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Restricted driver licensing for medical impairments: Does it work?

Shawn C. Marshall^*, Robert Spasoff, Rama Nair and Carl van Walraven^*¶**

From the Departments of *Medicine and Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ont.; the Institute for Rehabilitation Research and Development, The Rehabilitation Centre, Ottawa, Ont.; the University of Ottawa Institute on Health of the Elderly at the SOC (Sisters of Charity of Ottawa) Health Service, Ottawa, Ont.; ¶the Clinical Epidemiology Unit, Ottawa Health Research Institute, Ottawa, Ont.; and **the Institute for Clinical Evaluative Sciences, Toronto, Ont.

Correspondence to: Dr. Shawn C. Marshall, The Rehabilitation Centre, 505 Smyth Rd., Ottawa ON K1H 8M2; smarshall{at}ottawahospital.on.ca

Background: Medical conditions may adversely affect driving ability. Many North American jurisdictions provide restricted driving licences that permit people with certain medical conditions to drive under limited conditions, but the effectiveness of such programs has not yet been determined. The objectives of this study were to evaluate the rates of crashes and traffic violations among drivers with a restricted licence, compared with the rates in the general driving population, and to compare the crash and traffic violation rates before and after driving restrictions were imposed.

Methods: We retrospectively analyzed a cohort of all licensed Saskatchewan drivers registered from Jan. 1, 1992, to Apr. 19, 1999. The cohort was divided into those with a restricted licence and those with an unrestricted general licence. We used multivariate Poisson regression to calculate incidence rate ratios (IRRs) for at-fault crashes and traffic violations, adjusting for age, sex and residence (urban v. rural). We used interventional time series analysis to compare rates of crashes and traffic violations before and after the imposition of driving restrictions.

Results: Of the 703 758 drivers in the study, 23 185 (3.3%) had a restricted licence. Restricted licence holders had a higher crash rate than drivers without restrictions (adjusted IRR 1.13, 95% confidence interval [CI] 1.11–1.17). However, this rate was lower than that among male drivers (adjusted IRR 2.01, 95% CI 1.99–2.02) and urban drivers (adjusted IRR 1.38, 95% CI 1.37–1.39). Drivers with restricted licences had a lower traffic violation rate than those without restrictions (adjusted IRR 0.93, 95% CI 0.91–0.95). At-fault crash rates decreased by 12.8% (95% CI 2.4%–23.2%) and adjusted traffic violation rates decreased by 10.0% (95% CI 4.4%–15.7%) after restrictions were imposed. During the study period, licence restrictions likely averted up to 816 crashes and 751 traffic violations.

Interpretation: Province-wide population data suggest that a restricted licensing program appears to provide a significant decrease in the rates of crashes and traffic violations.

This article has been cited by other articles:

				G. Caragata Nasvadi and A. Wister Do Restricted Driver's Licenses Lower Crash Risk Among Older Drivers? A Survival Analysis of Insurance Data From British Columbia Gerontologist, August 1, 2009; 49(4): 474 - 484. [Abstract] [Full Text] [PDF]

				S. Leproust, E. Lagarde, S. Suissa, and L R. Salmi Association between road vehicle collisions and recent medical contact in older drivers: a case-crossover study Inj. Prev., December 1, 2007; 13(6): 382 - 387. [Abstract] [Full Text] [PDF]

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