Price to pay for freedom to ride: deregulation of All-Terrain and Utility Task Vehicles operation is associated with increased crashes and healthcare costs in Iowa, USA - a retrospective cohort study.

BACKGROUND

Effective 1 July 2022, the state of Iowa enacted House File 2130, authorising the use of All-Terrain and Utility Task Vehicles (ATV/UTV) on secondary roadways and state highways. Widely recognised safety guidelines identify roadway operation on both paved and unpaved surfaces as a significant risk factor for injuries and fatalities. We hypothesised that this legislation would be associated with increased ATV/UTV-related trauma, greater injury severity and worse clinical outcomes.

METHODS

This retrospective study reviewed ATV/UTV crashes reported by the Department of Transportation, admissions for crash-related injuries at a level 1 trauma centre and statewide hospital admissions from 1 January 2020 to 31 December 2024. Crash counts and circumstances were analysed. Demographics, comorbidities, substance use, injury characteristics, hospital course, complications and hospitalisation costs were collected and compared pre and post-legislation. A p<0.05 was considered significant.

RESULTS

There were 241 crashes prelegislation and 339 postlegislation, a 40.7% increase. Crashes on concrete surfaces (61.1% vs 48.5%; p=0.004) and state routes (7.1% vs 1.7%; p=0.047) rose significantly. Fatal crashes doubled postlegislation (11.8% vs 6.2%; p=0.008). Trauma centre admissions increased by 11%. Abdominal (26.1% vs 12.9%; p=0.001), chest (37.7% vs 27.4%; p=0.032) and upper extremity injuries (67.6% vs 45.2%; p<0.001) also rose. Unplanned reoperations and intensive care unit admissions increased to 7.2% from 0.5% (p<0.001). Adjusted hospitalisation costs rose (US$50 820 vs US$38 021; p<0.011).

DISCUSSION: Implementation of House File-2130 was associated with increased ATV/UTV crashes, more severe injuries, higher mortality, greater need for unplanned interventions and elevated hospitalisation costs.

CONCLUSIONS

Prospective, multicentre studies and real-time surveillance systems would further strengthen evaluation of the public health impact of legislative changes and guide evidence-based policy development.