Roadway crash risks in recent immigrants
Highlights
► Recent immigrants are sometimes characterized as unsafe drivers and responsible for excess road crashes. ► This study examined almost one million immigrants to one of the most ethnically diverse regions of North America. ► The findings suggest that recent immigrants are less likely to be drivers involved in a serious motor vehicle crash compared to long-term residents. ► These results call into question common risk perceptions and a widespread negative stereotype. ► The differences in crash risks are unlikely to reflect differences in diet, genetics, or language that would be difficult for an adult to change.
Introduction
Motor vehicle crashes are a widespread cause of death and disability that accounts for about $33 billion in health care costs annually in North America (Blinco et al., 2002, SMARTRISK, 2009). Most crashes are caused by driver error and could have been prevented by a small change in driver behavior (McFarland and Moore, 1957). A frequently blamed group of drivers are adult immigrants as typified by negative stereotypes (Braun, 1989, Bode, 2008, Corbett, 2010, Milano, 2009, Pearlman, 1999). Such beliefs are based on the person's presumed lack of familiarity with geographic locations, roadway layout, prevailing laws, common customs, local signage, social etiquette, basic skills, or language idioms (Statistics Canada, 2010). A negative image of foreign travelers on public roads is also reinforced by anecdotes of tourists fumbling with maps, violating norms, or delaying the transit of surrounding commuters (Booker, 2005).
Research in medical domains indicates that immigrants are not always a drain on public resources. Indeed, recent immigrants sometimes show reduced amounts of cardiovascular strokes, maternal placental syndromes, and other medical diseases (Chen et al., 1996, Ray et al., 2007, Saposnik et al., 2010b). Some of the risk reduction reflects self-selection by individuals (those with marginal health choose not to change home countries) or by government (screening policies that reject candidates failing basic health standards) (Palloni and Arias, 2004). Many other factors might contribute to some advantages observed in recent immigrants including differences in genetics, diet, and culture. Another factor among immigrants might be that the decreased amount of local experience is accompanied by an increased sense of personal trepidation (Slovic, 1987).
The objective of this study was to test whether recent immigrants are predisposed to serious motor vehicle crashes. If true, an increased risk might argue for restricted driver licenses, higher vehicle insurance premiums, or more intense public safeguards (Canada Immigration Services, 2011). Otherwise, policies might prioritize public health education and protective caution for long-term residents despite their years of local experience. Studies of driver error, for example, suggest that long-term overconfidence is a widespread and intense reason explaining why drivers fail to follow basic safety practices (Gregersen, 1996, Koustanaï et al., 2008, Petridou and Moustaki, 2000). The many overt differences between recent immigrants and long-term residents, therefore, provide an integrated test of a combination of human factors contributing to road trauma.
Section snippets
Setting
Ontario in 2006 (accrual end-point) was characterized by 8,867,965 licensed drivers, 8,016,875 registered motor vehicles, 130 billion kilometers of driving, and 216,247 reported crashes (of which 5626 resulted in hospital admission) (Ontario Ministry of Transportation, 2006, Ontario Ministry of Transportation, 2009). Ontario was also Canada's most populous province, accounting for one-third of the population and one-half of new immigrant arrivals (Statistics Canada, 2007a). From 1996 to 2006
Overview
A total of 4,238,222 individuals were included in our study of whom 965,829 were recent immigrants and 3,272,393 were long-term residents. The overall match ratio was about 3.4 and reflected 387,342 recent immigrants matched to 5 controls, 105,411 recent immigrants matched to 4 controls, 137,007 recent immigrants matched to 3 controls, 166,949 recent immigrants matched to 2 controls, and 169,120 recent immigrants matched to 1 control. Overall, 105,167 recent immigrants were unmatched and
Summary
We studied almost one million recent immigrants in one of the most ethnically diverse regions of North America. We found that recent immigrants were less likely to be drivers involved in a serious motor vehicle crash compared to long-term residents. This pattern was difficult to attribute to chance, persisted after adjustment for baseline characteristics, extended to the highest levels of crash severity, and was particularly large during the early years following immigration. In contrast,
Conclusions
We do not know which specific errors prevail among the general population and contribute to about 2000 hospital admissions for road trauma each day in North America (National Highway Traffic Safety Administration, 2010). The data from recent immigrants suggests, however, that more than a third of these admissions might be prevented by a change in behavior. At face value, the differences in crash risks are unlikely to reflect differences in diet, genetics, or language that would be difficult for
Conflict of interest
The funding organizations had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript. All authors had no financial or personal relationships or affiliations that could influence the decisions and work on this manuscript. The lead author had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the analysis.
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