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1 Jamie Dow MBA MD Émilie Turmel BSc Société de l assurance automobile du Québec NMEDA, Quebec 23 septembre septembre ( ) Société de l'assurance automobile du Québec, 2010 Page 1

2 The study 5-year project To examine : crash risk associated with medical conditions the effect of the severity of medical conditions upon crash risk the effectiveness of voluntary reporting of medical conditions the effectiveness of physician reporting (possibly) crash risk associated with medications

3 Situation Quebec has 4.9 million drivers /7.7 million population Universal health care coverage (RAMQ) Universal insurance coverage for personal injury caused by a road accident One agency administers road injury insurance, drivers permits and vehicle matriculation (SAAQ) Four-year approval process in order to combine both data banks SAAQ and RAMQ

4 Method Health insurance, hospitalisation and medications data obtained from Health Insurance Board (RAMQ) for all drivers with permits All health data grouped using the 3M CRG software Each driver assigned to a unique Clinical Risk Group (CRG) The CRG assigned reflects the nature and the severity of the driver s medical condition The basic health data may still be accessed (dx)

5 Data permit holders submitted to RAMQ were matched with their health data Health data obtained 1 July June drivers retained for study CRGs were assigned for each driver CRGs were then assigned to groupings that corresponded to the sub-divisions of the QC medical standards for drivers Data was analysed according to age, sex and permit class

6 Our population male drivers female drivers Age: 16 to 100 Permit class: Beginners:

7 Clinical Risk Groups Nine levels with increasing severity 1 Healthy 2 Significant acute illness 3 Single minor chronic disease 4 - Minor chronic disease in multiple organ systems 5 Single dominant or moderate chronic disease 6 Significant chronic disease in multiple organ systems 7 Dominant chronic disease in 3 or more organ systems 8 Dominant, metastatic and complicated malignancies 9 Catastrophic conditions

8 CRG Distribution

9 CRG Distribution 1,48% 0,73% 0,21% 7,20% 1 - Healthy + 17,43% 4 - Minor chronic disease multiple systems 2,50% 70,46% 5 - Single dominant or moderate chronic disease 6 - Significant chronic disease multiple systems 7 - Dominant chronic disease 3 or more systems 8 - Dominant, metastasic and complicated malignancies 9 - Catastrophic conditions

10 Drivers health 2003 Dementia 0% Endocrinology 4% Cancer 9% Other 20% Cardiac 22% Locomotor 6% Multiple 7% Diabetes 12% Psychiatry 10% Neurology 4% Vision 3% Respiratory 3%

11 Predicted versus observed medical conditions Predicted Study Healthy Cardiac Diabetes Predictions: Institut de la statistique du Québec: 2009

12 Voluntary declarations

13 Drivers health ,40% 70,60% Healthy/Minor Identified Condition

14 Drivers declarations 33,45% 66,55% Declaration No declaration

15 Voluntary declarations 80,00% 70,00% 60,00% 50,00% 40,00% 30,00% 20,00% 10,00% 0,00%

16 Diabetes declarations Dx Diabetes Declaration

17 Psychiatric declarations Psychiatric Dx Declaration

18 Class 1 drivers declarations 19,21% 80,79% Declaration No declaration

19 Class 1 drivers declarations 80,00% 79,43% 70,00% 60,00% 50,00% 40,00% 30,00% 20,00% 10,00% 0,00% 4,15% 6,07% 4,06% 0,86%1,25% 0,08% 0,87%0,35%0,07%0,04%0,07%0,32%0,05% 0,78% 0,99% 0,56%

20 Comparison declarations Class 1 versus all classes 80,00% 70,00% 60,00% 50,00% 40,00% 30,00% Class 1 All classes 20,00% 10,00% 0,00%

21 >65 drivers Men: Women: Total: % of the total driving population Page 21

22 Comparison >65 drivers with general driving population >65 All Men 61.24% 53.53% Women 38.76% 46.47%

23 Age groups Men Women Total > Total Page 23

24 Classes of permit Class % Class % Class % Class 4a % Class 4b % Class 4c % Class % Class 5 & motorcycle % Class 5 Learner %

25 Older drivers health 2003 Healthy General population 39.66% Population > % Of all who are healthy Men > % Women > % Of those > 65 who are healthy Men 57.54% Women 42.46%

26 Healthy Men >65 Men Healthy % % % % % % % % Total %

27 Healthy women >65 Women Healthy % % % % % % % % Total %

28 Healthy Men versus women drivers > 65 Men Women % 13.56% % 9.23% % 6.88% % 4.79% % 4.35% % 7.19% % 7.69% Total 8.97% 10.85%

29 Older drivers health 2003 Heart attack General population 1.47% Population > % Of all who had a heart attack Men > % Women > % Of those > 65 who had a heart attack Men 80.42% Women 19.58%

30 Heart attacks Men drivers > 65 Men With heart attack % % % % % % % % Total %

31 Heart attacks women drivers > 65 % Women With heart attacks % % % % % % Total %

32 Heart attacks Men versus women drivers > 65 Men Women % 2.25% % 3.33% % 4.78% % 6.54% % 9.08% % 10.07% % 15.38% Total 8.97% 3.45%

33 Older drivers health cataracts Cataracts General population 3.02% Population > % Of all who have cataracts Men > % Women > % Of those > 65 who have cataracts Men 56.46% Women 45.54%

34 Cataracts Men drivers > 65 Men With cataracts % % % % % % % % Total %

35 Cataracts women drivers > 65 Women With cataracts % % % % % % % % Total %

36 Cataracts Men versus women drivers > 65 Men Women % 14.25% % 24.38% % 31.76% % 34.95% % 32.63% % 25.90% % 38.46% Total 18.29% 22.28%

37 Older drivers health 2003 high blood pressure High blood pressure General population 16.10% Population > % Of all who have high blood pressure Men > % Women > % Of those > 65 who have high blood pressure Men 59.44% Women 40.56%

38 High blood pressure Men drivers >65 Men With HBP % % % % % % % % Total %

39 High blood pressure Women drivers >65 % Women With HBP % % % % % % % Total %

40 High blood pressure Men versus women drivers > 65 Men Women % 49.07% % 58.21% % 64.08% % 68.79% % 70.94% % 71.22% % 61.54% Total 52.25% 56.34%

41 Older drivers health diabetes Diabetes General population 6.28% Population > % Of all who have diabetes Men > % Women > % Of those > 65 who have diabetes Men 70.09% Women 29.91%

42 Older drivers health stroke Stroke (including TIA) General population 1.06% Population > % Of all who have had a stroke Men > % Women > % Of those > 65 who have had a stroke Men 69.67% Women 30.33%

43 Older drivers health 2003 substance abuse/dependency Substance abuse/dependency General population 1.59% Population > % Of all who have substance abuse/dependency Men > % Women > % Of those > 65 who have substance abuse/dependency Men 78.63% Women 21.37%

44 Older drivers health 2003 dementia Dementia General population 0.48% Population > % Of all who have dementia Men > % Women > % Of those > 65 who have dementia Men 68.77% Women 31.23%

45 Voluntary declaration >65 drivers 14,00% Drivers >65 with diagnosed condition 12,00% 10,00% 8,00% 6,00% 4,00% Drivers >65 with diagnosed condition 2,00% 0,00%

46 Declarations to the SAAQ by physicians for drivers >75 Chest pain/angina Age of drivers Health records Declared to SAAQ

47 Declarations to the SAAQ by physicians for drivers >75 Chest pain/angina 25.00% Heart attack 35.76% Congestive heart failure 24.03% High blood pressure 62.57% Respiratory (asthma, etc) 27.60% Cataracts 63.84% Glaucoma 33.73% Macular degeneration 39.49% Epilepsy 42.33% Diabetes 64.67%

48 Voluntary versus physicians declarations 70,00% 60,00% 50,00% 40,00% 30,00% Voluntary Physicians 20,00% 10,00% 0,00% Epilepsy Diabetes HBP Resp

49 Conclusions Most drivers report medical conditions they believe will not influence permit retention Voluntary disclosure of medical conditions is an unreliable source of information on the medical status of the driver Physicians tend to be selective in reporting conditions that may influence permit status Consequently, health data solicited without the accompanying health records is suspect

50 This study is financed and conducted by the SAAQ The study has been approved by the Commission d accès à l information du Québec and complies with all privacy of personal information laws. No personal information acquired through the study may be utilised by the SAAQ in its daily operations. Use of the CRG programme was made possible through an arrangement with 3M Canada. Particular thanks to Dr Marc Berlinguet and Jon Eisenhandler, 3M HIS Inc., USA Queries and correspondence: Dr Jamie Dow: jamie.dow@saaq.gouv.qc.ca

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