11. cao my phuong risk factors of pre diabetes in adults aged 45
Presentation mekong conference
1. RISK OF ROAD TRAFFIC INJURY AFTER ALCOHOL CONSUMPTION IN VIETNAM Hue, August 2010 Dr. Nguyen Minh Tam Prof. Michael Dunne Prof. Ross Young A/Prof. Peter Hill A/Prof. Pham Van Linh
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7. Objective & Conceptual Framework Objective: To identify the risk of traffic injury after alcohol consumption among patients with recent traffic injuries in the ED
8. Methodological considerations – the case-crossover design and analysis Maclure M (Am J Epidemiol 1991), Maclure M & Mittleman MA. (Ann Rev of Public Health 2000)
9. Case-crossover analysis Event: Traffic Injury Exposure: Acute Alcohol Consumption Length of the exposure effect: 6 hours Hazard period: 6 hours before traffic injury onset Control data The drinking information from a 6 hour period at the same time same day in the prior week of the onset of traffic injury Unexposed Exposed Unexposed Exposed Control Period Hazard Period OR = b/c Maclure M (Am J Epidemiol 1991), Redelmeier DA, Tibshirani RJ. (New Eng J Med 1997), Gullette EC, et al. (JAMA 1997), Meier CR, et al. (Lancet 1998), Barbone F, et al. (Lancet 1998), Borges G, et al. (Soc Sci Med 2004) Aug 8 Aug 1
24. Patients with recent traffic injuries n (%) p value Pedestrian Car driver Motorcycle / bicycle driver Passenger Age (Mean ± SD) 43.33 ± 20.551 30.75 ± 8.593 30.78 ± 11.593 26.71 ± 9.987 <0.001 Income (Mean ± SD) (in multiples of Vietnamese minimum annual wage of US $ 410 [190]) 3.19 ± 1.424 3.44 ± 1.236 3.30 ± 1.335 2.91 ± 1.571 0.583 Education level 0.772 Secondary school or lower 10 (52.6%) 3 (27.3%) 158 (40.6%) 14 (48.2%) High school 6 (31.6%) 6 (54.5%) 147 (37.5%) 9 (31.0%) College/University 3 (15.8%) 2 (18.2%) 86 (21.9%) 6 (20.7%) Marital status 0.286 Single 8 (40.0%) 7 (61.5%) 209 (52.6%) 20 (66.7%) Married 12 (60.0%) 5 (38.5%) 189 (47.4%) 10 (33.3%) Employment status 0.306 No 4 (19.0%) 1 (7.7%) 67 (17.2%) 9 (29.0%) Yes 17 (81.0%) 11 (92.3%) 327 (82.8%) 22 (71.0%) Alcohol dependent (AUDIT-C) 0.229 No 5 (41.7%) 3 (37.5%) 159 (49.8%) 16 (69.6%) Yes 7 (58.3%) 5 (62.5%) 160 (50.2%) 7 (30.4%)
25. Research Variables & Analysis Plan Main Study Case-crossover Design A scientific way to ask and answer the question that “Was the patient doing anything unusual just before the onset of the disease?” A design that compares the exposure to certain agent during the interval when the event does not occur (control period) , to the exposure during the interval when the event occurs (hazard period) Case-crossover design is used when a brief exposure causes a transient change in risk of an acute onset event Objective 1: To estimate the risk of traffic injuries after alcohol consumption
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Notas do Editor
Road traffic injury is a major global public health problem. Every year, more than one million people were killed and about 50 million people injured worldwide in road traffic crashes. The vast majority of the burden are in developing countries where accounted for more than 90 percent of deaths and disability-adjusted life years lost to road traffic injuries worldwide. Worldwide, drinking and driving is a major road safety problem but continues to receive inadequate attention. In developed countries, the dramatic decline in the last three decades in drink-driving has recently plateaued or begun rising. In developing countries, the risk of drink-driving is much higher due to the dominance of motorcycles. However, the absence of surveillance systems has resulted in an underestimation of the problem. Data are the key for assessing the current situation and evaluating the effectiveness of interventions on drinking and driving. These data however, are not always available and when they are available might not represent the current prevalence of driving after drinking. It is thus impossible to estimate the ‘true size’ of the problem in developing countries.
Even small amount of alcohol consumption increases risk of RTI. However, the scale of the problem is not well understood in many countries. Research show that there is a wide range of the magnitude of risk estimated in different regions. Research also show that alcohol increases the severity of RTI. People who are positive with alcohol are more severely injured, required more hospital care, and have worse outcomes in terms of fatality and post-trauma disabilities. In developing countries; however, very few studies have been conducted and less is known about the magnitude of the role of alcohol in road traffic injury. Furthermore, besides the issues of lacking human resources and infrastructures, the most important issue that limited policy advocacy and the political will to tackle the problem is a lack of evidence of good practice.
In Vietnam, economic development has brought about a significant increase in number of motor vehicles. As about eight thousand motorcycles are newly registered a day, it is understandable why traffic injuries has changed dramatically during the last two decades in Vietnam.
With the increase in incomes and rising living standard, there has been a significant increase in alcohol consumption and change in drinking patterns in Viet Nam. Consumption of alcohol in Viet Nam has increased more than 50% in the five year period from 2003 to 2008. Drinking at bar or restaurant becoming more popular and is considered as part of a highly desirable social life As the Vietnamese economy is expected to continue to progress well over the next few years, leading to higher disposable incomes as well as modern lifestyles, consumption of alcohol is projected to continue growing.
There are very few studies in regards to drinking and driving in Vietnam. Moreover, available data are not consistent. Official data and community surveys express a very low rate of alcohol involvement in road traffic injury, which are about 6 to 7 percent. While h ospital data using blood sample results provided a much higher prevalence of alcohol related traffic injuries which are above 30%. The lack of surveillance and reporting system makes it not possible to estimate the true size of the problem.
This is the framework of the study process in which legislation and law enforcement were reviewed and data on alcohol related traffic injuries and perceptions toward drink-driving were collected by interviewing and breath testing. To prevent drinking and driving, it is important to identify the scale of the problem and to examine factors behind the drink-driving behavior. Essential data for this should include data on alcohol related traffic injuries, assessment of drink-driving laws, and identifying perceptions of people toward drink-driving. In Vietnam, such an approach is yet to be established. This guide the author to develop the conceptual framework of this study. The primary goal of this research is to help policy makers and practitioners to choose priority actions aimed at reducing alcohol related traffic injuries in Vietnam.
Case-crossover is a design that compares the exposure to certain agent during the interval when the event does not occur (control period) , to the exposure during the interval when the event occurs (hazard period) In this figure, a collision at noon today, was exposed to a hazard, such as a cell phone call (shaped ellipse). A control group is needed to examine how unusual this exposure was. Instead of using a different car at the same time (bottom left), the same car at noon yesterday (top right) can be used as a matched control.
In our study, as drinking patterns are different between weekdays and weekends, our control data were the drinking information from a 6 hour period at the same time same day in the prior week of the onset of traffic injury The control data here are from a comparable control period, so the analysis will be the same as that for a matched case-control study. After arranging the data in a 2 by 2 table, we can just use the standard method for matched case-control to get the odds ratio.
In the result section, we will present in three parts. First is the overall sample characteristics. Then the perceptions towards drink-driving. And lastly is the risk of traffic injuries after alcohol consumption.
In the study in hospital, during data collection time, there were 1012 male patients admitted to the Emergency Department with injuries and 66.8% of these were traffic related injuries (n=676). 61 patients did not provide consent (61) 196 patients that we could not obtain breath analysis and complete interview because they were either ventilated/resuscitated (9), too severely injured or unconscious (77), confused (13), too intoxicated to cooperate (16), or because of other reasons (20) leaving the final sample of size of 480 participants. Most of them (414 out of 480) were motorcycle or bicycle riders.
This table show data we use to estimate the risk of traffic injuries by number of drinks using case-crossover analysis. Results indicate a dose-response relationship between alcohol consumption and the risk of traffic injury. The risk of traffic injury increased when alcohol was consumed before driving. and People who consumed alcohol were about 9 times more likely to get traffic injuries compared to people who did not drink. People who consumed from 2 to 3 drinks were more than 7 times more likely to have traffic injuries compared to people who did not drink. There was a more than 13 fold increase when six or more drinks were consumed.
Findings in this study have considerable implications for national policy, injury prevention, clinical practice, reporting systems, and for further research. The low rate of compliance with existing laws and a generally low perceived legal risk toward drink-driving in this study call for the strengthening of enforcement along with mass media campaigns and news coverage in order to decrease the widespread perception of impunity and thereby, to reduce the level of drink-driving. In addition, no significant difference was found in this study on risk of traffic injuries between car drivers and motorcycle drivers. The current inconsistency between legal BAC for drivers of motorcycles, compared to cars, thus needs addressing. Furthermore, as drinking was found to be very common, rather than solely targeting drink-driving, it is important to call for a more strategic and comprehensive approach to alcohol policy in Viet Nam. This study also has considerable implications for clinical practice in terms of screening and brief interventions. Our study suggests that the short form of the AUDIT (AUDIT-C) screening tool is appropriate for use in busy emergency departments. The high proportion of traffic injured patients with evidence of alcohol abuse or hazardous drinking suggests that brief interventions by alcohol and drug counselors in emergency departments are a sensible option to addressing this important problem.
Educational programs to raise awareness of drinkers and the general community on drink-driving are urgently needed in Vietnam. These programs should include education on responsible drinking and beverage service. The most productive intervention would be to encourage people not to drive to drinking events. Encouraging alternative transport both to and from the venue, relieving drinkers of their anxieties around leaving their vehicles unprotected.
This study also has considerable implications for clinical practice in terms of screening and brief interventions. Our study suggests that the short form of the AUDIT (AUDIT-C) screening tool is appropriate for use in busy emergency departments. The high proportion of traffic injured patients with evidence of alcohol abuse or hazardous drinking suggests that brief interventions by alcohol and drug counselors in emergency departments are a sensible option to addressing this important problem. For further study, the case-crossover offered obvious advantage of eliminating interpersonal confounding and problems in selecting control groups. As the patients serve as their own control, the procedure take away confounding from many uncontrollable determinant of patient outcomes, such as age, socio-economic status, and geographical figures. From the statistical perspective, the pair-matching in case-crossover design is more powerful compared to group-matching (as in a randomized trial). As it was not necessary to recruit control group, the case-crossover design helped to assure the feasibility of the study in terms of time and cost.
This is the first study of its kind in Vietnam and one of a limited number of studies conducted in developing countries that examines the drinking patterns, perceptions of drink-driving and the risk of traffic injury after alcohol consumption among males. The study was conducted in hospital and restaurant settings and involved more than one thousand male patrons and male traffic injured patients. The significance of the study is employing a combination of the systematic collection of breath test and use of case-crossover design to estimate the risk of traffic injuries after alcohol consumption. Most of all, the results provide convincing evidence to policy makers, health authorities and the media to help raise community awareness and policy advocacy toward the drink-driving problem in Vietnam. The study provide a better understanding of contemporary drink-drivers thus should inform the formulation of interventions designed to reduce drinking and driving in Vietnam and other developing countries. The findings suggest an urgent need for a multi-sectoral approach to curtail drink-driving in Vietnam, especially programs to raise community awareness and effective legal enforcement.
The next slides will present research variables and analysis plan for each objective For the first objective, we will use the case-crossover design to estimate the risk of traffic injuries after alcohol consumption. Case-crossover design is a scientific way to … Case-crossover is a design that compares …
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