Hamann Cara J, Davis Jonathan A, Pae Gilsu, Zhu Motao, Shill Gregory H, Tefft Brian, Cavanaugh Joseph E
Injury Prevention Research Center, University of Iowa, 145 N Riverside Dr., Iowa City, IA, 52242, USA.
Department of Epidemiology, University of Iowa College of Public Health, 145 N Riverside Dr., Iowa City, IA, 52242, USA.
Inj Epidemiol. 2025 Jan 14;12(1):3. doi: 10.1186/s40621-024-00555-9.
Motor vehicle crashes are the second leading cause of injury death among adults aged 65 and older in the U.S., second only to falls. A common state-level approach to mitigating older adult crash risk is the implementation of driver license renewal policies which vary largely between states and data on their effectiveness in preventing crashes and injuries are limited. To fill this gap, the aim of this study is to examine the association between state driver license renewal policies and older driver crash and injury rates.
Historical crash data, license renewal policy data, and other relevant policy and demographic data were gathered from 13 U.S. states (CO, IL, IA, KS, MN, MO, NE, ND, OH, SD, UT, WI, WY) for years 2000 through 2019, inclusive. Main exposures included six license renewal policies: renewal period, in-person renewal frequency, vision testing, knowledge testing, on-road drive testing, and mandatory physician reporting. The primary outcomes were crash and injury rates per 100,000 population.
The study population included 19,010,179 crash-involved drivers aged 40 and older. State policies became less restrictive in many states over the study period, even for drivers aged 75 and older, resulting in longer times between renewals and fewer in-person renewal requirements. Loosening of in-person renewal from every time to less than every time was associated with increased crash rates, among drivers aged 65 to 74 (RR = 1.08, 95% CI: 1.01-1.16). A longer duration between in-person renewals was associated with increased injury rates among drivers 75 and older (RR = 1.18, 95% CI: 1.00-1.39).
Generally, state policies became less restrictive and resulted in longer required intervals between license renewal. Loosening of driver license renewal policies was associated with increased crash and injury rates. However, safety benefits of restrictive older driver licensing policies should be carefully weighed against costs to older adult well-being and quality of life following licensure loss. Additional methods to assess fitness to drive are necessary to identify the mechanisms behind the increased rates.
在美国，机动车碰撞事故是65岁及以上成年人受伤死亡的第二大原因，仅次于跌倒。减轻老年驾驶员碰撞风险的一种常见的州级方法是实施驾照更新政策，各州之间差异很大，而且关于这些政策在预防碰撞和伤害方面有效性的数据有限。为填补这一空白，本研究的目的是检验州驾照更新政策与老年驾驶员碰撞及受伤率之间的关联。
收集了美国13个州（科罗拉多州、伊利诺伊州、爱荷华州、堪萨斯州、明尼苏达州、密苏里州、内布拉斯加州、北达科他州、俄亥俄州、南达科他州、犹他州、威斯康星州、怀俄明州）2000年至2019年（含）的历史碰撞数据、驾照更新政策数据以及其他相关政策和人口数据。主要暴露因素包括六项驾照更新政策：更新期限、亲自更新频率、视力测试、知识测试、路考以及强制医生报告。主要结局是每10万人口的碰撞及受伤率。
研究人群包括19,010,179名40岁及以上涉及碰撞事故的驾驶员。在研究期间，许多州的政策限制有所放宽，即使是75岁及以上的驾驶员，这导致更新间隔时间延长，亲自更新要求减少。对于65至74岁的驾驶员，将亲自更新从每次变为少于每次与碰撞率增加相关（风险比=1.08，95%置信区间：1.01-1.16）。亲自更新之间的间隔时间延长与75岁及以上驾驶员的受伤率增加相关（风险比=1.18，95%置信区间：1.00-1.39）。
总体而言，州政策限制有所放宽，导致驾照更新所需间隔时间延长。驾照更新政策的放宽与碰撞及受伤率增加相关。然而，严格的老年驾驶员驾照政策的安全益处应与驾照丧失后对老年人福祉和生活质量的成本仔细权衡。需要额外的方法来评估驾驶适宜性，以确定发生率增加背后的机制。
