Introduction Fatal road traffic crashes (RTC) among drivers result not only from erroneous manoeuvre. They can also be triggered by health issues like suicidal acts and acute illness, 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 they evolve over time. This Swedish national study investigates those questions considering drivers 50+ years.

Method For the period 2010–2019, data were extracted from the Swedish Transport Administration’s in-depth studies of fatal RTCs, a database encompassing all road traffic fatalities. The crash triggers reported were classified as suicide, acute illness, own manoeuvre (single or other type of crash), other cause, and undetermined. Total and annual frequencies were compiled by trigger, overall and stratified by sex and age group.

Results In total, 763 fatalities were identified, 10% resulting from suicide and 27%, acute illness; 48% were due to the driver’s own manoeuvre. Suicides increased from 6% in 2010–2014 to 13% in 2015–2019 while acute illness decreased (30% to 25%). The overall male-to-female ratio was 4.5 and rose to 8.5 for acute illness. The relative importance of each trigger varied with age, with for instance acute illness being more frequent for those 65–79 years (33%) and own manoeuvre, for the 80+ years (58%).

Conclusion Over one-third of fatal RTCs among drivers 50+ years result from a mental or physical illness, a remarkable amount.

Learning outcomes Technological development may help impede the occurrence and consequences of such crashes.