Distance from home to motor vehicle crash location: Implications for license restrictions among medically-at-risk older drivers

Background/ObjectivesThirty states allow licensing agencies to restrict the distance from home that "medically-at-risk" drivers are permitted to drive. However, there is little information on where older drivers crash relative to their home or how distance to crash varies by medical condition, and thus, what impact distance limits may have on motor vehicle crash rates for "medically-at-risk" drivers. DesignObservational study of crash-involved drivers. SettingMedicare fee-for-service claims linked to geocoded crash locations and residential addresses from police crash reports in the state of New Jersey from 2007 through 2017. ParticipantsNew Jersey Medicare fee-for-service beneficiaries aged 68 years and older involved in police-reported crashes. MeasurementsThe outcome was Euclidian distance from home to crash location. Covariates included driving-relevant medical conditions from Medicare claims, crash characteristics from police reports, and demographics from both sources. ResultsThere were 197,122 crash-involved older drivers for whom approximately 70% of crashes occurred within 5 miles and 95% within 25 miles of the drivers residence. The mean distance to crash was 6.0 miles. Although distance from home to the crash was generally lower among drivers with (versus without) each of the medical conditions studied, the differences were small (maximum mean difference of 2.1 miles). The largest difference in distance was by licensure status, where unlicensed/suspended drivers crashed significantly farther from home than validly licensed drivers (8.8 miles, 95% Confidence Interval [CI]: 8.4-9.1 vs 5.9 miles, 95% CI: 5.9 - 6.0). ConclusionsFindings suggest that the majority of older adults who crash do so within a few miles from home and that the distance to crash does not differ substantially by the presence of a driving-relevant medical condition. Thus, distance restrictions may not reduce crash rates among older adults and the tradeoff between safety and mobility warrants consideration. KEYPOINTSO_LI30 states permit restriction of driving distance for medically-at-risk drivers C_LIO_LIThe vast majority of crashes involving older drivers occur [≤] 25 miles of home C_LIO_LIDistance to crash does not differ markedly across driving-relevant medical conditions C_LI Why does this matter?O_LIDistance restrictions are likely to impact mobility and autonomy but not crash rates C_LI