A comparison of collision factors and toxicologic characteristics for rural and urban drivers presenting to the emergency department after a vehicular collision

OBJECTIVES: Impaired driving is a significant public health and safety issue. There is limited information about the differences in toxicologic characteristics and collision factors amongst rural and urban drivers. The aim of this study is to compare demographic and toxicologic characteristics between urban and rural drivers involved in motor vehicle collisions (on and off-road vehicle use). METHODS: We prospectively analyzed blood samples for 13,792 injured drivers who presented to 17 Canadian emergency departments (ED) between 2018 and 2024 and had bloodwork drawn within six hours of their collision. Data extracted by patient record review included demographics, collision characteristics and disposition. A comparison of demographic, toxicologic and collision characteristics was conducted based on the de-identified injured drivers' residential postal code. RESULTS: Of 13,792 injured drivers,15.1% had a rural residential postal code. Rural drivers were more likely to be younger (6% vs 3.4% between 16-18 years of age), involved in a single vehicle crash (56.2% vs 39.4%) and more likely to be admitted to hospital (55.3% vs 33.4%). Blood alcohol content (BAC) > 0 (24.6% vs 14.8%; aPR = 1.21; 95%CI: 1.12-1.31) and BAC >0.08% (18.5% vs 11.3%; aPR = 1.23; 95%CI: 1.12-1.36) were both more prevalent amongst rural drivers. THC > 0 was more common amongst rural drivers (17.2% vs 14.6%; aPR = 1.14; 95%CI: 1.03-1.26) as was polysubstance use (28.8% vs 19.6%; PR = 1.24; 95%CI: 1.15-1.34). CONCLUSIONS: This study demonstrated a higher prevalence of elevated BAC and THC levels and increased polysubstance use amongst younger rural drivers. These findings should be used to target injury prevention initiatives for rural youth regarding the risks associated with substance misuse prior to driving.