Prescription medicine use by pedestrians and the risk of injurious road traffic crashes: A case-crossover study

Née, Mélanie; Avalos, Marta; Luxcey, Audrey; Contrand, Benjamin; Salmi, Louis-Rachid; Fourrier-Réglat, Annie; Gadegbeku, Blandine; Lagarde, Emmanuel; Orriols, Ludivine · 2017 · Crossref

DOI: 10.1371/journal.pmed.1002347

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Summary

This study investigates the association between prescription medicine use and the risk of injurious road traffic crashes involving pedestrians. While previous research has established that certain medications impair driving ability, no prior studies had examined whether these drugs similarly increase crash risk for pedestrians, who constitute 22% of global road traffic deaths. The authors aimed to fill this gap by determining if specific medicinal classes are linked to pedestrian crash involvement. The researchers conducted a case-crossover study using data from three French nationwide databases: the national healthcare insurance database, police reports, and the national police database of injurious crashes. The study population comprised 16,458 pedestrians involved in crashes between July 2005 and December 2011. To control for time-invariant confounders, each pedestrian served as their own control, comparing medication exposure in the period immediately preceding the crash (case period) to an earlier control period. To address unmeasured time-varying factors and multiple testing issues, the authors varied the washout period between case and control windows from 30 to 119 days and employed a bootstrap-enhanced Lasso (Bolasso) regression method for variable selection. Only prescription medicines classified by French authorities as having a non-negligible risk of impairing attention or precision were included. The analysis identified 48 medicine classes associated with an increased risk of pedestrian crashes, with median odds ratios ranging from 1.12 to 2.98. The associations varied in stability depending on the washout period length. Among the medicines most frequently consumed by the study cohort, benzodiazepines and benzodiazepine-related drugs, antihistamines, and anti-inflammatory and antirheumatic drugs showed significant associations with increased crash risk. Other classes, such as certain insulins and alpha-adrenoreceptor antagonists, also demonstrated consistent associations across different model specifications. The study noted that nearly 60% of the participants were women, and a significant portion were aged 65 or older. The findings indicate that therapeutic classes known to impair driving ability also elevate the risk of road traffic crashes for pedestrians. This suggests that the cognitive, perceptive, and motor impairments caused by these medications affect all road users, not just drivers. The authors conclude that there is a critical need to improve awareness regarding the risks of medication use among pedestrians, as current safety warnings often focus exclusively on drivers. Limitations of the study include the potential overrepresentation of pedestrians in severe crashes, the exclusion of over-the-counter drugs and self-medication, and a lack of data on the volume of walking performed by participants.

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• prescription meds