title: Driver's obesity and road crash risks in the United States.
abstract: We assessed obesity trends in U.S. drivers involved in fatal crashes since 1999 and distinguished whether crash risk factors were different between obese and nonobese drivers.
  
  
  
  We included only drivers of passenger cars involved in fatal traffic crashes between January 1, 1999, and December 31, 2012. Obesity was classified according to the World Health Organization guidelines and profiled between 1999 and 2012 using the adjusted prevalence ratio (aPR) from log-binomial regression models. Differences in crash risks (e.g., driver's fatality, drunk driving, seat belt nonuse) between obese and nonobese drivers were estimated as adjusted odds ratios (aORs) using logistic regression models.
  
  
  
  A total of 753,024 U.S. drivers were involved in fatal crashes, for which obesity information was available for 534,887. About 56% (n = 299,078) were driving passenger cars. The prevalence of class I obesity increased from 10% in 1999 to 14% in 2012 (aPR = 1.50, 95% confidence interval [CI], 1.42-1.58), class II obesity from 3 to 5% (aPR = 2.22, 95% CI, 2.05-3.01), and class III obesity from 1 to 2% (aPR = 2.65; 95% CI, 2.27-3.10). Compared to nonobese controls, obese drivers had significantly higher risks for fatality (1.10 ≤ aOR ≤ 1.47), seat belt nonuse (1.00 ≤ aOR ≤ 1.21), need for extrication (1.01 ≤ aOR ≤ 1.23), and ambulance transport time ≥30 min (1.01 ≤ aOR ≤ 1.28). Compared to nonobese controls, obese drivers were less likely to drink drive (0.41 ≤ aOR ≤ 0.72) or speed >65 mph (0.78 ≤ aOR ≤ 0.93).
  
  
  
  The rising national prevalence of obesity extends to U.S. drivers involved in fatal crashes and indicates the need to improve seat belt use, vehicle design, and postcrash care for this vulnerable population.
authors.affiliation: a Evaluative Clinical Sciences, Trauma, Emergency and Critical Care Research Program, Sunnybrook Research Institute , Toronto , Ontario , Canada.|b University of Toronto , Department of Surgery , Toronto , Ontario , Canada.|c Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.
authors.forename: Junaid A
authors.initials: JA
authors.lastname: Bhatti
authors.affiliation: a Evaluative Clinical Sciences, Trauma, Emergency and Critical Care Research Program, Sunnybrook Research Institute , Toronto , Ontario , Canada.|b University of Toronto , Department of Surgery , Toronto , Ontario , Canada.|c Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|d Department of Surgery , Sunnybrook Health Sciences Centre , Toronto , Canada.
authors.forename: Avery B
authors.initials: AB
authors.lastname: Nathens
authors.affiliation: a Evaluative Clinical Sciences, Trauma, Emergency and Critical Care Research Program, Sunnybrook Research Institute , Toronto , Ontario , Canada.|b University of Toronto , Department of Surgery , Toronto , Ontario , Canada.|c Institute for Clinical Evaluative Sciences , Toronto , Ontario , Canada.|e Department of Medicine , Sunnybrook Health Sciences Centre , Toronto , Ontario , Canada.
authors.forename: Donald A
authors.initials: DA
authors.lastname: Redelmeier
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000293:Adolescent; D000328:Adult; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D009765:Obesity / Q000453:epidemiology*; D015995:Prevalence; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: body mass index; prevalence; traffic accident