Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Article
  • Published:

Epidemiology and Population Health

Comparison of injuries of belted occupants among different BMI categories in frontal crashes

International Journal of Obesity volume 44, pages 1319–1329 (2020)Cite this article

Subjects

Abstract

Background

Previous studies have shown that occupants with obesity are at a greater risk of fatality and serious injury than other occupants in motor vehicle crashes.

Objective

To provide a more complete description of the most frequent injuries and the most frequently injured body regions for occupants with obesity.

Methods

Sampled cases (n = 13,470) representing ~4.7 million adult occupants involved in frontal crashes (between 2000 and 2015) were selected from the U.S. National Automotive Sampling System—Crashworthiness Data System database. A retrospective cohort study was performed to study the effect of BMI on the risk of injury to different body regions and to identify the most frequent injuries to occupants with different BMIs. Lastly, in-depth crash analysis cases from the U.S. Crash Injury Research and Engineering Network (CIREN) database were studied to elucidate the source of the most common injuries to occupants with obesity.

Results

Occupants with obesity experienced a higher risk of upper extremity (4.79 vs 2.92%), lower extremity (8.37 vs 3.23%), and spine (1.53 vs 1.09%) injuries than other occupants. After adjusting for other variables, the risks of spinal, thoracic, and extremities injuries were found to be affected by the BMI class. Seven out of the ten most common injuries sustained by occupants with obesity were lower extremity injuries, and talus fractures were the most common overall. Direct loading through the plantar surface of the foot by the vehicle toe pan was found to be a likely cause of many of those injuries based on CIREN cases.

Conclusions

The injuries of occupants with obesity are different than other occupants which can be attributed to their different interaction with the seat belt and vehicle interior. The findings of this study should be considered for designing restraint systems to protect occupants with obesity in car crashes.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

Similar content being viewed by others

References

  1. Van Gaal LF, Mertens IL, Christophe E. Mechanisms linking obesity with cardiovascular disease. Nature. 2006;444:875.

    PubMed  Google Scholar 

  2. Viano DC, Parenteau CS, Edwards ML. Crash injury risks for obese occupants using a matched-pair analysis. Traffic Inj Prev. 2008;9:59–64.

    PubMed  Google Scholar 

  3. Zhu S, Layde PM, Guse CE, Laud PW, Pintar F, Nirula R, et al. Obesity and risk for death due to motor vehicle crashes. Am J Public Health. 2006;96:734–9.

    PubMed  PubMed Central  Google Scholar 

  4. Mock CN, Grossman DC, Kaufman RP, Mack CD, Rivara FP. The relationship between body weight and risk of death and serious injury in motor vehicle crashes. Accid Anal Prev. 2002;34:221–8.

    PubMed  Google Scholar 

  5. Spicer RS, Miller TR, Hendrie D, Blincoe LJ, editors. Quality-adjusted life years lost to road crash injury: updating the injury impairment index. In: Annals of Advances in Automotive Medicine/Annual Scientific Conference. Paris, France: Association for the Advancement of Automotive Medicine; 2011.

  6. Ma X, Laud PW, Pintar F, Kim J-E, Shih A, Shen W, et al. Obesity and non-fatal motor vehicle crash injuries: sex difference effects. Int J Obes. 2011;35:1216.

    CAS  Google Scholar 

  7. Finkelstein EA, Chen H, Prabhu M, Trogdon JG, Corso PS. The relationship between obesity and injuries among US adults. Am J Health Promot. 2007;21:460–8.

    PubMed  Google Scholar 

  8. Forman J, Lopez-Valdes FJ, Lessley D, Kindig M, Kent R, Bostrom O, editors. The effect of obesity on the restraint of automobile occupants. Annals of Advances in Automotive Medicine/Annual Scientific Conference. Baltimore, Maryland, USA: Association for the Advancement of Automotive Medicine; 2009.

  9. Adomeit D, Heger A. Motion sequence criteria and design proposals for restraint devices in order to avoid unfavorable biomechanic conditions and submarining. SAE Technical Paper. Report No: 0148-7191. United States: SAE; 1975.

  10. Kent RW, Forman JL, Bostrom O. Is there really a “cushion effect”?: a biomechanical investigation of crash injury mechanisms in the obese. Obesity. 2010;18:749–53.

    PubMed  Google Scholar 

  11. Joodaki H, Forman J, Forghani A, Overby B, Kent R, Crandall J, et al. Comparison of kinematic behaviour of a first generation obese dummy and obese PMHS in frontal sled tests. In: Proceedings of the 2015 IRCOBI Conference, Lyon, France; 2015.

  12. Reed MP, Ebert-Hamilton SM, Rupp JD. Effects of obesity on seat belt fit. Traffic Inj Prev. 2012;13:364–72.

    PubMed  Google Scholar 

  13. Kim T, Park G, Montesinos S, Subit D, Bolton J, Overby B, et al., editors. Abdominal Characterization Test Under Lap Belt Loading. In: Proceedings of the 24th International Technical Conference on the Enhanced Safety of Vehicles (ESV). Gothenburg, Sweden: National Highway Traffic Safety Administration; 2015.

  14. Durbin DR, Jermakian JS, Kallan MJ, McCartt AT, Arbogast KB, Zonfrillo MR, et al. Rear seat safety: variation in protection by occupant, crash and vehicle characteristics. Accid Anal Prev. 2015;80:185–92.

    PubMed  Google Scholar 

  15. Insurance Institute for Highway Safety. Fatality Facts: Passenger Vehicle Occupants. Arlington, VA: Author; 2017. https://www.iihs.org/topics/fatalitystatistics/detail/passenger-vehicle-occupants. Accessed 18 June 2019.

  16. Rupp JD, Flannagan CA, Leslie AJ, Hoff CN, Reed MP, Cunningham RM. Effects of BMI on the risk and frequency of AIS 3+ injuries in motor‐vehicle crashes. Obesity. 2013;21:E88–E97.

    PubMed  Google Scholar 

  17. Radja GA. National Automotive Sampling System—Crashworthiness Data System, 2015 Analytical User’s Manual. Washington DC: U.S. Department of Transportation, National Highway Traffic Safety Administration; 2016.

  18. Medicine AftAoA. Abbreviated injury scale; 1990 revision: update 98: Des Plaines, IL: AAAM; 1998.

  19. Hershman, L. The U.S. New Car Assessment Program (NCAP): Past, Present, and Future. In Proceedings of the 17th International Technical Conference on the Enhanced Safety of Vehicles (ESV), Amsterdam, Netherlands, 2001.

  20. Forman JL, Lopez-Valdes FJ, Duprey S, Bose D, De Dios EDP, Subit D, et al. The tolerance of the human body to automobile collision impact–a systematic review of injury biomechanics research, 1990–2009. Accid Anal Prev. 2015;80:7–17.

    PubMed  Google Scholar 

  21. Kent R, Lee S-H, Darvish K, Wang S, Poster CS, Lange AW, Brede C, Lange D, Matsuoka F. Structural and material changes in the aging thorax and their role in crash protection for older occupants. Stapp Car Crash Journal. Washington DC, USA, 2005;49:1–19.

  22. Parenteau C, Holcombe S, Zhang P, Kohoyda-Inglis C, Wang S. The effect of age on fat and bone properties along the vertebral spine. SAE Int J Transp Saf. 2013;1:226–40.

    Google Scholar 

  23. Parenteau CS, Zuby D, Brolin K, Svensson MY, Palmertz C, Wang SC, editors. Restrained male and female occupants in frontal crashes: are we different? In Proceedings of International Research Council on Biomechanics of Injury. Gothenburg (Sweden): IRCOBI; 2013.

  24. Funk JR, Crandall JR, Tourret LJ, MacMahon CB, Bass CR, Patrie JT, et al. The axial injury tolerance of the human foot/ankle complex and the effect of Achilles tension. J Biomech Eng. 2002;124:750–7.

    PubMed  Google Scholar 

  25. Kenwright J, Taylor R. Major injuries of the talus. J Bone Joint Surg Br. 1970;52:36–48.

    CAS  PubMed  Google Scholar 

  26. Roberts D, Donnelly B, Severin C, Medige J. Injury mechanisms and tolerance of the human ankle joint. Atlanta, Georgia: Centers for Disease Control; 1993.

  27. Funk JR, Rudd RW, King RJ, Srinivasan S, Bailey AM, Crandall JR. Injuries caused by brake pedal loading of the midfoot. Biomed Sci Instrum. 2012;48:134–40.

    PubMed  Google Scholar 

  28. Funk JR, Srinivasan SC, Crandall JR. Snowboarder’s talus fractures experimentally produced by eversion and dorsiflexion. Am J Sports Med. 2003;31:921–8.

    PubMed  Google Scholar 

  29. Valderrabano V, Perren T, Ryf C, Rillmann P, Hintermann B. Snowboarder’s talus fracture: treatment outcome of 20 cases after 3.5 years. Am J Sports Med. 2005;33:871–80.

    PubMed  Google Scholar 

  30. McCrory P, Bladin C. Fractures of the lateral process of the talus: a clinical review. “Snowboarder’s ankle”. Clin J Sport Med. 1996;6:124–8.

    CAS  PubMed  Google Scholar 

  31. Kent RW, Patrie J, Poteau F, Matsuoka F, Mullen C, editors. Development of an age-dependent thoracic injury criterion for frontal impact restraint loading. In: Proceedings of the International Technical Conference on the Enhanced Safety of Vehicles. Nagoya, Japan: National Highway Traffic Safety Administration; 2003.

  32. Wang SC, Bednarski B, Patel S, Yan A, Kohoyda-Inglis C, Kennedy T, et al. Increased depth of subcutaneous fat is protective against abdominal injuries in motor vehicle collisions. Annu Proc Assoc Adv Automot Med. 2003; pp. 545–9.

  33. Lichtenstein MJ, Bolton A, Wade G. Body mass as a determinant of seat belt use. Am J Med Sci. 1989;297:233–7.

    CAS  PubMed  Google Scholar 

  34. Zarzaur BL, Marshall SW. Motor vehicle crashes obesity and seat belt use: a deadly combination? J Trauma Acute Care Surg. 2008;64:412–9.

    Google Scholar 

  35. Gepner B, Joodaki H, Sun Z, Jayathirtha M, Kim T, Forman JL, Kerrigan JR. 2018. Performance of the obese GHBMC models in the sled and belt pull test conditions. Athens, Greece: Proceedings of the 2018 IRCOBI Conference; pp. 355–68.

  36. Jingwen H, Rupp JD, Reed MP. Focusing on vulnerable populations in crashes: recent advances in finite element human models for injury biomechanics research. J Automot Saf Energy. 2012;3:295–307.

    Google Scholar 

  37. Shi X, Cao L, Reed MP, Rupp JD, Hu J. Effects of obesity on occupant responses in frontal crashes: a simulation analysis using human body models. Comput Methods Biomech Biomed Eng. 2015;18:1280–92.

    Google Scholar 

  38. Zhang K, Cao L, Wang Y, Hwang E, Reed MP, Forman J, et al. Impact response comparison between parametric human models and postmortem human subjects with a wide range of obesity levels. Obesity. 2017;25:1786–94.

    PubMed  Google Scholar 

Download references

Acknowledgements

This study was supported by the National Highway Traffic Safety Administration (NHTSA) by DTNH2215D00022–0004. Views or opinions expressed or implied are those of the authors and are not necessarily representative of the views or opinions of the NHTSA.

Author information

Authors and Affiliations

  1. Center for Applied Biomechanics, Department of Mechanical and Aerospace Engineering, University of Virginia, 4040 Lewis and Clark Dr, Charlottesvillle, VA, 22911, USA

    Hamed Joodaki, Bronislaw Gepner & Jason Kerrigan

  2. Department of Public Health Sciences, University of Virginia, PO Box 800717, Charlottesville, VA, 22908, USA

    Timothy McMurry

Authors
  1. Hamed Joodaki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Bronislaw Gepner
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Timothy McMurry
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jason Kerrigan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hamed Joodaki.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Joodaki, H., Gepner, B., McMurry, T. et al. Comparison of injuries of belted occupants among different BMI categories in frontal crashes. Int J Obes 44, 1319–1329 (2020). https://doi.org/10.1038/s41366-019-0481-2

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/s41366-019-0481-2

Search

Advanced search

Quick links