seat belt use both in cars with and without air bags. ACKNOWLEDGMENTS This work was supported by the Insurance Institute for Highway Safety. The assistance of Michael A. Ciccone is gratefully acknowledged.
REFERENCES 1. US Dept of Transportation: Evaluation Plan; Federal Motor Vehicle Safety Standards; Passenger Car Front Seat Occupant Protection. Federal Register 1990; 55:1586-1591. 2. Williams AF, Wells JD, Lund AK, Teed N: Observed use of automatic seat belts in 1987 cars. Accident Anal Prev 1989; 21:427-433. 3. National Highway Traffic Safety Administration: Restraint System Usage in the Traffic Population, 1988 Annual Report. (DOT HS 807 447). Washington, DC: US Department of Transportation, 1989. 4. Lund AK: Voluntary seat belt use among US drivers: Geographic, socioeconomic and demographic variation. Accident Anal Prev 1986; 18:43-50.
Age, Sex, and Road-Use Patterns of Motor Vehicular Trauma in Rhode Island: A Population-Based Hospital Emergency Department Study IAN R.H. ROCKETT, PHD, MPH, ELLICE S. LIEBERMAN, MD, DRPH, WILLIAM H. HOLLINSHEAD, MD, MPH, SANDRA L. PUTNAM, PHD, AND HENRY C. THODE, PHD Abstract: Population-based hospital emergency department data on motor vehicle traffic trauma in Rhode Island, 1984-85, are analyzed by age, sex, and road-use status. Annualized rates of overall and severe trauma were 1,195 cases (95% confidence interval [CI] = 1,164, 1,225) and 102 cases (95% CI = 94, 111) per 100,000 population, respectively. Overall and severe rates peaked at ages 15-24 years. Male rate excesses were most pronounced for motorcycle and pedal cycle trauma. (Am J Public Health 1990; 80:15161518.)
From the Department of Health, Leisure, and Safety, and the Health Services Research Center, University ofTennessee, Knoxville; Department of Maternal and Child Health, Harvard School of Public Health, and Department of Obstetrics and Gynecology, Brigham and Women's Hospital, Boston; Division of Family Health, Rhode Island Department of Health; and the Injury Prevention and Analysis Group, Brookhaven National Laboratory. Address reprint requests to Ian R.H. Rockett, PhD, MPH, Department of Health, Leisure, and Safety, University of Tennessee, 1914 Andy Holt Avenue, Knoxville, TN 37996-2700. This paper, submitted to the Journal October 13, 1989, was revised and accepted for publication May 17, 1990.
© 1990 American Journal of Public Health 0090-0036/90$1.50
1516
Introduction Population-based data on nonfatal motor vehicular trauma are not collected routinely. In population-based studies, case selection has typically been restricted in terms of injury diagnoses, road-use status, and age ofpopulation. '-5 An exception is the Northeastern Ohio Trauma Study, in which a comprehensive sample of motor vehicular trauma cases was drawn from regionwide hospital emergency department records.6 Adopting a similar methodology, the Rhode Island Department of Health instituted a motor vehicular trauma surveillance system.7 This report documents patterns of motor vehicle traffic trauma rates for Rhode Island by age, sex, and road-use status. Methods Cases represent a 25 percent systematic sample of first encounter motor vehicle traffic trauma patients treated during 1984 and 1985 in the emergency departments of the 12 Rhode Island civilian, acute care, nonpsychiatric hospitals with an emergency facility. They include only Rhode Island patients and fatalities (on RI roads) with known age and sex, who were or could be assigned an ICD-9CM external cause of injury AJPH December 1990, Vol. 80, No. 12
PUBLIC HEALTH BRIEFS
code (E-code) within ranges E810-E816 and E818-E819. Additional information on the methodology is available elsewhere.7,8 Numerators in the overall rates represent annual averages estimated from emergency department cases weighted for the inverse of the sampling fraction. Severe cases were a combination of weighted hospital nonfatal admissions and total fatalities; their initial age groups were collapsed in order to address the small numbers. For both sets of rates, denominators are mid-period age- and sex-stratified population estimates that were based on the 1980 Census for Rhode Island9 and an official projection of the State population for
45-64. The highest rates in the motor vehicle occupant, motorcyclist and other/unspecified road-use categories were registered in the 15-24 age group. Rates peaked at 0-14 years in the pedal cyclist category. There was a bimodal distribution in the pedestrian category, with rates highest at the extreme ages. Males manifested an 80 percent greater risk of sustaining severe motor vehicular trauma than females. In the motorcyclist category, the overall relative risk for males was nine. Discussion
July 1, 1985.10
Results Overall Trauma Sample cases numbered 6,268; 92 percent involved Rhode Island residents, and constituted the focus of this report. The estimated 1984-85 average annual number of motor vehicular trauma cases among Rhode Island residents was 11,538, and the corresponding rate was 1,195 cases per 100,000 population (Table 1). Motor vehicle occupants contributed three-fourths of the cases. The estimated annualized motor vehicular trauma rate for males was 1,311 per 100,000 population, and that for females was 1,080. Irrespective of sex, the rates peaked at ages 15-19 years.* Although varying by sex, this age group also registered the highest rates in the motor vehicle occupant, motorcyclist, and other/unspecified road-use categories. Rates for the pedestrian, pedal cyclist and motorcyclist categories peaked at ages 5-9, 10-14, and 20-24 years, respectively. * Rates were lowest at the extremes of the age spectrum, and were 21 percent greater for males than females. Male predominance was most evident in the motorcyclist category, where the relative risk exceeded five. Severe Trauma The estimated annualized rate of severe trauma (fatalities and hospital admissions) was 103 per 100,000 population (Table 2); 64 percent were in the motor vehicle occupant category; pedestrian and motorcycle trauma cases together comprised almost 30 percent. Respective estimated rates for males and females were 133 and 74 per 100,000 population. Regardless of sex, the severe trauma rate reached a zenith at ages 15-24 years, and was lowest at ages 0-14 and *Detailed age-, and sex- and road-use-specific data pertaining to both overall and severe motor vehicular trauma are available from the first author upon request.
Overall trauma rates are probably underestimated here because cases involving individuals who refrained from seeking treatment or were self-treated and those treated in out-of-state hospitals or other health care facilities were outside the study population. Estimated severe trauma rates more closely approximate true rates than do the rates of overall trauma, since they are less likely to be influenced by differential discretionary care-seeking behavior among population sub-groups. Although the Rhode Island study is more recent than the Ohio study,6 comparisons are instructive. During the respective time frames of these two studies, neither population was covered by a motorcycle helmet law or by a universal seat belt use law. For every motor vehicle traffic trauma fatality among Rhode Island residents, there were an estimated 11 hospital admissions and 130 patients treated in hospital emergency departments. Respective figures for Northeastern Ohio were one, 11, and 137. Other remarkable similarities are apparent in patterns of overall trauma rates by age, sex, and road-use status as, for example, the excess rates for males and young adults. Severe trauma rates were not computed in the Ohio study. Experience from the two studies underscores the need for comprehensive E-coding of motor vehicular trauma in hospital records. Also essential in identifying high-risk populations, and designing, targeting, and evaluating appropriate interventions, is compilation and analysis of environmental and behavioral data, such as road configurations at trauma sites and motorist usage of safety devices, alcohol, and other drugs. Rhode Island was the second state in the nation to enact a child restraint use law. The current data were collected as the founding activity of a nascent injury control unit at the Rhode Island Department of Health with the expectation that they would be useful in advocacy for, and evaluation of, a universal seat belt use law. Unfortunately, Rhode Island remains in the minority of states without such a law. Ironically, absence of a law enabled the Rhode Island
TABLE 1-Number and Percentage of Resident Cases in a 25% Motor Vehicular Trauma Sample by Road-use Status for Persons Treated in Hospital Emergency Departments, and Associated Annualized Rates per 100,000 Population, Rhode Island, 1984-85
Sample
95%
Road-use Status
No.
%
Motor vehicle occupant Motorzed cyclist Pedal cyclist
4,319
74.9 5.5 1.9 4.7 13.0 100.0
Pedestran
Other/unspecified Total
AJPH December 1990, Vol. 80, No. 12
318 109 273 750
5,769
Rate
Confidence Interval
894 66 23 57 155
868, 921 59, 73 18, 27 50, 63 144, 166 1,164,1,225
1,195
1517
PUBLIC HEALTH BRIEFS TABLE 2-Number and Percentage of Resident Motor Vehicular Trauma Fatalities and Nonfatal Hospital Admissions by Road-use Status, and Associated Annualized Rates per 100,000 Population, Rhode Island, 1984-85
Road-use Status
Fatalities*
Admissionst
%t
Rate
95% Confidence Interval
Motor vehicle occupant Motorized cyclist Pedal cyclist Pedestrian Other/unspecified Total
84 18 4 50 21 177
295 61 10 67 18 451
63.8 13.2 2.2 16.1 4.7 100.0
65 14 2 16 5 103
58, 73 10, 17 1, 4 13, 20 3, 7 94,111
No.
'Fatalities represent a complete enumeration of residents who died due to motor vehicular trauma sustained on in-state public roads in 1984 or 1985. The data source is the Division of Vtal Statistics, Rhode Island Department of Heaith. tAdmissions derive from resident cases in a 25% sample for persons treated in hospital emergency departments for motor vehicular trauma. The 35 fatal emergency departnent cases are excluded. *Percentages are based on a combination of total fatalities and weighted nonfatal admissions. The weights are the inverse of the sampling fraction; four.
population to serve as an external control in an ongoing epidemiologic evaluation of the New York State law.8,1' The surveillance system which is described here provided data for an alcohol-related injury intervention study.12 Rhode Island has now established an Office of Injury Control and implemented a variety of interventions aimed at reducing both vehicular and nonvehicular trauma. E-coding by all hospitals is a top priority of the Office, and geographic study of trauma sites is also planned. Both seat belt and helmet use bills were introduced again in the 1990 session of the State Legislature by the Governor. ACKNOWLEDGMENTS The authors are deeply indebted to Carmel Doyle for her role as a medical records technician; Susan Wilkinson for conducting data validation; Eleanor Alger, Brenda Doyle, and Maureen Sullivan for contributions to the field work; John Migotsky and Bill Brinson for technical assistance; Dr. David Parker for editorial suggestions; Roberta Chevoya and Edward Martin for providing access to the vital records; and to the medical, administrative, and clerical staffs of all participating hospitals. This research was supported by the National Highway Traffic Safety Administration of the US Department of Transportation (Grant DTNH22-91-C05026).
REFERENCES 1. Annegers JF, Grabow JD, Kurland LT, et al: The incidence, causes and secular trends of head trauma in Olmstead County, Minnesota, 1953-1974. Neurology 1980; 30:912-919.
1518
2. Whitman S, Coonley-Hoganson R, Desai BT: Comparative head trauma experience in two socioeconomically different Chicago-area communities: A population study. Am J Epidemiol 1984; 119:570-580. 3. Kraus JF, Riggins RS, Franti CE: Some epidemiologic features of motorcycle collision injuries: I. Introduction, methods and factors associated with incidence. Am J Epidemiol 1975; 102:74-98. 4. Kraus JF, Franti CE, Riggins RS, et al: Incidence of traumatic spinal cord lesions. J Chronic Dis 1974; 23:471492. 5. Gallagher SS, Finison K, Guyer B, et al: The incidence of injuries among 87,000 Massachusetts children and adolescents: Results of the 1980-81 Statewide Childhood Injury Prevention Program surveillance system. Am J Public Health 1984; 74:1340-1347. 6. Barancik JI, Chatterjee BF, Greene-Cradden YC, et al: Motor vehicle trauma in Northeastern Ohio. I: Incidence and outcome by age, sex, and road-use category. Am J Epidemiol 1986; 123:846-861. 7. Rockett I, Hollinshead WH, Lieberman E: A statewide motor vehicle injury surveillance system. RI Med J 1986; 69:67-70. 8. Rockett IRH, Hollinshead WH, Lieberman ES: A preliminary assessment of change in motor vehicle trauma incidence and outcome: Rhode Island, 1984-85. Bull NY Acad Med 1988; 64:750-756. 9. US Department of Commerce: 1980 Census of Population. General Population Characteristics, Rhode Island. Washington, DC: Govt Printing Office, 1981. 10. Statewide Planning Program: Monthly Progress Report for October 1986. Providence, RI: Rhode Island Department of Administration, 1986. 11. Barancik JI, Kramer CF, Thode HC, Harris D: Epidemiology of motor vehicle injuries in Suffolk County, New York, before and after enactment of the New York State seat belt use law: Preliminary assessment of occurrence and severity. Bull NY Acad Med 1988; 64:742-749. 12. Putnam SL: Planning, development and process issues in the Rhode Island Alcohol-Related Injury Prevention Project. In: Giesbrecht N, Conley P, Denniston R, et al (eds): Research, Action and the Community: Experiences in the Prevention of Alcohol and other Drug Problems. OSAP Prevention Monograph-4. Rockville, MD; Office for Substance Abuse Prevention, DHHS Publication No. (ADM) 89-1651, 1990; 183-195.
AJPH December 1990, Vol. 80, No. 12
