Citation

Waller JA. Proc. Am. Assoc. Automot. Med. Annu. Conf. 1964; 8: 70-82.

Copyright

(Copyright © 1964, Association for the Advancement of Automotive Medicine)

DOI

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PMID

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Abstract

California is one of 17 states which regulate the driving privilege of people with specific chronic medical conditions. The basis of such regulation is the assumption that the existence of certain conditions represents a handicap to safe driving and therefore a danger to the driving public. This assumption has never been adequately tested using basic epidemiologic techniques. Therefore, the present study was undertaken to review the medical and driving records of people with chronic medical conditions reported to the California Department of Motor Vehicles (DMV) in comparison with the driving records of people not known to have chronic medical conditions. The chronically ill people came to the attention of the DMV by their affirmatively answering questions about the presence of a chronic medical condition on the driver license application, through reporting under the epilepsy reporting law which requires physicians to report any person with a chronic condition resulting in lapses of consciousness or of conscious control, through the drug addiction reporting law requiring the courts to report convictions for illegal possession or use of addicting drugs, through voluntary reports by police, relatives, or concerned citizens, or because of a traffic accident or violation in which the person stated that he had a medical condition. Over three quarters of the people with medical conditions in the present study came to the attention of the DMV through the questions on the driver's license application or through the compulsory reporting laws.

The records of 2,672 people with chronic medical conditions who were known to the California Department of Motor Vehicles were compared with those of 922 California drivers renewing their licenses who were not known to have chronic medical conditions. The medical groups differed from the comparison sample in distribution by age, sex, marital status and socioeconomic status. In one third of the people with traumatic epilepsy the seizures had been initiated by brain injury suffered in a prior automobile accident and probably could have been prevented by using seat belts.

Drivers with diabetes, epilepsy, cardiovascular disease, alcoholism, and mental illness averaged twice as many accidents per million miles of driving and 1.3 to 1.8 times as many violations per 100,000 miles as did drivers in the comparison group on an age-adjusted basis. Drivers convicted for illegal use of drugs averaged 1.8 times as many violations but no more accidents than those in the comparison group. The accident rates of drivers with medical conditions were further increased for drivers over age 60, those with a poor attitude toward driving and maintaining proper medical regimen, those with more severe illness, and drivers with a past history of an accident or violation related to the medical condition.

The results of the study suggest that the present emphasis on epilepsy as the major medical handicap to safe driving is too narrow an approach. However routine physical examinations for all drivers, as attempted in Pennsylvania, are also inadequate. Since the present study is limited to drivers whose medical conditions were known to the Department in assuming a similar degree of driving handicap in unreported drivers with the same condition.