1. Motorcycle Related Crash Victims and Their Associates Hospital Charges in Illinois Mehdi Nassirpour Wei Wu Illinois Department of Transportation Division of Transportation Safety Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

2. Objectives Overview of the Traffic Safety Programs Overview of the Traffic Safety Programs Overview of Facts on Motorcycles Overview of Facts on Motorcycles Limitations of Crash Data Limitations of Crash Data Data Linkage Programs (CODES) Data Linkage Programs (CODES) Motorcycle Related injuries and Cost Motorcycle Related injuries and Cost Results and Policy Implications Results and Policy Implications Future Plans Future Plans Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

3. Illinois Highway Safety Program Areas Occupant Protection Occupant Protection Impaired Driving Impaired Driving Speed Control Speed Control Traffic Records Traffic Records Emergency Medical Services Emergency Medical Services Pedestrian/Bicycle Pedestrian/Bicycle Motorcycle Safety Motorcycle Safety Large Truck Large Truck Police Traffic Services Police Traffic Services Distracted Driving Distracted Driving We are required to identify those programs most effective in reducing crashes, injuries, and deaths, and eligible use of highway safety funds awarded to the State of Illinois Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

4. Highlights of Activities and Accomplishments Coordinated with other highway safety programs during major safety campaigns (CIOT, YD&DYL, and Drive Sober or Get Pulled Over. Coordinated with other highway safety programs during major safety campaigns (CIOT, YD&DYL, and Drive Sober or Get Pulled Over. Student training has increased from 16,701 in 2009 to 20,361 in 2012, an increase of 21.9% annually. Student training has increased from 16,701 in 2009 to 20,361 in 2012, an increase of 21.9% annually. Educational outreach has increased through educational/promotional events from 3 per year to 15 events in 2013. Educational outreach has increased through educational/promotional events from 3 per year to 15 events in 2013. Produced and aired first public informational videos for television in 2010 - 2013. Produced and aired first public informational videos for television in 2010 - 2013. Developed and went online with www.STARTSEEINGMOTORCYCLES.org web site. Developed and went online with www.STARTSEEINGMOTORCYCLES.org web site. www.STARTSEEINGMOTORCYCLES.org Developed and distributed a new “START SEEING MOTORCYLES” and “DON’T DRINK AND RIDE” poster for distribution at various locations statewide. Developed and distributed a new “START SEEING MOTORCYLES” and “DON’T DRINK AND RIDE” poster for distribution at various locations statewide. Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

5. What We Know about Motorcycles  Motorcyclists have high death rates  Motorcycle deaths are increasing  Motorcycles are becoming popular  About 50% of motorcycle driver deaths involved in Single vehicle crashes  Demographics--average age of riders is going up (37)  Engine size is increasing—The higher the engine size, the higher the probability of being fatally injured Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

6. What We Know about Motorcycles  Rider Characteristics differ by types of motorcycles  Alcohol use is a problem among motorcyclists  Supersport motorcycles have the highest overall collisions  Motorcycles don’t have safety gear that is comparable to what we found in passenger cars  Rider safety training and education tend to reduce motorcycle related crashes (based on anecdotal information) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

7. Helmet Laws Laws requiring all motorcyclists to wear a helmet are in place in 19 states (Universal Helmet Law). Laws requiring all motorcyclists to wear a helmet are in place in 19 states (Universal Helmet Law). Laws requiring only some motorcyclists (most often age 17 and under) to wear a helmet are in place in 28 states. Laws requiring only some motorcyclists (most often age 17 and under) to wear a helmet are in place in 28 states. Two states (Florida and Michigan) allow motorcyclists over the age of 21 to ride without helmet if they have a certain level of medical insurance (over $10,000 or $20,000). Two states (Florida and Michigan) allow motorcyclists over the age of 21 to ride without helmet if they have a certain level of medical insurance (over $10,000 or $20,000). There is no motorcycle helmet use law in 3 states (Illinois, Iowa, and New Hampshire). There is no motorcycle helmet use law in 3 states (Illinois, Iowa, and New Hampshire). Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

8. Motorcyclist Fatalities Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

9. Change in Composition of Fatalities Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

10. Registered Motorcycles in Illinois by Year Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

11. Motorcycle Fatalities and Fatality Rate Per 100,000 Registered Motorcycles, by Year (Illinois) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

12. Motorcycle Fatalities and Fatality Rate Per 100,000 Registered Motorcycles, by Year (US) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

13. Percent No Valid Motorcycle License Among Motorcycle Riders Involved in Fatal Crashes by Year (Illinois Versus US) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

14. Total Motorcycle Fatalities and Licensed Motorcyclists by Age (2010-2012) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

15. Percent Helmeted Motorcyclists who died in Motor Vehicle Crashes by Age (2010-2012) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

16. Motorcycle Fatalities, Total Injuries, and A-Injuries by Age Group (2010-2012) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

17. Motorcycle Fatalities, Total Injuries, and A- Injuries by 23 County Model Location (2010-2012) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

18. Percent Fatalities by BAC Test in 2012 Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

19. Motorcycle Fatalities, Total Injuries, and A-Injuries by Time of Day (2010-2012) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

20. Motorcycle Helmet Use for Fatalities, Total Injuries, and A-Injuries by Time of Day (2010-2012) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

21. Illinois Data Linkage Project (Crash Outcome Data Evaluation System) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

22. What is CODES? Crash Outcome Data Evaluation System Crash Outcome Data Evaluation System CODES evolved from the (Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA 1991)--ISTEA mandated that National Highway Traffic Safety Administration (NHTSA) to prepare a report to Congress about the benefits of safety belt and helmet use. CODES evolved from the (Intermodal Surface Transportation Efficiency Act of 1991 (ISTEA 1991)--ISTEA mandated that National Highway Traffic Safety Administration (NHTSA) to prepare a report to Congress about the benefits of safety belt and helmet use. NHTSA sponsored the CODES projects and awarded grants to several states to link their databases. NHTSA sponsored the CODES projects and awarded grants to several states to link their databases. Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

23. CODES (Data Linkages) Provide funding to states to link their existing traffic- safety related databases Provide funding to states to link their existing traffic- safety related databases Injuries resulting from motor vehicle crashes is a major public health problem. Injuries resulting from motor vehicle crashes is a major public health problem. Injuries can be prevented, or reduced, if we understand their type, severity and cost. Injuries can be prevented, or reduced, if we understand their type, severity and cost. Crash data alone do not indicate the injury problem in terms of the medical and financial consequences. Crash data alone do not indicate the injury problem in terms of the medical and financial consequences. By linking crash data to their specific medical and financial outcomes, we can identify prevention factors. By linking crash data to their specific medical and financial outcomes, we can identify prevention factors. Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

24. Strategy Link crash report records to medical treatment records in a computer database to learn the full story Link crash report records to medical treatment records in a computer database to learn the full story Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

25. Data Linkage Model Bayesian Statistical Theory—The main objective of this theory is to calculate the probability of an uncertain claim in light of prior information and new experimental evidence. Bayesian Statistical Theory—The main objective of this theory is to calculate the probability of an uncertain claim in light of prior information and new experimental evidence. Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

26. CODES2000/Linksolve Linkage Software It is developed by Strategic Matching, Inc. that had contract with NHTSA. It is a probabilistic records Linkage Software that includes effective algorithms for data preparation, analysis, and comparison. Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

27. Benefits of Linked Data Linked data can be disaggregated to provide information to local communities. Linked data can be disaggregated to provide information to local communities. Linkage enhances the value of each state data file being linked by expanding the comprehensiveness of each state data set. Linkage enhances the value of each state data file being linked by expanding the comprehensiveness of each state data set. Linkage provides access to more detailed medical information for highway and traffic safety evaluation; and linkage provides more detailed safety information for injury control purposes. Linkage provides access to more detailed medical information for highway and traffic safety evaluation; and linkage provides more detailed safety information for injury control purposes. Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

28. Benefits of Linked Data Collaboration of traffic safety and health care communities Collaboration of traffic safety and health care communities The linked data can be used by multiple users for different purposes. The linked data can be used by multiple users for different purposes. The linked data process results in increased data quality. The linked data process results in increased data quality. Linking data encourages standardized and computerization of state data. Linking data encourages standardized and computerization of state data. Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

29. Linked Data Process in (2010-2011) Hospital Inpatient and Emergency Department (ED) Database Crash Total Crash Victim= 1,323,842 Linked Total =105,828 Outpatient =98,829 Inpatient =6,999 Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO Total Hospital Records= 2,454,006

30. Frequency and Percentage Distribution of All Crashes and Motorcycle Crashes All Crash persons Motorcycle Occupants Individuals involved in Crash FrequencyPercentFrequencyPercent Total hospital discharge data used for the linkage 2,454,006100.0% -- Total inpatient discharge records 192,2387.83% -- Total outpatient discharge records 2,261,76892.2% -- Total number of individuals involved in crashes 1,323,842100.0%8,647100.0% Linked hospital inpatients7,0000.53%1,10212.7% Linked hospital Outpatient98,8287.5%3,33138.5% Linked crash individuals (in & out) 105,8288.0%4,43351.3% Not linked crash individuals1,218,01492.0%4,21448.7% Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

31. Percent Total Inpatient and Outpatient Motorcycle Occupants by Gender Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

32. Percent Total Inpatient and Outpatient Motorcycle Occupants by Age Group Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

33. Motorcycle Fatalities, Total Injuries, and A- Injuries by Age Group (2010-2011) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

34. Helmet Use by Age Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

35. Frequency and Percentage Distributions of Linked Motorcycle Occupants By Helmet Status HelmetedNot Helmeted Miscoded /Not Available Inpatient Discharge 393 (35.7%) 706 (64.1%) 3 (0.2%) Outpatient Discharge (ED) 1442 (43.3%) 1872 (56.2%) 16 (0.5%) Total Hospital Discharge 1835 (41.4%) 2578 (58.2%) 19 (0.4%) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

36. Percent Head Injuries by Helmet Status Total helmeted with head injury =225 Total helmeted with no head injury=1610 Total Not helmeted with head injury =590 Total Not helmeted with no head injury=1988 Note: the relationship between Helmet use and head injury is significant. Odd Ratio (OR) value is over 0.34 indicates that wearing helmet a protective against head injury. Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

37. Frequency and Percentage Distributions of Helmet Use and Head Injury Helmet UseNo InjuryMinor ModerateSeriousSevereCritical No Helmet 20051501696816243 % 77.20%5.78%6.51%2.62%6.24%1.66% Helmeted 16103793315212 % 87.74%2.02%5.07%1.69%2.83%0.65% All 36151872619921455 % 81.58%4.22%5.89%2.23%4.83%1.24% Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

38. Average Hospital Charge Per Discharge All Crash Victims Motorcycle Occupants Inpatient Discharge $68,659$86,703 Outpatient Discharge (ED) $4,407$7,576 Total Hospital Discharge $8,657$27,248 Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

39. Average Hospital Charge by Age Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

40. Average Hospital Charge Per Discharge (Mean) HelmetedNot Helmeted Percent Difference Inpatient Discharge $86,644$86,7370.11% Outpatient Discharge (ED) $6,936$8,06516.28% Total Hospital Discharge $24,015$29,53222.97% Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

41. Average Hospital Charge Per Discharge (Median) HelmetedNot Helmeted Percent Difference Inpatient Discharge $44,928$45,5051.28% Outpatient Discharge (ED) $3,931$5,24633.44% Total Hospital Discharge $6,028$9,01549.56% Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

42. Mean Charges by Gender Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

43. Research Questions What variables predict a head injury? What variables predict a head injury? What Variables Predict Hospital Charges What Variables Predict Hospital Charges Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

44. Definition of Selected Variables Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO VariablesDefinition Gender Dummy variable with a value of 1 for male occupants and 0 for female occupants AgeSelf-explanatory Occupant TypeDummy variable with a value of 1 for operator and 0 for passenger Time of Day Dummy variable with a value of 1 for occupants involved in nighttime crashes (6:00PM – 5:59AM) and 0 for occupants involved in daytime crashes (6:00AM – 5:59PM) Day of Week Dummy variable with a value of 1 for occupants involved in weekend crashes and 0 for occupants involved in weekday crashes Crash Location Dummy variable with a value of 1 for occupants involved in crashes on rural roads and 0 for occupants involved in crashes on other roads Alcohol Involvement Dummy variable with a value of 1 for occupants involved in alcohol related crashes and 0 for all other occupants Helmet Use Dummy variable with a value of 1 for occupants wore helmet in crashes and 0 for all unprotected occupants involved in crashes Injury location Dummy variable with a value of 1 for occupants experienced head injury from crashes and 0 for all other occupants who do not have head injury from crashes. Intersection Related Dummy variable with a value of 1 for occupants who are involved in Intersection-related crashes and 0 for all other occupants who are not involved in intersection-related crashes Hospital Charges Total hospital charge per discharge

45. Result of Logistic Regression Analysis on Head Injury SELECTED VARIABLESEstimateStd Error Chi SquareP-valueOdd Ratio Intercept -2.20450.0850672.5434<.0001 HELMET STATUS (HELMETED=1) -0.65400.1026-6.38<.0001 0.519 ALCOHOL IMPAIRMENT (IMPAIRED=1) 0.68840.10946.29<.0001 1.237 GENDER (MALE=1) 0.21270.16461.290.1967 1.237 AGE 0.00930.00293.170.0015 1.009 RURAL/URBAN (RURAL=1) -0.01240.0949-0.130.8959 0.990 TIME OF CRASH (Night=1) 0.29520.08693.40.0007 1.047 DAY OF WEEK (WEENKEND=1) 0.04760.08530.560.5771 1.127 OPERATOR/PASSENGER (OPERATOR=1) 0.11640.21250.550.5846 0.840 INTERSECTION-RELATED (INTERSECTION=1) -0.17420.0877-1.980.0473 1.066 SPEED RELATED (SPEED=1) 0.06170.09630.640.5241.749 Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

46. Results of Regression Analysis on Hospital Charges SELECTED VARIABLESEstimateStd Errort ValuePr > |t| Intercept 8.3852946470.04118056203.62<.0001 HELMET STATUS (HELMETED=1) -0.1174296300.01826189-6.43<.0001 ALCOHOL IMPAIRMENT (IMPAIRED=1) 0.2536351550.028335488.95<.0001 GENDER (MALE=1) -0.1256760450.03295624-3.810.0001 AGE 0.0076314910.0006411811.90<.0001 RURAL/URBAN (RURAL=1) -0.0789321290.01999662-3.95<.0001 TIME OF CRASH (Night=1) 0.0566507620.019253612.940.0033 DAY OF WEEK (WEENKEND=1) 0.0117618660.018125500.650.5164 OPERATOR/PASSENGER (OPERATOR=1) 0.2640757350.040156456.58<.0001 HEAD/NO HEAD INJURY (HEAD INJURY=1) 0.4831351200.0078138161.83<.0001 INTERSECT RELATED (INTERSECTION=1) -0.1165741960.01882384-6.19<.0001 SPEED RELATED (SPEED=1) 0.1404181780.018975807.40<.0001 Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

47. Definition of Serious Injury The FHWA recommends “serious injuries” as “`suspected serious injury' (A)” as identified in the latest edition of the MMUCC. The MMUCC definition of a suspected serious injury (A) is any injury, other than fatal, which results in one or more of the following: 1.Severe laceration resulting in exposure of underlying tissues, muscle, organs, or resulting in significant loss of blood; 2.Broken or distorted extremity (arm or leg); 3.Crush injuries; 4.Suspected skull, chest, or abdominal injury other than bruises or minor lacerations; 5.Significant burns (second and third degree burns over 10 percent or more of the body); 6.Unconsciousness when taken from the crash scene; or 7.Paralysis. (Illinois Definition: severe lacerations, broken limbs, skull or chest injuries, and abdominal injuries) Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

48. Problem with Definition of Serious Injury The DOT also recognizes that as serious injury data is migrated to the MMUCC definition, variances may occur in the data collected and reported by States and that States should make necessary adjustments in establishing targets to accommodate these changes. Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

49. Proposed Solution Finally, in section 490.207(d), the FHWA recommends, but would not require, that States prepare themselves so that no later than calendar year 2020, serious injuries data is collected through and reported by a hospital records injury outcome reporting system that links injury outcomes from hospital inpatient and emergency discharge databases to crash reports. An example of a crash outcome data linkage system is the NHTSA Crash Outcome Data Evaluation System (CODES). Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

50. Comparing KABCO to MAIS Categories Max AIS Score by Crash Severity Level for Year 2010-2011 Max AIS Property Damaged OnlyMildModerateIncapacitatedKilledTotal Scores N%N%N%N%N%N% No Injury 10.5%41.9%231.0%140.8%139.5%551.2% Mild 13666.7%15467.0%126758.4%52431.0%2417.9%210547.5% Moderate 5325.9%5925.5%64829.9%60936.0%2316.7%139131.4% Serious 73.3%73.2%1506.9%32519.2%2719.8%51611.6% Severe 63.0%52.3%753.5%19711.6%128.6%2956.7% Critical 10.7%00.0%70.3%241.4%3726.8%691.6% Maximum 00.0%0 0 10.1%10.7%20.0% All 203100.0%230100.0%2169100.0%1694100.0%137100.0%4433100.0% Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

51. Future Plan Complete the analysis of the linked data Develop a comprehensive profile of Motorcyclists who injured in motor vehicle crashes using 2012 data Produce Fact Sheets and reports on several traffic safety issues Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO

52. Contact Information Mehdi Nassirpour Wei Wu Division of Traffic Safety at IDOT 1340 North 9 th Springfield, IL 62702 Email: Mehdi.nassirpour@illinois.gov DTS’ Evaluation Website: http://www.dot.il.gov/trafficsafety/tsevaluation.html Contact Information Mehdi Nassirpour Wei Wu Division of Traffic Safety at IDOT 1340 North 9 th Springfield, IL 62702 Email: Mehdi.nassirpour@illinois.gov DTS’ Evaluation Website: http://www.dot.il.gov/trafficsafety/tsevaluation.html Presented at the International Forum on Traffic Records & Information Systems in St. Louis, MO