Examination of driver license renewal policies and older driver crash and injury rates by rurality

• Less restrictive driver licensing laws showed increased older driver crash and injury rates in urban areas. • Impacts of loosening licensing laws was less clear in rural areas, given mixed results. • Safety benefits of restrictive driver licensing laws should be carefully weighed against costs. • Additional methods to assess fitness to drive could help identify mechanisms for increased rates. Background: Among adults aged 65 and older, motor-vehicle crashes are the second leading cause of injury-related death—following falls. State driver license renewal laws commonly have provisions targeting older drivers, but limited evidence exists on their effectiveness in reducing crash and injury rates and how this may vary by rurality. This study aimed to investigate the impact of state driver license renewal policies on older driver crash and injury outcomes, by rurality. Methods: Crash data, license renewal policies, and other relevant state policies were drawn from 13 U.S. states for the years 2000 to 2019. The primary exposures analyzed included the length of the license renewal cycle (in years) and the frequency of in-person renewal. Key outcomes included crash and driver injury rates, stratified by rurality. Results: The study population included 15.6 million crash-involved drivers aged 40 and older. State license renewal laws generally became less restrictive during the study period. Among drivers 75 and older, crash rates in urban areas were higher in states where renewal periods and in-person renewal became less restrictive compared to states with no law change (RR = 1.30, 95% CI: 1.14–1.49). Among drivers aged 65 and older, injury rates were elevated in urban areas as renewal laws became less restrictive (RR 65-74 = 1.23, 95% CI: 1.02–1.47; RR 75+ = 1.32, 95% CI: 1.12–1.57). Discussion: The observed relaxation of driver license renewal policies was correlated with higher crash and injury rates among drivers aged 75 and older in urban areas. Restrictive license renewal policies that rely on age and time cut points should be weighed carefully against possible negative effects from premature license removal. Movement toward a performance-based licensing system and away from arbitrary age and time cut points may more effectively keep unfit drivers off the road, while retaining those who remain fit to drive.