Getting to Zero Alcohol-Impaired Driving Fatalities A Comprehensive Approach to a Persistent Problem (2018) / Chapter Skim
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6 Data and Surveillance Needs and Opportunities
6 Data and Surveillance Needs and Opportunities
Pages 329-376
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From page 329... ...
Having a comprehensive understanding of alcoholimpaired driving, both in regard to the rates of occurrence, traffic crashes, injuries, fatalities, arrests, and convictions, as well as qualitative data on when and why people drive while impaired, is vital to create targeted interventions to reduce it. From a public health perspective, understanding the scope and burden of alcohol-impaired driving requires triangulation across multiple sources of data to identify primary, secondary, and tertiary interventions as well as interventions that can be used prior to alcohol consumption, 329
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OVERVIEW OF AVAILABLE DATA SOURCES ON ALCOHOL-IMPAIRED DRIVING The datasets described in this section provide behavioral, crash, fatal injury, nonfatal injury, and denominator data related to alcohol-impaired driving and alcohol-related fatalities. They are summarized in Table 6-2 and grouped by the stages of the drinking-to-crash processes in the conceptual framework (see Figure 1-5)
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From page 331... ...
. The data collected cover chronic health conditions, the use of preventive services, and health-related risk behaviors, including a question pertaining to alcohol-impaired driving that has been asked biennially since 2006 (CDC, 2017a; DiMaggio et al., 2018)
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. The National Roadside Survey of Alcohol and Drug Use by Drivers was first conducted by the National Highway Traffic Safety Administration (NHTSA)
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collects information on state- and federal-level policies related to alcohol, including detailed information by state on 35 specific policies related to taxation, underage drinking, alcohol beverage pricing, blood alcohol concentration (BAC) limits, transportation, retail sales, alcohol control systems, pregnancy and alcohol, and health care services and financing (APIS, n.d.-b)
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From 1992 to 2013, NHTSA oversaw the Crash Outcome Data Evaluation System (CODES) , an autonomous system that creates probabilistic data linkages between crash report data, hospital data, and EMS data -- some states have opted to also include data from death certificates, trauma registries, driver citations, and motor vehicle licensing (Cook et al., 2015; Kindelberger and Milani, 2015; NHTSA, n.d.-d)
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, the vehicles, and the people involved by collecting data from PARs, state vehicle registration files, state driver licensing files, state highway department data, vital records department data, death certificates, coroner/medical examiner reports, and EMS reports (DiMaggio et al., 2018; NHTSA, 2014)
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Detailed data on injuries that would allow the calculation of an Injury Severity Score, and would also provide information on potential vehicle design modifications to prevent fatal injuries, are not included, as death certificates do not generally contain detailed injury descriptions. Review of autopsy reports as well as details in hospital records would be necessary to obtain this information.
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Driving record information for the 3 years prior to the fatal 6 The AAA Foundation for Traffic Safety has developed an imputation method for can nabis (AAA Foundation for Traffic Safety, 2016)
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Working to improve the FARS can be a challenge, but there would be benefits to doing so, including a unique opportunity to explore the utility of using the FARS along with other datasets to address specific issues related to alcohol-impaired driving. Another source of data for fatal motor vehicle crashes is the Webbased Injury Statistics Query and Reporting System (WISQARS)
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From page 339... ...
The data elements included in a driving record vary by state but fall under the general domains of court or administrative actions, reports of crashes, moving violations, drug- and alcohol-related offenses, licensure information and issues, and, in some cases, child support and child endangerment violations. State-level crash data are based primarily on police investigation reports.
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, and the National Hospital Discharge Dataset, which CDC also maintains. The ICD-9 codes can be translated to AIS codes using available software, and, if desired, Injury Severity Score can be calculated.
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have the highest incidence of fatal crashes. The discharge dataset alone may be helpful if one is studying a particular type of injury resulting from motor vehicle crashes; however, this is dependent on how the incidents are coded.
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In addition to data availability and quality limitations of HVMT for use as a denominator in assessing crash risk, normalizing data across HVMT may obscure the contribution of salient risk factors including, but not limited, to alcohol. There are multiple options for assessing crash risk; measures such as the crash incidence ratio (CIR)
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From page 343... ...
For example, it is difficult to assess whether the higher proportion of alcohol-impaired driving fatalities in rural areas is related to a higher number of miles traveled in rural areas as compared to urban areas, or some other factors. However, VMTs are not routinely measured, so this method of analysis cannot be used readily.
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TABLE 6-2 Strengths, Weaknesses, and Biases of Datasets That Include Information on Alcohol-Impaired 344 Driving Conceptual Data Collection Method Important Characteristics (Strengths, Framework Phase Data Source Conducted/Managed by and Data Collected Weaknesses, Biases, and Limitations) Alcohol Behavioral Centers for Disease • Telephone survey that • Health-related risk behavior question Consumption; Risk Factor Control and Prevention collects information on alcohol-impaired driving only asked Drink to Surveillance about chronic health biennially since 2006 Impairment; System conditions, use of • Conducted via telephone and thus Drive Impaired preventive services, excludes some populations and health-related risk • Nationally representative behaviors • Effective tool for tracking trends over time • Relies on self-reported data that may contain biases • Results not available on local level Youth Risk Centers for Disease • In-school survey that • Representative of adolescents in school Behavior Control and Prevention collects information • Effective tool for tracking trends over Surveillance on behaviors time System that contribute to • Relies on self-reported data that may unintentional injuries contain biases and violence, sexual • Administered in schools and thus behaviors related excludes youth not in school to unintended • Not all school districts include all pregnancy and sexually standard Youth Risk Behavior Survey transmitted infections, questions on their questionnaires diet and exercise, and drug use (including alcohol and tobacco, with questions related to alcohol-impaired driving)
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, tobacco, illegal • Relies on self-reported information drug use, and mental • Does not assess outcomes at local level health disorders National National Highway • Drivers complete • Data based on a combination of Roadside Survey Traffic Safety questionnaires physical tests and self-report, reducing of Alcohol and Administration • Breath, oral fluid, and measurement error compared to Drug Use by blood samples collected surveys relying on self-report only Drivers • Survey participation is voluntary, so those who think/know they are impaired may choose not to participate National Alcohol Alcohol Research Group • Conducted ~5 years on • Provides information on alcohol-related Surveys and National Alcohol alcohol use and alcohol- patterns and trends over time span of Research Center related problems for 35 years adults ages 18 years and older Alcohol Policy CDM Group, Inc.; • State- and federal- • Provides detailed information by Information National Institute on level policies related to state on 35 specific policies related System Alcohol Abuse and alcohol to taxation, underage drinking, Alcoholism; Pacific alcohol beverage pricing, BAC limits, Institute for Research transportation, retail sales, alcohol and Evaluation control systems, pregnancy and alcohol, and health care services and financing continued 345
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TABLE 6-2 Continued 346 Conceptual Data Collection Method Important Characteristics (Strengths, Framework Phase Data Source Conducted/Managed by and Data Collected Weaknesses, Biases, and Limitations) Motor Vehicle State Data National Highway • Data on crashes • Variability in data collected by each Crash System Traffic Safety resulting in injury, state Administration death, or vehicle • Data not readily available to the damage collected from public, as access to state data requires police accident reports permissions from that specific state • Most states report if driver had been drinking alcohol in proximity to crash; information about passengers' alcohol use usually not included Crash Outcome National Highway • Autonomous system • Provides more comprehensive Data Evaluation Traffic Safety that creates probabilistic understanding of medical and financial System Administration data linkages between consequences of a crash crash report data, • Allows for more accurate analysis of hospital data, and EMS injury diagnosis and crash severity data • Cases of missing data, data that Crash • Some states also Outcome Data Evaluation System include data from cannot access, and instances in which death certificates, data available fails to link trauma registries, driver citations, and motor vehicle licensing
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and location, System time of day, victim, known offenders, arrestees, relationships between those involved, property involved in the crime Uniform Crime Federal Bureau of • Collects statistics on • Provides less qualitative detail than Reporting Investigation violent crime (murder the National Incident-Based Reporting and nonnegligent System manslaughter, rape, robbery, and aggravated assault) and property crime (burglary, larceny, theft, and motor vehicle theft)
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, vehicles, • Well-documented methodology and people involved • Only includes information on crashes by collecting data from resulting in at least one fatality within police accident reports, 30 days of a crash state vehicle registration • Collects race and ethnicity information files, state driver from death certificates, so such data licensing files, state only known for those fatally injured highway department • Does not differentiate whether person data, vital records was impaired by a drug at time of crash department data, death certificates, coroner/ medical examiner reports, and EMS reports • Data from breath, blood, and urine BAC tests as well as police behavioral assessments • Information on whether a drug was present in a driver's system
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• Non-fatal injury data obtained through National Electronic Injury Surveillance System (emergency department data) National Trauma American College of • Trauma registry data • Does not provide national statistical Data Bank Surgeons submitted by hospitals sample throughout the country • Not all hospitals contribute data and include injury • Focused on trauma, so includes detailed event information, information on injury severity and detailed diagnoses, and injury treatment information on hospital stay and outcomes continued 349
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database • Collects data for more than 100 Emergency Research and Quality's on all-payer emergency variables, including patient Department Healthcare Cost and department visits demographic and payment information Sample Utilization Project at the national level that includes detailed information on visits related to injury from alcohol misuse and alcohol-impaired driving Denominator National Federal Highway • Transportation habits • Low response rates Data Household Administration including purpose • Difficulty reaching demographic Travel Survey of trips, how long subgroups trips take, when trips • Race and ethnicity of survey respondent take place, means of applied to rest of his or her household transportation; if in a private vehicle, number of vehicle occupants, driver's characteristics, and vehicle's attributes Highway Vehicle Federal Highway • Statistics on motor • Based on vehicle counts, therefore Miles Travel Administration fuel, motor vehicle demographics of miles traveled registration, driver unavailable licenses, highway miles • Only collected on 4,000 automatic traffic traveled, highway user recorders nationwide taxation, and highway • Limited data available on local traffic finance
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The NTDB contains information on alcohol involvement but lacks data from many hospitals with low rates of BAC testing, particularly as state laws vary on whether law enforcement has access to the results of BAC tests that are obtained for clinical purposes (Meisel, 2006)
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, which exists in the majority of states, may have some lessons to be learned about standardized data collection, as well as data linkages, as the lack of standardized and coordinated data jeopardizes public health activities in addition to law enforcement and policy development. One of the potential difficulties with NVDRS is that the same data elements may be entered from multiple sources (Crosby et al., 2016)
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Use of law enforcement estimates of severity are less specific than identifying the actual severity of injury using diagnoses made in a health care setting. Limiting attribution of a death that occurs later than 30 days after a crash may result in an underestimate of the number of fatalities caused by alcohol-impaired driving crashes.
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Information obtained from various datasets that have different data points can aid researchers and evaluators in identifying unique risk factors that are associated with the consequences of alcohol impairment. A dataset that focuses on reported alcohol consumption across various age groups in a population provides the patterns of alcohol use that are most common in various age groups.
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It is labor intensive, and there are limitations on the number of teams potentially available at any given time and costs incurred to send them to a location. Ideally public health, law enforcement, health care, traffic safety engineers, and researchers would all be involved in such an approach for studying alcohol-impaired driving.
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From page 356... ...
offer recommendations to improve source investigations through interagency collaboration, training for enforcement officials, and media coverage of the investigations. To enhance the implementation of source investigations, the National Liquor Law Enforcement Association created a toolkit as an online resource for local enforcement agencies.11 Another approach that could effectively identify areas in need of intervention is the spatial mapping of motor vehicle crashes.
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. Big Data from the Private Sector The beverage, health care, and insurance industries routinely collect massive quantities of data related to alcohol-impaired driving.
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. Sources and Opportunities for Big Data Linkages The Crash Injury Research and Engineering Network As mentioned earlier in this chapter, CIREN, which began in 1996, is a research program that links level I trauma centers through a computer network, enabling each center to add discrete crash and medical data on motor vehicle crashes to a single database (NHTSA, n.d.-a)
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are emerging. In the past few years several states have begun initiatives to leverage big data to predict high-risk crash areas and more effectively and efficiently allocate resources to improve traffic safety.
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. Each municipality began by sharing a traffic safety challenge specific to their city, around which city-specific data were used to build and train machine learning models to assess effects of and potential sites for local interventions (Grossman, 2017)
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This kind of analysis could be applied to alcohol-impaired driving. Law enforcement officers can refer to the map to locate areas with increased crash likelihood and strategically dispatch officers to these locations.
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collaboration has enabled state and municipal agencies to leverage various public and private data sources to locate traffic crash hotspots and implement proven and promising safety interventions in these areas with consideration of local circumstances. Telematics and Usage-Based Insurance Usage-based insurance involves real-time monitoring of driver behavior (vehicle miles driven, time of day, location of driving activity, speed and acceleration, and braking)
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Using GIS to Study Motor Vehicle Crashes Evidence suggests that GIS can be an effective tool for collecting geolocation data to analyze motor vehicle crashes. GIS data can be used to identify and examine a range of factors that contribute to alcoholimpaired driving fatalities, including spatial relationships between motor vehicle crashes and alcohol outlets as well as areas with high risk for crashes owing to poor roadway design and adverse weather conditions.
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(2016) analyzed spatial relationships between driving fatalities by state and adverse weather conditions.
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From page 365... ...
For example, in looking at alternative transportation as a prevention method, aggregate data on the numbers and locations of alternative transportation options, combined with information on the trends in alcohol-impaired driving crashes in the areas where alternative transportation options are available as compared to areas with limited alternative transportation options, may provide valuable information on the effect of such transports on decreasing alcohol-impaired driving crashes. This is an example of combining information from multiple datasets that illustrates the potential for combining publicly available data with private or proprietary data in a way that allows for the use of summary data rather than detailed data that a private entity might be reluctant to release.
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Ultimately this will result in a better use of resources and provide more targeted and effective solutions. Data from multiple sources (insurers, transportation sector, law enforcement, automobiles, payment systems, and so on)
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Critical issues include timeliness as well as some degree of uniformity in the reporting of variables. The committee recommends: Recommendation 6-1: The National Highway Traffic Safety Administration should ensure that timely standardized data on alcohol-impaired driving, crashes, serious injuries, and fatalities are collected and accessible for evaluation, research, and strategic public dissemination; should ensure that data
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Examples of improvements necessary for advancing the science include • Standardized data definitions across multiple sectors regarding assessment of crash occurrence, severity, and alcohol involvement; • Harmonization of reported data regarding assessment of alcohol involvement, including use of imputation models for assessment of alcohol-related crashes; • Universal assessment of drug involvement among fatally injured drivers across states; and • Increased capacity and resources for data linkages (e.g., state data systems that feed into national databanks) for research purposes across multiple systems including EMS, hospital and other care facilities, law enforcement, and medical examiners/coroners.
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The committee recommends: Recommendation 6-2: To facilitate surveillance of alcohol impaired driving that is timely, ongoing, concise, and action able, the National Highway Traffic Safety Administration should convene a diverse group of stakeholders that includes academic researchers, law enforcement, city and state public health, transportation sector, and other federal agency repre sentation to create and maintain a metrics dashboard, and pub lish brief, visually appealing quarterly and annual national and state-by-state reports that analyze and interpret progress in reducing alcohol-impaired driving. This recommendation entails identifying the data elements and data sources that are needed to monitor changes in rates of alcohol-impaired driving risk factors (including place of last drink)
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Washington, DC: National Highway Traffic Safety Administration. Berning, A., R
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DOT HS 812 179. Washington, DC: National Highway Traffic Safety Administration.
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2017. PowerPoint presentation to the Committee on Accelerating Progress to Reduce Alcohol-Impaired Driving Fatalities, Washington, DC, March 22, 2017.
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: Program transition and promising practices. Washington, DC: National Highway Traffic Safety Administration.
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Washington, DC: National Center for Health Statistics. NHTSA (National Highway Traffic Safety Administration)
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1998. The spatial relationship between licensed alcohol outlets and alcohol-related motor vehicle crashes in Gwinnett County, Georgia.
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