Chronic medical conditions and their association with crash risk and changes in driving habits: a prospective study of the GAZEL cohort

Turrado, Juan Naredo; Orriols, Ludivine; Contrand, Benjamin; Zins, Marie; Salmi, Louis-Rachid; Lafont, Sylviane; Lagarde, Emmanuel · 2021 · Crossref

DOI: 10.1136/injuryprev-2019-043460

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Summary

This prospective cohort study investigates the association between chronic medical conditions and both crash risk and driving habits among drivers entering old age. Motivated by the increasing prevalence of elderly drivers and the need to understand whether self-regulatory behaviors sufficiently mitigate crash risks associated with aging and health decline, the research utilizes data from the French GAZEL cohort. The study aims to identify specific conditions that increase crash risk and determine if drivers adapt their mileage or avoid specific driving situations in response to these conditions. The analysis included 12,460 drivers from the GAZEL cohort, a group of former employees of Electricité de France–Gaz de France, followed from 2007 to 2014. The study employed three distinct analytical approaches: a longitudinal analysis of road traffic crashes, a longitudinal analysis of driving cessation, and a cross-sectional assessment of mileage and driving avoidance based on a 2015 questionnaire. Chronic conditions were defined as those reported for at least two consecutive years and grouped into clinically homogenous categories. Statistical methods included multivariable mixed effects logistic models for crash risk, discrete-time models for driving cessation, and linear and logistic regressions for mileage and avoidance behaviors, adjusting for confounders such as age, gender, and alcohol consumption. The results identified three distinct patterns of association. First, conditions such as stroke, glaucoma, and cardiovascular diseases were associated with reduced mileage or avoidance of specific driving situations (e.g., heavy traffic, bad weather) but did not increase crash risk, suggesting effective self-regulation. Second, hearing difficulties, joint disorders, and gout were associated with an increased odds of crash (adjusted ORs of 1.19 and 1.17, respectively) without corresponding reductions in mileage or avoidance behaviors. Third, depression, anxiety, and stress were linked to increased crash risk (OR 1.23) despite higher rates of driving avoidance. Notably, Parkinson’s disease was strongly associated with driving cessation (adjusted HR 32.61). The study concludes that while many older drivers successfully self-regulate to mitigate risks from certain medical conditions, others fail to adapt despite increased crash risk. Specifically, hearing impairment and joint disorders pose significant safety threats because drivers do not perceive them as requiring behavioral changes. The findings highlight the need for targeted interventions to improve risk perception and awareness for conditions like hearing loss, which are rarely considered threats to road safety, to enhance public health outcomes for aging drivers.

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Topics

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• medical conditions
• mci dementia driving
• sex gender
• older drivers