Peer reviewed pøper Older drivers in rural and urban areas: Comparisons ofcrash, serious injury, and fatality rates Thompson, J.P.l'2, Baldock, M.R.J.l, Mathias, J.L.2, Wundersitz, L.N. I lCentre for Automotive Safety Research, The University of Adelaide; 2School of Psychology, The University of Adelaide email: james@casr.adelaide.edu.au Abstract Previous analyses ofcrash statistics have indicated that older drivers (aged 65 years and older) have fewer crashes than other age groups. However, they have an elevated crash risk on a per kilometre driven basis and are at an increased risk of death and serious injury from crashes. Rural older drivers may be particularly at risk due to a greater dependence on driving, which may create a reluctance to cease driving. It is often demonstrated that motor vehicle crash fatality rates are higher in rural areas than urban areas. However, more research that compares the crash, serious injury, and fatality rates of rural and urban older drivers is required. A database ofpolice-reported road crashes in South Australia, the Traffic Accident Reporting System, was used to obtain crash, serious injury, and fatality data for 2004 to 2008. The crash involvement ofdrivers ofvarious age groups from both rural and urban areas was adjusted for population and licensure exposure measures. Crashes involving rural drivers aged75 and over were more likely to have resulted in a serious or fual injury than crashes involving their urban counterparts. The results indicate that rural older drivers present a unique road safety problem. Keywords Older drivers, crash rate, rural areas, urban areas, fatalífy, serious injury Introduction Research investigating the crash risk of older drivers (here defined as persons aged 65 years and older) hasdemonstratedthatcrashnumbersdecline withage ll,2]. ln fact,driversoverthe ageof 65have a lower number of crashes than all other age groups. Even after controlling for decreases with age in population and rates of licensure, older drivers still have fewer crashes. Older drivers also drive fewer kilometres, on average, than drivers from other age groups, which may account for their low crash numbers. Indeed, when controlling ñr the number of kilometres driven, studies have demonstrated that older drivers have an elevated crash risk on a per kilometre driven basis, which is second only to the very youngest age groups. In addition to this elevated crash risk per distance driven, older drivers are at an increasedrisk ofdeath [3] and serious injury [1 -5 ] from crashes in which they are involved. This is attributed to increased frailty with older age [6]. In support ofthis, Hanrahan et al. [3] have demonstrated that drivers aged 85 years and older were greater than five times more likely to experience a moderate or severe injury than those aged 25 to 44 and are the age group most likely to die or to suffer an injury in a crash. The crash, serious injury and fatality risk ofolder adults in rural areas may be greater than that ofurban older drivers because they may be less able to reduce or cease driving when they are no longer fit to drive. This may be due to several reasons. First, public transport is generally less available or not available at all. Indeed, Corcoran et al. [7] found that in Victoria, Australia the proportion ofolder drivers with access to public transport decreases as rurality increases. Second, family and friends are likely to live further away and, therefore, be less available to provide transport [8]. Finally, necessary services, such as general practitioners and supermarkets, are ofen further away and only accessible by car. Therefore, older adults who live rurally are more dependent on the car and the ability to drive to meet their mobility requirements. Consequently, rural older drivers may have a greater crash risk. Past research has shown that motor vehicle crash death rates, in general, are higher in rural areas than urban areas [9-13], which has been attributed to higher speed limits [4], delayed medical care [5], reduced availability of medical care [13], and alcohol use [9]. With regard to age, two studies [9,121 examining motor vehicle crash deaths in rural areas of Michigan, USA ôund an association between