臺灣博碩士論文加值系統

背景：死亡車禍是全球致死的重要原因之一。職業駕駛員常常暴露於這個危險的職場環境中。然而，有關職業駕駛員之死亡車禍的危險因子資訊目前相當缺乏。
方法：我們探索是否職業駕駛員有高於一般駕駛員易發生死亡車禍，並且釐清有關職業駕駛員之潛在死亡車禍的危險因子。我們利用初步的資料，分析全國的死亡車禍的發生率。進一步利用此資料，將職業駕駛員與一般駕駛員以一比四比例分配，去比較兩者的死亡車禍危險因子分析。再者，我們利用全民的資料庫去做一個回溯性世代追蹤研究—比較藥物濫用者與其接受美沙酮治療者發生車禍的情形。
結果：在2003至2016年中，臺灣職業駕駛員的粗死亡車禍率約為每一千人年平均1.09。在全車禍中之死亡車禍的占率，職業駕駛員確實有高於一般駕駛員。在十四年的批配一般駕駛員的初步研究顯示:職業駕駛員的死亡車禍與過去有發生車禍過(校正過危險率是2.157，95%信賴區間為1.896至2.453)、有使用過安眠藥物病史(校正過危險率是1.385，95%信賴區間為1.215至1.579)，及車速過快(校正過危險率是1.009，95%信賴區間為1.006至1.013)因子有正相關。在藥物濫用者接受美沙酮治療者發生車禍率在統計學上高於藥物濫用者未接受美沙酮治療者(校正過危險率是2.75，95%信賴區間為1.87至4.04) 。
結論：上述的研究發現有助於對於職業駕駛員的死亡車禍預防政策的制定。

Background: A major cause of fatalities globally is fatal vehicle collisions (FVCs). Professional drivers frequently have no choice but to execute their work under dangerous conditions. The factors enhancing the FVC risk of professional drivers have rarely been investigated, however.
Methods: We executed our study with the purpose of comparing the FVC risk of professional versus nonprofessional drivers and identifying FVC risk factors for these two groups. In our preliminary study, we determined the nationwide incidence of FVCs. A professional driver group was then frequency matched (1:4) with a nonprofessional driver group, and the two groups’ risk factors were compared. Additionally, two population-based matched retrospective cohorts were created: one comprising new opiate users not undergoing methadone maintenance treatment (MMT) and the other comprising such users undergoing MMT.
Results: In Taiwan, over the period 2003–2016, the average crude FVC incidence was determined to be 1.09 per 1,000 person-years among professional drivers. The percentage of collisions that were FVCs was higher in the professional group. Our preliminary study covering a 14-year period, in which professionals were frequency matched with nonprofessionals, revealed that the following factors were significantly associated with FVC risk in the professional group: speeding [adjusted odds ratio (aOR) = 1.009; 95% confidence interval (95% CI) = 1.006–1.013], benzodiazepine use history (aOR = 1.385; 95% CI = 1.215–1.579), and previous involvement in a motor vehicle collision [adjusted (aOR) = 2.157; CI = 1.896–2.453]. Among opiate users, motor vehicle collisions were significantly more common in the MMT subgroup than in the non-MMT subgroup (adjusted hazard ratio = 2.75, 95% CI = 1.87–4.04).
Conclusion: Policymakers hoping to prevent FVCs involving professional drivers can consult the present findings.

封面
論文指導教授及口試委員之畢業論文通過證明書
無違反學術倫理聲明書
中文摘要 ………………………………………………………………………… 1
英文摘要 ………………………………………………………………………… 2, 3
致謝 ……………………………………………………………………………… 4
內容 (CONTENTS)
1. BACKGROUND AND INTRODUCTION …………………………………………………………… 12-16
1.1. Introduction to road transport and fatal vehicle collisions
1.2. FVCs involving professional drivers
1.3. MVCs after methadone use
1.4. Aims of the present study
2. METHODS …………………………………………………………………… 17-22
2.1. Data source
2.2. Study population and design
2.3. Comparing related characteristics and potential FVC risk factors in the professional versus nonprofessional groups
2.3.1. Study population and design
2.3.2. Study outcomes and potential covariates
2.4. Statistical analysis
3. RESULTS ……………………………………………………………………… 23-28
3.1. Crude incidence of FVCs in Taiwan
3.2. Characteristics of professional drivers
3.3. Study outcome and potential covariates among professional drivers in FVCs
3.3.1. Crude nationwide incidence of MVCs in Taiwan
3.3.2. Cohort population with methadone use characteristics
3.3.3. Study outcome and potential covariates after methadone use
4. DISSCUSSION ………………………………………………………………… 29-42
4.1. Main results
4.2. Analysis of FVCs in professional versus nonprofessional drivers in Taiwan
4.3. FVC risk factors in the professional and nonprofessional groups
4.3.1. Previous involvement in an MVC
4.3.2. Driving speed
4.3.3. Driving while being under the influence of medications
4.3.4. Other risk factors
4.4. Cohort study between opiate users undergoing versus not undergoing MMT
4.4.1. Crude incidence of MVCs
4.4.2. MVC risk after methadone use
4.4.3. Systematic review and meta-analysis of MVC risk after methadone use
4.4.4. Mechanism of MVC risk after methadone use
4.5. Strengths and limitations
5. CONCLUSION ………………………………………………………………… 43
6. REFERENCES ………………………………………………………………… 44-53
TABLES …………………………………………………………………………… 54-60
Table 1. All transports of the five main world economies in 2012.
Table 2. Transportation fatalities by mode in the US from 2011 to 2020
Table 3. Baseline characteristics of the professional and nonprofessional groups
Table 4. Risk factors for FVCs involving professional drivers
Table 5. Baseline characteristics of opiate users in Taiwan over 2010–2016
Table 6. Independent predictors of MVCs among opiate users receiving MMT
Table 7. Summary of seven included epidemiological studies
FIGURES ……………………………………………………………………… 61-68
Figure 1. Flowchart of participant selection between the professional and nonprofessional groups
Figure 2. Flowchart of participant selection between opiate users receiving MMT and those not receiving
Figure 3. Rates of FVCs among professional drivers from 2003 to 2016
Figure 4. Crude nationwide incidence rates of MVCs annually among the general adult population, opiate adults, and those receiving MMT
Figure 5. Comparison of cumulative incidence rates of MVCs between opiate users receiving MMT and those not receiving
Figure 6. Flowchart of paper disposition and study selection for this meta-analysis
Figure 7. Quality assessment of seven included epidemiological articles by the Newcastle-Ottawa
Figure 8. Poor estimate relative risk of all-cause MVCs
SUPPLEMENTARY TABLE & FIGURE ……………………………………… 69-71
Supplementary Table 1. The data of each variable in the study derived from these datasets
Supplementary Table 2. ICD-9-CM and ATC codes used in the present study
Supplementary Table 3. The types of benzodiazepine use among professional drivers in the present study.

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