PDF(Pubmed)
Abstract：
OBJECTIVE: To examine the relationship between schizophrenia, antipsychotic medication adherence and driver responsibility for motor vehicle crash.
METHODS: Retrospective observational cohort study using 20 years of population-based administrative health and driving data.
METHODS: British Columbia, Canada.
METHODS: Licensed drivers who were involved in a police-attended motor vehicle crash in British Columbia over a 17-year study interval (2000-16).
METHODS: Incident schizophrenia was identified using hospitalisation and physician services data. Antipsychotic adherence was estimated using prescription fill data to calculate the \'medication possession ratio\' (MPR) in the 30 days prior to crash.
METHODS: We deemed drivers \'responsible\' or \'non-responsible\' for their crash by applying a validated scoring tool to police-reported crash data. We used logistic regression to evaluate the association between crash responsibility and exposures of interest.
RESULTS: Our cohort included 808 432 drivers involved in a police-attended crash and for whom crash responsibility could be established. In total, 1689 of the 2551 drivers with schizophrenia and 432 430 of the 805 881 drivers without schizophrenia were deemed responsible for their crash, corresponding to a significant association between schizophrenia and crash responsibility (66.2% vs 53.7%; adjusted OR (aOR), 1.67; 95% CI, 1.53 to 1.82; p<0.001). The magnitude of this association was modest relative to established crash risk factors (eg, learner license, age ≥65 years, impairment at time of crash). Among the 1833 drivers with schizophrenia, near-optimal antipsychotic adherence (MPR ≥0.8) in the 30 days prior to crash was not associated with lower crash responsibility (aOR, 1.04; 95% CI, 0.83 to 1.30; p=0.55).
CONCLUSIONS: Crash-involved drivers with schizophrenia are more likely to be responsible for their crash, but the magnitude of risk is similar to socially acceptable risk factors such as older age or possession of a learner license. Contemporary driving restrictions for individuals with schizophrenia appear to adequately mitigate road risks, suggesting more stringent driving restrictions are not warranted.
METHODS: Retrospective observational cohort study using 20 years of population-based administrative health and driving data.
METHODS: British Columbia, Canada.
METHODS: Licensed drivers who were involved in a police-attended motor vehicle crash in British Columbia over a 17-year study interval (2000-16).
METHODS: Incident schizophrenia was identified using hospitalisation and physician services data. Antipsychotic adherence was estimated using prescription fill data to calculate the \'medication possession ratio\' (MPR) in the 30 days prior to crash.
METHODS: We deemed drivers \'responsible\' or \'non-responsible\' for their crash by applying a validated scoring tool to police-reported crash data. We used logistic regression to evaluate the association between crash responsibility and exposures of interest.
RESULTS: Our cohort included 808 432 drivers involved in a police-attended crash and for whom crash responsibility could be established. In total, 1689 of the 2551 drivers with schizophrenia and 432 430 of the 805 881 drivers without schizophrenia were deemed responsible for their crash, corresponding to a significant association between schizophrenia and crash responsibility (66.2% vs 53.7%; adjusted OR (aOR), 1.67; 95% CI, 1.53 to 1.82; p<0.001). The magnitude of this association was modest relative to established crash risk factors (eg, learner license, age ≥65 years, impairment at time of crash). Among the 1833 drivers with schizophrenia, near-optimal antipsychotic adherence (MPR ≥0.8) in the 30 days prior to crash was not associated with lower crash responsibility (aOR, 1.04; 95% CI, 0.83 to 1.30; p=0.55).
CONCLUSIONS: Crash-involved drivers with schizophrenia are more likely to be responsible for their crash, but the magnitude of risk is similar to socially acceptable risk factors such as older age or possession of a learner license. Contemporary driving restrictions for individuals with schizophrenia appear to adequately mitigate road risks, suggesting more stringent driving restrictions are not warranted.
摘要：
目的：研究精神分裂症与精神分裂症、抗精神病药物的依从性和机动车碰撞的驾驶员责任。
方法：使用20年基于人群的行政健康和驾驶数据进行回顾性观察性队列研究。
方法：不列颠哥伦比亚省，加拿大。
方法：在不列颠哥伦比亚省进行了17年的研究间隔（2000-16年），参与警察参与的机动车撞车事故的许可驾驶员。
方法：使用住院和医生服务数据确定精神分裂症事件。使用处方填充数据估算抗精神病药的依从性，以计算撞车前30天的“药物持有率”（MPR）。
方法：通过对警方报告的撞车数据应用经过验证的评分工具，我们认为驾驶员对撞车事故负责或不负责。我们使用逻辑回归来评估撞车责任与感兴趣的暴露之间的关联。
结果：我们的队列包括808432名参与警察参与撞车事故的驾驶员，可以为他们确定撞车责任。总的来说,2551名患有精神分裂症的驾驶员中的1689名和805881名没有精神分裂症的驾驶员中的432名430名被认为对他们的撞车负责。对应于精神分裂症和崩溃责任之间的显著关联(66.2%vs53.7%；校正OR(AOR)，1.67；95%CI，1.53至1.82；p<0.001)。相对于既定的撞车风险因素，这种关联的程度是适度的(例如，学习者执照,年龄≥65岁，崩溃时的减值)。在1833名患有精神分裂症的司机中，撞车前30天内接近最佳的抗精神病药物依从性(MPR≥0.8)与较低的撞车责任无关(aOR,1.04；95%CI，0.83至1.30；p=0.55）。
结论：患有精神分裂症的撞车驾驶员更有可能对撞车负责，但是风险的大小类似于社会可接受的风险因素，例如年龄较大或拥有学习执照。当代对精神分裂症患者的驾驶限制似乎可以充分减轻道路风险。暗示更严格的驾驶限制是没有必要的。
方法：使用20年基于人群的行政健康和驾驶数据进行回顾性观察性队列研究。
方法：不列颠哥伦比亚省，加拿大。
方法：在不列颠哥伦比亚省进行了17年的研究间隔（2000-16年），参与警察参与的机动车撞车事故的许可驾驶员。
方法：使用住院和医生服务数据确定精神分裂症事件。使用处方填充数据估算抗精神病药的依从性，以计算撞车前30天的“药物持有率”（MPR）。
方法：通过对警方报告的撞车数据应用经过验证的评分工具，我们认为驾驶员对撞车事故负责或不负责。我们使用逻辑回归来评估撞车责任与感兴趣的暴露之间的关联。
结果：我们的队列包括808432名参与警察参与撞车事故的驾驶员，可以为他们确定撞车责任。总的来说,2551名患有精神分裂症的驾驶员中的1689名和805881名没有精神分裂症的驾驶员中的432名430名被认为对他们的撞车负责。对应于精神分裂症和崩溃责任之间的显著关联(66.2%vs53.7%；校正OR(AOR)，1.67；95%CI，1.53至1.82；p<0.001)。相对于既定的撞车风险因素，这种关联的程度是适度的(例如，学习者执照,年龄≥65岁，崩溃时的减值)。在1833名患有精神分裂症的司机中，撞车前30天内接近最佳的抗精神病药物依从性(MPR≥0.8)与较低的撞车责任无关(aOR,1.04；95%CI，0.83至1.30；p=0.55）。
结论：患有精神分裂症的撞车驾驶员更有可能对撞车负责，但是风险的大小类似于社会可接受的风险因素，例如年龄较大或拥有学习执照。当代对精神分裂症患者的驾驶限制似乎可以充分减轻道路风险。暗示更严格的驾驶限制是没有必要的。
