title: Traffic-law enforcement and risk of death from motor-vehicle crashes: case-crossover study.
abstract: BACKGROUND
  Driving offences and traffic deaths are common in countries with high rates of motor-vehicle use. We tested whether traffic convictions, because of their direct effect on the recipient, might be associated with a reduced risk of fatal motor-vehicle crashes.
  
  
  METHODS
  We identified licensed drivers in Ontario, Canada, who had been involved in fatal crashes in the past 11 years. We used the case-crossover design to analyse the protective effect of recent convictions on individual drivers.
  
  
  RESULTS
  8975 licensed drivers had fatal crashes during the study period. 21501 driving convictions were recorded for all drivers from the date of obtaining a full licence to the date of fatal crash, equivalent to about one conviction per driver every 5 years. The risk of a fatal crash in the month after a conviction was about 35% lower than in a comparable month with no conviction for the same driver (95% CI 20-45, p=0.0002). The benefit lessened substantially by 2 months and was not significant by 3-4 months. The benefit was not altered by age, previous convictions, and other personal characteristics; was greater for speeding violations with penalty points than speeding violations without points; was no different for crashes of differing severity; and was not seen in drivers whose licences were suspended.
  
  
  CONCLUSIONS
  Traffic-law enforcement effectively reduces the frequency of fatal motor-vehicle crashes in countries with high rates of motor-vehicle use. Inconsistent enforcement, therefore, may contribute to thousands of deaths each year worldwide.
authors.affiliation: Department of Medicine, University of Toronto, Sunnybrook and Women's College Health Sciences Centre, and Institute for Clinical Evaluative Sciences in Ontario, ON, Toronto, Canada. dar@ices.on.ca
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Tibshirani
authors.forename: Leonard
authors.initials: L
authors.lastname: Evans
mesh_terms: D000056:Accident Prevention; D000063:Accidents, Traffic / Q000401:mortality* / Q000517:prevention & control* / Q000706:statistics & numerical data; D000328:Adult; D001334:Automobile Driving / Q000331:legislation & jurisprudence* / Q000523:psychology*; D001521:Behavior Therapy; D018592:Cross-Over Studies; D005260:Female; D006801:Humans; D035846:Law Enforcement; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D012306:Risk; D012309:Risk-Taking