Graduated Driver Licensing and Fatal Crashes Involving 16-to 19-Year-Old Drivers
Graduated Driver Licensing and Fatal Crashes Involving 16-to 19-Year-Old Drivers
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DOI：
10.1001/jama.2011.1277
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发表时间：
2011-09-14
影响因子：
120.7
通讯作者：
Marshall, Stephen W.
中科院分区：
文献类型：
--
作者：
Masten, Scott V.;Foss, Robert D.;Marshall, Stephen W.
在美国的背景下，分级驾驶执照(GDL)系统只允许18岁以下的司机在最初的监督驾驶和限制夜间驾驶、运送多名年轻乘客或两者兼而有之的无监督驾驶的中间时期后，获得完全的、不受限制的驾照。目的评估GDL计划与16至19岁司机发生致命车祸的关联。设计、设置和参与者汇集了所有50个州和哥伦比亚特区1986-2007季度涉及16至19岁司机的致命车祸事件的横断面时间序列分析。主要结果衡量16至19岁司机致命车祸的基于人口的比率，17岁、18岁和19岁的司机。比率和95%的CI将州区与较强(限制夜间驾驶和允许乘客)或较弱(限制夜间驾驶或允许乘客)GDL计划与没有GDL的州区进行比较。结果青少年司机的致命车祸发生率随着年龄的增长而增加，从每10万人(16岁司机)中的28.2人增加到每10万人(17岁)中的36.9人，然后达到平台期，分别为46.2/10万(18岁)和44.0/10万(19岁)。在调整了潜在的混杂因素后，对于16岁的司机来说，较强的GDL计划与较低的致命撞车发生率相关，而没有关键GDL元素的计划(比率比，0.74[95%CI，0.65-0.84])。然而，GDL计划越强，18岁司机的致命车祸发生率就越高(比率比，1.12[95%CI，1.01-1.23])。17岁(0.91[95%CI，0.83-1.01])、19岁(1.05[95%CI，0.98-1.13])和16-19岁合计(0.97[95%CI，0.92-1.03])的比率与零相比没有统计学差异。结论在美国，与没有关键GDL要素的项目相比，限制夜间驾驶和允许乘客的GDL项目更强，这与16岁司机的致命撞车事故发生率显著降低，但18岁司机的致命撞车事故发生率略高有关。未来的研究应该寻求确定18岁司机人数增加的原因，以及GDL计划的改进是否可以减少这种联系。贾玛2011；306(10)：1098-1103 www.jama.com
Context In the United States, graduated driver licensing (GDL) systems allow full, unrestricted licensure for drivers younger than 18 years only after an initial period of supervised driving and an intermediate period of unsupervised driving that limits driving at night, transporting multiple young passengers, or both.Objective To estimate the association of GDL programs with involvement in fatal crashes among 16- to 19-year-old drivers.Design, Setting, and Participants Pooled cross-sectional time series analysis of quarterly 1986-2007 incidence of fatal crashes involving drivers aged 16 to 19 years for all 50 states and the District of Columbia combined.Main Outcome Measures Population-based rates of fatal crash involvement for 16-, 17-, 18-, and 19-year-old drivers. Rate ratios and 95% CIs comparing state-quarters with stronger (restrictions on both nighttime driving and allowed passengers) or weaker (restrictions on either nighttime driving or allowed passengers) GDL programs with state-quarters without GDL.Results Fatal crash incidence among teen drivers increased with age, from 28.2 per 100 000 person-years (16-year-old drivers) to 36.9 per 100 000 (17-year-olds), before reaching a plateau of 46.2 per 100 000 (18-year-olds) and 44.0 per 100 000 (19-year-olds). After adjusting for potential confounders, stronger GDL programs were associated with lower incidence of fatal crashes for 16-year-old drivers, compared with programs having none of the key GDL elements (rate ratio, 0.74 [95% CI, 0.65-0.84]). However, stronger GDL programs were associated with higher fatal crash incidence for 18-year-old drivers (rate ratio, 1.12 [95% CI, 1.01-1.23]). Rate ratios for 17-year-olds (0.91 [95% CI, 0.83-1.01]), 19-year-olds (1.05 [95% CI, 0.98-1.13]), and 16- to 19-year-olds combined (0.97 [95% CI, 0.92-1.03]) were not statistically different from the null.Conclusions In the United States, stronger GDL programs with restrictions on nighttime driving as well as allowed passengers, relative to programs with none of the key GDL elements, were associated with substantially lower fatal crash incidence for 16-year-old drivers but somewhat higher fatal crash incidence for 18-year-old drivers. Future studies should seek to determine what accounts for the increase among 18-year-old drivers and whether refinements in GDL programs can reduce this association. JAMA. 2011;306(10):1098-1103 www.jama.com