Older drivers, medical condition, medical impairment and crash risk.

New evidence has appeared to support the fact that the over-involvement of older drivers in traffic accidents disappears when the low mileage bias is taken into account. As a group, older drivers are as safe as or safer than other age groups, and only low mileage older drivers have a high crash rate. Furthermore, the role of the medical condition of older drivers in traffic accidents, as well as the fitness to drive evaluation, are objects of controversy. We examined all this with a cohort of 4316 drivers attending Medical Driving Test Centres for a mandatory fitness to drive evaluation. Our data shows that older drivers (> or =75) have a lower crash rate. Medical conditions that impair fitness to drive, as a tendency, increased with advanced age and with lower mileage group. The multivariate analysis of variance showed that there is an effect (p<0.0001) of age-range and mileage on the annual crash rate per million kilometres driven, while a medical restriction ("fit to drive with restriction") has no effect (p>0.05). Our data suggests that health status is not associated with increased crash risk for the low mileage group, although further studies are needed.