Comorbid Conditions and Driving Status Among Older Low-Income African Americans

  • Quratulain SyedEmail author
  • Pranusha Dubbaka
  • Ike Okosun



While driving is an important instrumental activity of daily living (ADL), older adults belonging to low-income racial minorities make up a large proportion of never-drivers who utilize alternative modes of transportation (Babulal et al., Geriatrics 3, 2018; Choi and Mezuk, J Appl Gerontol 32:902–912, 2013). Our study is a comparative analysis of comorbid health conditions among older drivers and nondrivers receiving care at a safety net hospital in Atlanta in order to assess utilization of healthcare resources and chronic disease burden among the two groups.


This is a retrospective cohort study of 690 patients age 65 or older who received care at the Emma Darnell Geriatric Center at Grady Hospital during 2/1/2016–2/1/2017.

Self-reported driving status was analyzed and compared for all variables including demographics, insurance information, ADL scores, use of assistive device, sensory impairment, number of Geriatric Clinic visits in a year, and associated visit diagnoses.


Twenty-three percent of total 690 patients reported being drivers. Over 94% patients were African Americans and over 67% were women in both groups. Drivers were more functionally independent and were less likely to have cognitive impairment compared with nondrivers. Mean number of visits to Geriatric Primary Care Clinic in a year was low in both groups, and enrollment in a Medicare advantage plan did not affect the association.


Approximately 77% of older adults getting care at a safety net hospital in Atlanta reported not driving a motor vehicle. Utilization of primary healthcare resources was low in both groups and was not affected by enrollment in a Medicare advantage plan.


Utilization of healthcare Older drivers Chronic disease burden Transportation Underserved 



We acknowledge Elizabeth N. Head, MPH, at the Georgia Department of Public Health for the input on study design. We also acknowledge Camille P. Vaughan, MD, MS, Associate Professor, Section Chief of Geriatric Medicine and Gerontology, Emory University School of Medicine, for the input on study design and editing support.

Compliance with Ethical Standards

Conflict of Interest

Dr. Quratulain Syed is a member of the Driver’s License Advisory Board at the Georgia Department of Driver Services. Dr. Okosun and Ms. Dubbaka declare no conflicts of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was not required as this research is a retrospective chart review, and the manuscript does not contain any protected health information.


  1. 1.
    Doroudgar S, Chuang HM, Perry PJ, Thomas K, Bohnert K, Canedo J. Driving performance comparing older versus younger drivers. Traffic Inj Prev. 2017;18(1):41–6.CrossRefGoogle Scholar
  2. 2.
    Marshall SC, Man-Son-Hing M. Multiple chronic medical conditions and associated driving risk: a systematic review. Traffic Inj Prev. 2011;12(2):142–8.CrossRefGoogle Scholar
  3. 3.
    Edwards JD, Lunsman M, Perkins M, Rebok GW, Roth DL. Driving cessation and health trajectories in older adults. J Gerontol A Biol Sci Med Sci. 2009;64(12):1290–5.CrossRefGoogle Scholar
  4. 4.
    Marottoli RA, Mendes de Leon CF, Glass TA, Williams CS, Cooney LM Jr, Berkman LF, et al. Driving cessation and increased depressive symptoms: prospective evidence from the New Haven EPESE. Established Populations for Epidemiologic Studies of the Elderly. J Am Geriatr Soc. 1997;45(2):202–6.CrossRefGoogle Scholar
  5. 5.
    Babulal GM, Williams MM, Stout SH, Roe CM. Driving outcomes among older adults: a systematic review on racial and ethnic differences over 20 years. Geriatrics (Basel). 2018;3(1).
  6. 6.
    Choi M, Mezuk B, Lohman MC, Edwards JD, Rebok GW. Gender and racial disparities in driving cessation among older adults. J Aging Health. 2012;24(8):1364–79.CrossRefGoogle Scholar
  7. 7.
    Choi M, Mezuk B. Aging without driving: evidence from the health and retirement study, 1993 to 2008. J Appl Gerontol. 2013;32(7):902–12.CrossRefGoogle Scholar
  8. 8.
    Bhat G, Naumann RB. Travel-related behaviors, opinions, and concerns of U.S. adult drivers by race/ethnicity, 2010. J Saf Res. 2013;47:93–7.CrossRefGoogle Scholar
  9. 9.
    Katz index of independence in activities of daily living (ADL). Accessed 01/29/2019, 2019.
  10. 10.
    The Lawton instrumental activities of daily living (IADL) scale. Accessed 01/29/2019.
  11. 11.
    Vegda K, Nie JX, Wang L, Tracy CS, Moineddin R, Upshur REG. Trends in health services utilization, medication use, and health conditions among older adults: a 2-year retrospective chart review in a primary care practice. BMC Health Serv Res. 2009;9.Google Scholar
  12. 12.
    Nathan TA, Cohen AD, Vinker S. A new marker of primary care utilization - annual accumulated duration of time of visits. Isr J Health Policy Res. 2017;6(1):35.CrossRefGoogle Scholar
  13. 13.
    Arcury TA, Preisser JS, Gesler WM, Powers JM. Access to transportation and health care utilization in a rural region. J Rural Health. 2005;21(1):31–8.CrossRefGoogle Scholar
  14. 14.
    Vivoda JM, Harmon AC, Babulal GM, Zikmund-Fisher BJ. E-hail (Rideshare) knowledge, use, reliance, and future expectations among older adults. Transp Res Part F Traffic Psychol Behav. 2018;55:426–34.CrossRefGoogle Scholar

Copyright information

© W. Montague Cobb-NMA Health Institute 2019

Authors and Affiliations

  1. 1.Division of General Medicine and GeriatricsEmory University School of MedicineAtlantaUSA
  2. 2.Georgia State UniversityAtlantaUSA
  3. 3.Division of Epidemiology & BiostatisticsGeorgia State UniversityAtlantaUSA

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