• Donald A Redelmeier, Jonathan Wang, and Samantha S M Drover.
• Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Ont, Canada; Department of Medicine, University of Toronto, Ont, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ont, Canada; Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, Ont, Canada; Center for Leading Injury Prevention Practice Education & Research, Sunnybrook Research Institute, Toronto, Ont, Canada. Electronic address: dar@ices.on.ca.
• Am. J. Med. 2024 Mar 1; 137 (3): 227235.e6227-235.e6.

BackgroundCOVID vaccine hesitancy identifies a discrepancy between personal decisions and public guidelines. We tested whether COVID vaccine hesitancy was associated with the long-term risks of a traffic crash.MethodsWe conducted a population-based longitudinal cohort analysis of adults by determining COVID vaccination status through linkages to electronic medical records. Traffic crashes requiring emergency medical care were defined by multicenter outcome ascertainment of all hospitals throughout the region over the subsequent year.ResultsWe identified 11,598,549 total individuals, of whom 1,210,754 had not received a COVID vaccine. A total of 54,558 were subsequently injured in traffic crashes during the 1-year follow-up interval, equal to a risk of 4704 per million. Those who had not received a COVID vaccine had a 58% higher risk than those who had received a COVID vaccine (6983 vs 4438 per million, P < .001). The increased traffic risks among unvaccinated individuals included diverse subgroups, were accentuated for single-vehicle crashes, extended to fatal outcomes, exceeded the risks associated with sleep apnea, and persisted after adjustment for baseline characteristics. The increased risks were validated in analyses using Artificial Intelligence techniques and generally larger than the risks of other adverse events frequently ascribed to COVID vaccination.ConclusionsCOVID vaccine hesitancy is associated with significant increased long-term risks of a traffic crash. A greater awareness of traffic risks might encourage patients to take protective actions for personal safety.Copyright © 2023 Elsevier Inc. All rights reserved.

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