Factors associated with severity of motorcycle injuries among young adult riders

doi:10.1067/mem.2003.186

Annals of Emergency Medicine

Volume 41, Issue 6, June 2003, Pages 783-791

https://doi.org/10.1067/mem.2003.186 Get rights and content

Abstract

Study objective: A cohort of 4,729 junior college students in Taiwan was studied to determine risk factors for increased severity of motorcycle injuries. Methods: Crash characteristics were collected by using self-administered questionnaires soon after a student was involved in a motorcycle crash. The proportional odds model with generalized estimating equations, with correlated ordinal responses for collisions categorized into not injured, mildly injured, and severely injured categories, was used to determine the odds of injury severity. Results: A total of 1,889 motorcycle crashes involving 1,284 persons occurred over a 20-month period from November 1994 to June 1996. There were 1,339 noninjuries, 474 mild injuries, and 76 severe injuries. The adjusted odds ratio (OR) of rural to urban roads having a greater level of injury severity was 1.64. Compared with noncollisions, collisions with a moving car (adjusted OR=1.76), a parked car (adjusted OR 1.90), or another stationary object (adjusted OR=2.31) increased the odds for a greater level of injury severity. Riders using Sanyang (adjusted OR=1.63) and Yamaha (adjusted OR=1.39) motorcycles had greater odds of being involved in a crash with a greater level of injury compared with those riding Kymco motorcycles. Darkness (adjusted OR=1.65) and greater speeds (adjusted OR=1.63 to 4.69) also increased the odds of greater injury severity. Conclusion: At the time of motorcycle crashes, factors such as being on rural roads, collisions with a heavier object, some motorcycle makes, darkness, and greater speeds increased the severity of motorcycle injuries among these young adult riders. [Ann Emerg Med. 2003;41:783-791.]

Introduction

Motorcycles in Taiwan are a major means of transportation and a common source of injury. According to police reports, 43% of the 2,717 deaths from traffic injuries in Taiwan in 1992 were among motorcycle riders, and of these motorcyclist deaths, 31% were young riders aged 16 to 25 years.¹ Emergency department records have shown that more than 66% of motorcycle injuries occur to riders aged younger than 20 years.2, 3, 4 Thus, identifying features and behaviors that might reduce injuries, especially among young riders, would be of value.

There are several inadequacies in previous studies related to severity of motorcycle injuries. First, police and hospital records traditionally used in motorcycle-injury studies are incomplete in that they usually overrepresent severely injured riders.5, 6 Only 53% to 91% of hospital admissions and 37% to 38% of ED visits caused by motorcycle injuries were reported by the police.7, 8, 9, 10, 11, 12 Motorcycle injuries caused by some crashes, such as on-scene deaths, mild injuries, and noninjuries, are often not included in hospital records. Hence, a representative sample of motorcycle crashes, particularly for determination of risk or protective factors for motorcycle injuries, is required to obtain unbiased results, as well as to validate those results from police and hospital records. Second, potential factors associated with severity of motorcycle injuries have only rarely been comprehensively measured in previous studies, and thus, independent effects of risk or protective factors on severity of injury might be inaccurately estimated. Finally, it is common for recurrent injuries to occur to a rider over time, but injury has often been treated as being independent; that is, only the first event for multiple events is counted.13, 14 Traditional statistical models using correlated data might result in inefficient estimates of regression parameters and inconsistent estimates of precision.¹⁵

Therefore, because of the high occurrence of motorcycle injuries in young adults, we believed that it was appropriate to conduct a cohort study of a representative sample of motorcycle crashes in this age group, with the goal of estimating the magnitude of risk factors for injury severity in this group.

Section snippets

Materials and methods

Junior college students from 2 residential areas, Taipei (an urbanized area in Taiwan with a population density of 10,001 persons per square kilometer) and Hualien (a rural area with a population density of 76 persons per square kilometer), were selected for this study. Two junior colleges from each area were randomly selected from a total of 8 junior colleges in Taipei and 3 in Hualien. Because one of the selected colleges in Taipei declined to participate, only 3 junior colleges were included

Results

During the 20-month study period, a total of 1,889 motorcycle crashes involving 1,284 study participants occurred. Of the 1,284 participants experiencing at least one motorcycle crash during the 20-month study period, 877 had one crash, 280 had 2 crashes, and 127 had 3 or more crashes. About 80% of the total crashes were reported by class representatives, 20% were from crash victims at the 3 follow-up assessment visits, and 2 fatal crashes were obtained from school records.

The time-of-day

Discussion

We collected a population-based sample of motorcycle crashes by following up more than 4,700 junior college students over a 20-month period to examine the risk factors for 3 levels of severity of motorcycle injuries. In the proportional odds model, generalized estimating equations were applied to adjust the correlation between recurrent motorcycle crashes for a single individual. Although the study population was limited to young adult riders, we believe the identified risk factors,

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^☆: Supported by funding from the National Science Council, Executive Yuan, Taiwan, Republic of China (grant NSC 88-2314-B-039-036).

^☆☆: Address for reprints: Mau-Roung Lin, PhD, Institute of Injury Prevention and Control, Taipei Medical University, 250 Wu-Hsing Street, Taipei 110, Taiwan, ROC; 886-2-27226109, fax 886-2-27390387; E-mail [email protected].

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Injury PreventionFactors associated with severity of motorcycle injuries among young adult riders☆,☆☆

Abstract

Introduction

Section snippets

Materials and methods

Results

Discussion

Accid Anal Prev

Accid Anal Prev

Accid Anal Prev

Accid Anal Prev

Accid Anal Prev

Accid Anal Prev

J Adolesc Health

J Clin Epidemiol

J Clin Epidemiol

Annual Report of Transportation and Communication in 1992

Motorcycle injuries—an epidemiologic study of emergency room patients in a large hospital in Taipei City

J Natl Public Health Assoc (ROC)

Estimate of case fatality rate and incidence rate of traffic injury in Taiwan—analysis of 4,329 victims at a medical center

J Formosan Med Assoc

Analysis of traffic injuries in Taiwan in relation to alcohol use and economic loss

Injury

Comparison of accident and emergency with police road injury data

J Trauma

Some epidemiologic features of motorcycle collision injuries. I. Introduction, methods and factors associated with incidence

Am J Epidemiol

Methodological challenges in injury epidemiology and injury prevention research

Annu Rev Public Health

Epidemiologic research on the etiology of injuries at work

Annu Rev Public Health

An overview of methods for the analysis of longitudinal data

Stat Med

Regression models for ordinal data

J Roy Stat Soc B

Generalized Linear Models

Longitudinal data analysis using generalized linear models

Biometrika

Injury Prevention
Factors associated with severity of motorcycle injuries among young adult riders☆,☆☆