Crash Outcome Data Evaluation System MORBIDITY, MORTALITY AND COSTS RELATED TO MOTOR VEHICLE CRASHES IN WHICH ALCOHOL WAS A FACTOR, WISCONSIN, 2010 Wayne Bigelow Center for Health Systems Research and Analysis University of Wisconsin Madison March, 2012 To contact the author: (608) 334-8228 wayne@chsra.wisc.edu
SUMMARY We evaluated motor vehicle crashes (MVCs) on public roads in Wisconsin for 2010 in which a police officer reported that alcohol consumption was a factor in the crash. In total, 12,101 persons were victims in alcohol related MVCs. Of those, 5,859 of those were not the responsible party. Highlights of our findings: Victims of alcohol related MVCs only made up 4.5% of all MVC victims. BUT: Victims of alcohol related MVCs made up 18.5 % of all hospitalizations Victims of alcohol related MVCs Have average costs which are 3.8 times higher and make up over 25% of all MVC related costs. Alcohol related MVCs cost Wisconsin $ 1.19 billion in 2010 221 persons (45% of all MVC fatalities), comprising 8,257 years of life lost, were victims of alcohol related MVCs. For non-responsible victims of alcohol related crahes: 896 (15.3%) visited an emergency room 168 victims (3.0%) were hospitalized three times the rate for non-alcohol related crashes 53 victims (.90%) were killed over six times the rate for non-alcohol related crashes 2,277 years of expected life were lost. For children (under 19 years): 19 were hospitalized and 7 died Drinking and driving remains a tragic problem in Wisconsin. BACKGROUND Perhaps no safety issue in transportation is more tragic than motor vehicle crashes related to alcohol consumption. Unlike motorcyclists who don t wear helmets and vehicle occupants who do not wear seat belts the consequences of which fall largely on the individual drinking and driving often involve innocent (ie. not responsible) persons. In Wisconsin, during 2010, there were 6,598 persons involved in alcohol related MVCs who were not drinking 48.4% of all persons involved in alcohol related crashes. NHTSA reports that in 2005 there were 16,885 fatalities in alcohol related crashes, one every half hour (Traffic Safety Facts 2005 Data). NHTSA also estimated that 254,000 persons were injured in alcohol related crashes, one every 2 minutes. Given the pervasiveness of the this problem and it s potential impact on transportation safety for communities and the state as a whole, we ve developed some basic information on alcohol related crashes costs and health events using the Wisconsin CODES data system. 2
METHODS Data Sources The data used in this analysis is from the Wisconsin Crash Outcomes and Data Evaluation System (CODES) database. The Wisconsin CODES project is funded through grants from NHTSA and the Bureau of Traffic Safety within the Wisconsin Department of Transportation. The CODES data is comprised of two sets of records.. The first is the Wisconsin motor vehicle crash records data. The 2010 crash data was obtained through the Wisconsin Department of Transportation (WisDOT). This crash data contains information on all reportable crashes (with at least one injury or fatality, or at least $1000 in property damage. The data are collected by police officers at the crash scene, and include detailed information on the time, location and characteristics of the crash, as well as on the vehicle(s) and occupant(s) involved. The 2010 hospital discharge and Emergency Department (ED) data is obtained from the Wisconsin Hospital Association. State law mandates that all Wisconsin licensed hospitals report all inpatient discharges. This data combines detailed information on patient demographics, up to nine ICD-9 and five procedure codes, an external cause of injury code (E-Code), charges, length of stay and admission and discharge information. Probabilistic Data Linkage The CODES analysis database was created by using a technique called probabilistic linkage. By utilizing information common to both crash and health (Emergency Department (ED) & Inpatient Hospital) data sets, probabilistic linkage iteratively estimates a set of log odds weights used to determine the probability that specific records apply to the same person and event. The information used to link Wisconsin s CODES data included sex, age, date of birth, zip code of residence, county of crash, E-code derived type of injury and dates of hospitalization and of the crash. The data linkage for 2010 was performed by staff within the Department of Health and Family Services. More information regarding probabilistic linkage can be found on the Wisconsin CODES website at: http://www.chsra.wisc.edu/codes/codes2/probabilistic%20c/probabilistic%20c.pdf. Software Probabilistic linkage was performed using CODES2000 software (Strategic Matching, New Hampshire). Statistical Analysis System (SAS) software (SAS Institute,Inc., Cary, NC) was used for all statistical analysis. Case Definitions For our analysis we defined as alcohol related all cases for which WisDOT s crash data system revealed that alcohol was indicated as a factor in the crash by the reporting police officer. This particular data element is labeled ALCFLAGA in the accident record component of the crash data, and its values are either Y or N. All other cases were defined as non-alcohol related. To determine whether a particular individual was a responsible party among persons in alcohol related crashes we utilized a special flag indicating the person for which the reporting police officer thought had been drinking (there may be more than one per accident). This data element is labeled ALCFLAG in the occupant record component of the crash data, and its values are also either Y or N. By definition, no vehicle passenger could be the responsible party only vehicular drivers, cycle/moped operators, bicycle operators and pedestrians. We then excluded all crashes which occurred in a parking lot or on private property. The data elements included in the analysis are shown in Figure 1 (next page). 3
Figure 1. Variables Used in the Analysis Alcohol Use: Age ER Visit Hospitalization Death Medical Costs Other Costs Quality of Life Costs Combines police officer report of whether or not alcohol was a factor in the crash and whether a specific person was the responsible party. < 19, 19-25, 26-35, 36-55, 55-64, 65 years or older and Missing Crash record was linked to an emergency department record. Crash record was linked to a hospital inpatient discharge record. Defined using K in the KABC0 scale in (WisDOT s crash data), and using hospital and ER discharge codes indicating death. Calculated from abbreviated injury scores and body part or region. Calculated from abbreviated injury scores and body part or region. Calculated from abbreviated injury scores and body part or region. A presentation on estimating these costs can be obtained from the author upon request.. When all three of these costs are combined they comprise Comprehensive crash costs as defined by the National Safety Council (NSC). If only Medical and Other costs are combined, the estimates comprise Human Capital model costs as used by both the NSC and NHTSA. All cost estimates are adjusted for inflation. Years of Life Lost For deaths, equal to life expectancy (75) minus age at death. 4
Table 1 shows the number of persons for whom police reported that their consumption of alcohol was a factor in causing the motor vehicle crash, as well as the number of persons who received a citation. By definition, no motor vehicle passenger is included in this group. Altogether, police reported that there were 6,242 persons whose alcohol consumption was a factor in the motor vehicle crash (MVC) they were involved with. As one would guess, most alcohol related crashes are due to motor vehicle drivers (94%) and motorcyclists (4%), with some pedestrians and a few bicyclists also being at fault. Overall, 91.3% of those persons received a citation. The percentage was greatest for motor vehicle drivers (94%) and motorcyclists (76%), with about half or less of bicyclists and pedestrians receiving citations. Table 1. Number & Percent of Persons Whose Alcohol Consumption Police Reported as Being a Factor in Causing the Crash, and the Number & Percent of Those Persons Receiving a Citation, Wisconsin, 2010 Number with Type of Person Alcohol as a Number Factor in Crash Percent Cited Percent Motor Vehicle Drivers 5,846 93.7% 5,435 93.0% Motorcycles/Moped Operators 253 4.1% 192 75.9% Bicyclists 27.4% 10 37.0% Pedestrians 116 1.9% 62 53.5% TOTAL 6,242 100.0% 5,699 91.3% 5
Table 2, below shows the number of responsible persons, and the number of other victims, by age group, along with the total number hospitalized and who died. While there were 6,242 responsible persons, there were almost as many non-responsible victims involved 5,859. There were 566 hospitalizations caused by the responsible parties (4.7% of all persons), and there were 221 persons (1.8%) who died. As can be seen, children and persons under 19 years make up over 14% (849) of all non-responsible crash victims, with 33 of them being hospitalized and 9 dying. The rates of hospitalization were highest for persons aged 36-55 (6.7%). The percentage dying were highest for 56-65 year olds (3.1). Table 2. Number of Responsible Persons, Number of Other Victims, Number and Percent Hospitalized and Died, For Alcohol Related Crashes, Wisconsin, 2010 Number Number Number of Other Persons Percent Number Percent AGE Responsible Persons Hospita- Hospita- Persons Who Persons Involved lized Lized Died Died Less Than 19 Years 323 849 33 3.1% 9.8% 19-25 Years 1,913 1,229 146 4.7% 59 1.9% 26-35 Years 1,517 849 120 5.1% 48 2.1% 36-55 Years 2,030 1,114 209 6.7% 76 2.4% 56-65 Years 396 308 40 5.7% 22 3.1% 65+ Years 143 208 17 4.8% 7 2.0% Age Missing 11 1,302 1.1% 0.0% Total 6,242 5,859 566 4.7% 221 1.8% 6
Table 3, below, shows a variety of health related outcomes, and costs, for persons involved in motor vehicle crashes where no alcohol was involved, and where alcohol was involved. The results are striking. MVC victims in crashes where alcohol is involved make up only about 4.5% of all crash victims. But they represent 18.5% of all hospitalizations and 38% of all deaths. Alcohol related MVC crash victims are 88% more likely to end up at an ER, 4.7 times as likely to be hospitalized and are 12,9 times as likely to die, as non-alcohol related MVC victims. On average, 17.7 times as many years of life are lost for each person involved in an alcohol related MVC by comparison to those involved in non-alcohol related MVCs. In total, 46% of all years of life lost due to MVCs result from alcohol related crashes. Alcohol related crashes account for almost $ 1.19 Billion in comprehensive costs, compared to $3.1 billion for non-alcohol related crashes or over a quarter of all costs. Alcohol related MVC victims have average overall costs which are almost 4 times higher than are those for non-alcohol related crashes ($253,248 compared to only $66,628). Table 3. Costs, and Health Events and Outcomes, for Persons Involved in Crashes in Which Alcohol was a Factor or Not, Wisconsin, 2010 No Alcohol No Alcohol Alcohol Alcohol Ratio of OUTCOME Involvement Involvement Involvement Involvement Alcohol to Non- MEASURE in Crash in Crash in Crash in Crash Alcohol # or $ Totals % or Average # or $ Totals % or Average Total Persons 258,353 100.0% 12,101 100.0% Ratio ER Visit 24,039 9.3% 2,115 17.5% 1.9 Hospitalized 2,493 1.0% 566 4.7% 4.7 Died 354.14% 221 1.8% 12.9 Years of Life Lost 9,990.039 8,597.71 18.2 Medical Costs $ 462 million $ 1,787 $ 100 million $ 8,259 4.6 Other Costs $2.30 billion $ 8,883 $ 529 million $ 43,745 4.9 Quality of Life Costs $1.48 billion $ 55,958 $ 5559 million $ 201,244 3.9 Total Costs $3.14 billion $ 66,628 $ 1.188 Billion $ 253,248 3.8 7
Table 4, below, shows the cost of drinking and driving for innocent victims across a variety of health related outcomes for alcohol related motor vehicle crashes. Out of 7,427 non-responsible victims: 896 (15.3%) visited an emergency room 168 victims (3%) were hospitalized almost three times the rate of non-alcohol related crashes in 2010 53 victims (.90%) were killed almost seven times the rate for non-alcohol related crashes 2,277 years of expected life were lost. For children (under 19 years): 19 were hospitalized and 7 died Table 4. Health Events and Outcomes, for Persons Involved in Alcohol Related Crashes Who Are Not Responsible, by Age Group, Wisconsin, 2010 Non- Responsible All Occupants ER Visit ER Visit Hospitalized Hospitalized Died Died Persons # % # % # % Years of Life Lost Age < 19 849 184 21.0% 19 2.2% 7.8% 442 19-25 1,229 232 18.9% 46 3.7% 18 1.5% 963 26-35 849 184 21.7% 37 4.4% 11 1.3% 496 36-55 1,114 225 20.2% 46 4.1% 10.9% 298 56-65 308 42 13.6% 7 2.3% 4 1.3% 65 65+ 208 29 13.9% 12 5.8% 3 1.4% 13 Missing 1,302 0 0.0% 1 0.1% 0 0.0% 0 ALL 5,859 896 15.3% 168 2.9% 53.90% 2,277 8