事故車輛與環境因素對台灣高齡機車騎士於事故後三十天內死亡影響之流行病學研究

Epidemiological study on the impact of vehicle-related and environmental factors on 30-day mortality after motor vehicle crashes among older motorcycle riders in Taiwan

目標：本研究旨在評估人口學、受傷嚴重度、共病、駕駛行為、環境、與車輛等因素對高齡機車騎士在事故後30天內死亡的獨立貢獻度，並探討環境與車輛因素是否對死亡風險具有額外的解釋力。方法：本研究從2019-2021年內政部警政署之交通事故資料中共擷取92,140名發生機車事故且有就醫的高齡機車騎士，其中1,274人於事故後30天內死亡。採階層式多元邏輯斯迴歸分析進行對數概似比檢定，評估各類風險因素對事故死亡風險的獨立貢獻和額外解釋力。結果：駕駛行為因素為死亡風險的最主要解釋因素。經控制其他因素後，可藉由非個體層面介入的車輛與道路環境因素仍具有顯著的額外貢獻，其中，事故發生於國道∕省道（aOR=1.39）、縣道∕鄉道（aOR=1.96）、一般鄉鎮市區地區（aOR=2.05）、高齡化市鎮（aOR=1.66）、農業市鎮（aOR=2.16），以及撞擊部位於側面車身（aOR=1.52）等因素都與事故死亡風險有顯著正相關。結論：本研究發現，在考量其他已知影響車禍死亡因素後，事故發生時的環境與車輛因素仍與高齡機車騎士的死亡風險呈顯著相關。

Objectives: This study examined the independent contributions of demographic characteristics, injury severity, comorbidities, and behavioral, environmental, and vehicle-related factors to 30-day mortality in older motorcycle riders involved in motor vehicle crashes. It also explored whether environmental and vehicle-related factors provide additional explanatory power for mortality risk. Methods: Data for the period between 2019 and 2021 were obtained from the Police-Reported Traffic Accident Registry. These data pertained to 92,140 older motorcycle riders who were involved in motor vehicle crashes and received medical care. Among these riders, 1,274 died within 30 days of the crash. Hierarchical multiple logistic regression analyses with likelihood ratio tests were used to assess the independent contribution of each risk factor and evaluate the additional explanatory power of each risk factor group for crash mortality. Results: Behavior was identified as the strongest predictor of 30-day mortality. After other covariates were adjusted for, vehicle- and road-environment-related factors amenable to non-individual-level interventions remained significantly associated with the risk of mortality. Crashes occurring on national or provincial roads (adjusted odds ratio [aOR] = 1.39), country or rural roads (aOR = 1.96), general townships (aOR = 2.05), areas with aging populations (aOR = 1.66), agricultural areas (aOR = 2.16), and areas involving side-impact collisions with other vehicles (aOR = 1.52) were all significantly associated with an increased risk of mortality. Conclusions: At the time of a motor vehicle crash, environmental and vehicle-related factors remain significantly associated with the risk of mortality among older riders.