Abstract
IMPORTANCE: Motor vehicle crashes are the leading cause of death for US teens. Newer vehicles and driver assistance technologies show promise in reducing crashes and injury severities; however, research on the age and technologies of vehicles driven by teens involved in fatal crashes is limited. OBJECTIVE: To examine the differences in vehicle age and driver assistance technologies between vehicles driven by teen and middle-aged drivers involved in fatal crashes and to investigate the associations among vehicle age, driver assistance technologies, and driver death in these crashes. DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study used fatal crash data (2016-2021) obtained from the Fatality Analysis Reporting System. Data analysis was restricted to passenger vehicles. Participants included teen drivers (15-18 years old) and middle-aged drivers (31-55 years old). All analyses were performed between December 1, 2023, and July 25, 2024. EXPOSURES: Exposures include the vehicle age (≤5, 6-15, or >15 years) and the number of driver assistance technologies installed (0 to 4). MAIN OUTCOMES AND MEASURES: The main outcome was whether the driver died in fatal crashes. Multivariable logistic regressions examined the associations between vehicle age (or driver assistance technologies installed) and driver death in fatal crashes, adjusting for driver sex, restraint use, and crash year. RESULTS: Among 81 145 drivers (49 838 male [61.4%]) involved in fatal crashes, there were 9809 teen drivers (mean [SD] age, 17.2 [0.9] years) and 71 336 middle-aged drivers (mean [SD] age, 41.7 [7.3] years). A higher proportion of teen drivers were operating vehicles older than 15 years compared with middle-aged drivers (2706 drivers [27.6%] vs 16 239 drivers [22.8%]). Driving vehicles aged 6 to 15 years (adjusted risk ratio [aRR], 1.19; 95% CI, 1.17-1.22) or older than 15 years (aRR, 1.31; 95% CI, 1.28-1.34) was associated with significantly higher odds of driver death in fatal crashes compared with driving vehicles 5 years old or newer, independently of driver age. Additionally, each installed driver assistance technology was associated with a 6% reduction (aRR, 0.94; 95% CI, 0.90-0.98) in the risk of driver death in fatal crashes. CONCLUSIONS AND RELEVANCE: These findings suggest that older vehicles and those with fewer driver assistance technologies are associated with increased risk of driver death in fatal crashes; thus, teens should drive the safest vehicles available, not older family cars. The findings underscore the urgent need to ensure teens drive safer vehicles to protect their lives.