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• From among all road fatalities during the 10-year period 2010–2019, 12% of the crashes were suicide (male-to-female ratio 4.3) and 29% attributable to acute disease (male-to-female ratio 8.7). • In 9% of acute disease-triggered crashes another road user was injured. • About half of the crashes were attributed to a manoeuvre performed by the older driver him or herself (male-to-female ratio 3.8). • In the main, there were no remarkable changes in the relative proportion of those circumstances/triggers over time. • The promotion of mobility and safety of drivers must include all triggers of road deaths, not least among older drivers. Road traffic fatalities among drivers result not only from erroneous driving manoeuvres. They can also be triggered by poor mental or physical health like suicidal acts and acute disease attacks, the latter being more frequent with age. There are few studies comprising all the different triggers of fatal crashes among older drivers and on how these triggers evolve over time. This Swedish national study aims to investigate this, considering drivers 50+ years. For the period 2010–2019, data on non-commercial car drivers aged 50 and older were extracted from the Swedish Transport Administration's in-depth studies of fatal crashes, compiled in a register encompassing all road traffic fatalities. The crash triggers reported were classified as suicide, acute disease, own manoeuvre (single or other type of crash), external, and undetermined. Total and annual frequencies were presented by crash trigger, overall and stratified by sex and age groups. In total, 762 fatalities were identified and with 709 of them, it was possible to classify the crash trigger: 12% resulting from suicide; 29% from acute disease; 49% from the driver's own manoeuvre; and 10% from an external crash trigger. Suicides increased from 9% in average 2010–2014 to 15% in 2015–2019 while acute disease decreased (from 32% to 27%). The overall male-to-female ratio was 4.5, and as high as 8.7 for acute disease. The relative importance of each trigger varied with age with, for instance, acute disease being more frequent in the two younger age groups; 31% for 50–64 and 52% for 65–79 years old drivers, while own manoeuvre was more prominent for drivers aged 80 and older (23%). The distribution of the four different triggers of road traffic fatalities varies only slightly over time and, a majority are triggered by the driver's own manoeuvre. However, a substantial proportion, about four out of ten, are triggered by a health condition, of which some are suicide but the major part an acute disease, mainly cardiovascular. In some instances, such crashes can be harmful to other road users. Having in mind the need for safety and mobility of older drivers and the protection of all road users, there is a need for the promotion of road safety policies that encompass a wider range of measures to help reducing the likelihood of fatal and severe crashes to happen e.g., targeting incapacitated drivers. [ABSTRACT FROM AUTHOR]

• Medical impairment was associated with increased road traffic crash in drivers 65+. • Strongest associations were found for epilepsy, and substance abuse and dependence. • Strong association, but very low prevalence was found for ADHD and autism. • Dementia and kidney disease showed no association to road traffic crashes. Several medical conditions are known to impair sensory, cognitive and motor functions and are associated with road traffic crashes (RTC). For the drivers of today, we lack updated knowledge on how driving-impairing conditions are associated with RTCs, across all driving-impairing conditions in a given population. We aim to determine this among older drivers in Sweden. A national, population register-based, matched case-control study comparing acknowledged driving-impairing health conditions among all older drivers (65 years or older) involved in an injurious RTC in the period 2011–2016 (n = 13,701) with those of controls: older drivers not involved in any RTC (n = 26,525) matched to the cases by age, sex and residential area. The medical conditions, extracted from the National Patient Register from 1997 up until date of RTC, were identified based on ICD-10 diagnosis codes and categorized into the 13 groups of medical conditions listed in the Swedish driver's license regulations. Conditional logistic regression was used to estimate crude and adjusted odds ratios (ORs) with 95% confidence intervals. Unadjusted ORs for RTC were increased for all conditions. After taking the other 12 medical conditions into account, the ORs remained significant in 11 out of the 13. A strong association was found for the group "ADHD and autism spectrum disorders" (OR 2.79, CI 1.47–5.30), although with very low prevalence among cases (0.2%). Moderate associations were found for three conditions with a case prevalence between 1.3% and 8.5%: epilepsy and seizure disorders (OR 1.53, CI 1.25–1.89), substance abuse and dependence (OR 1.45, CI 1.29–1.63), psychological diseases and mental disorders (OR 1.28, CI 1.18–1.39) and for one condition with a case prevalence of 14.7%, diabetes (OR 1.28, CI 1.20–1.36). In Sweden, in the current generation of older drivers, acknowledged driving-impairing medical conditions at the national and European levels remain a concern. After adjustment for one another, all but 2 of the conditions are associated with RTCs albeit to varying degrees and more pronounced in the age group 65–79 compared to 80 or older. To promote and sustain older people's mobility, addressing this issue will require a blend of interventions where, hopefully, technological and infrastructural innovations may help counteracting individual health-related shortcomings. [ABSTRACT FROM AUTHOR]