Limits of the quasi-induced exposure method when compared with the standard case-control design. Application to the estimation of risks associated with driving under the influence of cannabis or alcohol

The disparities between the quasi-induced exposure (QIE) method and a standard case–control approach with crash responsibility as disease of interest are studied. The 10,748 drivers who had been given compulsory cannabis and alcohol tests subsequent to involvement in a fatal crash in France between 2001 and 2003 were used to compare the two approaches. Odds ratios were assessed using conditional and unconditional logistic regressions. While both approaches found that drivers under the influence of alcohol or cannabis increased the risk of causing a fatal crash, the two approaches are not equivalent. They differ mainly with regards to the driver sample selected. The QIE method results in splitting the overall road safety issue into two sub-studies: a matched case–control study dealing with two-vehicle crashes and a case–control study dealing with single-vehicle crashes but with a specific control group. Using a specific generic term such as “QIE method” should not hide the real underlying epidemiological design. On the contrary, the standard case–control approach studies drivers involved in all type of crashes whatever the distribution of the responsibility in each crash. This method also known as “responsibility analysis” is the most relevant for assessing the overall road safety implications of a driver characteristic.