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Research ArticleArticle

Fibromyalgia and the Risk of a Subsequent Motor Vehicle Crash

Donald A. Redelmeier, Jeremy D. Zung, Deva Thiruchelvam and Robert J. Tibshirani
The Journal of Rheumatology May 2015, jrheum.141315; DOI: https://doi.org/10.3899/jrheum.141315
Donald A. Redelmeier
From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA. Supported by a Canada Research Chair in Medical Decision Sciences, the Canadian Institutes of Health Research, the Physicians’ Services Incorporated Foundation, and a D+H SRI Summer Student award. D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University. Address correspondence to Dr. D.A. Redelmeier, Sunnybrook Health Sciences Centre, G-151, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada. E-mail: dar@ices.on.ca Accepted for publication March 24, 2015.
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Jeremy D. Zung
From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA. Supported by a Canada Research Chair in Medical Decision Sciences, the Canadian Institutes of Health Research, the Physicians’ Services Incorporated Foundation, and a D+H SRI Summer Student award. D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University. Address correspondence to Dr. D.A. Redelmeier, Sunnybrook Health Sciences Centre, G-151, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada. E-mail: dar@ices.on.ca Accepted for publication March 24, 2015.
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Deva Thiruchelvam
From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA. Supported by a Canada Research Chair in Medical Decision Sciences, the Canadian Institutes of Health Research, the Physicians’ Services Incorporated Foundation, and a D+H SRI Summer Student award. D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University. Address correspondence to Dr. D.A. Redelmeier, Sunnybrook Health Sciences Centre, G-151, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada. E-mail: dar@ices.on.ca Accepted for publication March 24, 2015.
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Robert J. Tibshirani
From the Department of Medicine, University of Toronto; Evaluative Clinical Sciences Platform, Sunnybrook Research Institute; Institute for Clinical Evaluative Sciences in Ontario; Division of General Internal Medicine, Sunnybrook Health Sciences Centre; Center for Leading Injury Prevention Practice Education and Research, Toronto, Ontario, Canada; Department of Statistics, Stanford University, Stanford, California, USA. Supported by a Canada Research Chair in Medical Decision Sciences, the Canadian Institutes of Health Research, the Physicians’ Services Incorporated Foundation, and a D+H SRI Summer Student award. D.A. Redelmeier, MD, FRCPC, MSHSR, FACP, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario, and Division of General Internal Medicine, Sunnybrook Health Sciences Centre, and the Center for Leading Injury Prevention Practice Education and Research; J.D. Zung, BSc, Department of Medicine, University of Toronto, and the Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; D. Thiruchelvam, MSc, Evaluative Clinical Sciences Platform, Sunnybrook Research Institute, and the Institute for Clinical Evaluative Sciences in Ontario; R.J. Tibshirani, PhD, Department of Statistics, Stanford University. Address correspondence to Dr. D.A. Redelmeier, Sunnybrook Health Sciences Centre, G-151, 2075 Bayview Ave., Toronto, Ontario M4N 3M5, Canada. E-mail: dar@ices.on.ca Accepted for publication March 24, 2015.
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Abstract

Objective Motor vehicle crashes are a widespread contributor to mortality and morbidity, sometimes related to medically unfit motorists. We tested whether patients diagnosed with fibromyalgia (FM) have an increased risk of a subsequent serious motor vehicle crash.

Methods We conducted a population-based self-matched longitudinal cohort analysis to estimate the incidence rate ratio of crashes among patients diagnosed with FM relative to the population norm in Ontario, Canada. We included adults diagnosed from April 1, 2006, to March 31, 2012, excluding individuals younger than 18 years, living outside Ontario, lacking valid identifiers, or having only a single visit for the diagnosis. The primary outcome was an emergency department visit as a driver involved in a motor vehicle crash.

Results The patients (n = 137,631) accounted for 738 crashes during the first year of followup after diagnosis, equal to an incidence rate ratio of 2.44 compared with the population norm (95% CI 2.27–2.63, p < 0.001). The crash rate was more than twice the population norm for those with a new or a persistent diagnosis. The increased risk included patients with diverse characteristics, approached the rate observed among other patients diagnosed with alcoholism, and was mitigated among those who received dedicated FM care or a physician warning for driving safety.

Conclusion A diagnosis of FM is associated with an increased risk of a subsequent motor vehicle crash that might justify medical interventions for traffic safety.

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Vol. 46, Issue 12
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Fibromyalgia and the Risk of a Subsequent Motor Vehicle Crash
Donald A. Redelmeier, Jeremy D. Zung, Deva Thiruchelvam, Robert J. Tibshirani
The Journal of Rheumatology May 2015, jrheum.141315; DOI: 10.3899/jrheum.141315

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Fibromyalgia and the Risk of a Subsequent Motor Vehicle Crash
Donald A. Redelmeier, Jeremy D. Zung, Deva Thiruchelvam, Robert J. Tibshirani
The Journal of Rheumatology May 2015, jrheum.141315; DOI: 10.3899/jrheum.141315
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