title: Mature Driver Laws and State Predictors of Motor Vehicle Crash Fatality Rates Among the Elderly: A Cross-sectional Ecological Study.
abstract: OBJECTIVE
  State-level data have indicated that motor vehicle crash (MVC) fatality rates among the elderly vary widely across states. To date, the majority of states have implemented mature driver laws, which often require more frequent license renewals, in-person renewal, and vision testing for drivers above a certain age. We sought to evaluate the impact of mature driver laws on states' MVC fatality rates among the elderly while examining other state-level determinants of MVC-related deaths.
  
  
  METHODS
  We performed a cross-sectional ecological study and modeled state MVC fatality rates for the population over age 65 as a function of state transportation policies and demographic, health system, population health, travel, and climate characteristics using a general linear model. Principal component analysis was used to reduce dimensionality of the data and overcome multicollinearity of state predictor variables.
  
  
  RESULTS
  Higher average temperature, higher gas prices, and a greater number of emergency medicine physicians to population size were significantly associated with lower MVC fatality rates. Positive predictors of MVC fatality rates were percentage of population overweight or obese and percentage with college degree over the age of 65. Having any restriction on elderly drivers was associated with a higher MVC fatality rate and no individual component of mature driver laws (shortened renewal cycle, in-person renewal, and vision testing) was significantly associated with lower fatality MVC rates for adults over 65.
  
  
  CONCLUSIONS
  Mature driver laws are not associated with lower state MVC fatality rates among the elderly.
authors.affiliation: a Department of Surgery , Indiana University School of Medicine , Indianapolis , Indiana.
authors.forename: Teresa M
authors.initials: TM
authors.lastname: Bell
authors.forename: Nan
authors.initials: N
authors.lastname: Qiao
authors.forename: Ben L
authors.initials: BL
authors.lastname: Zarzaur
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality*; D000368:Aged; D001334:Automobile Driving / Q000331:legislation & jurisprudence*; D003430:Cross-Sectional Studies; D006801:Humans; D008004:Licensure / Q000331:legislation & jurisprudence; D014481:United States / Q000453:epidemiology; D014787:Vision Tests
keywords: elderly; fatality; licensing; old drivers; older occupant; regulations