Abstract Body (Do not enter title and authors here): Background: Syncope is a leading cause of transient loss of consciousness, especially in older adults. Post-syncopal driving restrictions are widely recommended, but the required duration varies by state. The impact of these policies on motor vehicle crash outcomes remains unclear.

Methods: We conducted a cross-sectional analysis of 45 U.S. states, comparing crash and fatality data between states requiring < 6 months vs. ≥ 6 months of driving restriction following a syncopal episode. Data were obtained from Fatality Analysis Reporting System, National Highway Traffic Safety Administration, state Department of Motor Vehicles, and medical boards. Crash rates were normalized by licensed drivers and population. Statistical comparisons were made using Welch’s t-tests.

Results: States with ≥ 6-month restrictions had significantly lower crash rates among older drivers (0.0171 vs. 0.0256, p = 0.0076). Relative crash ratios comparing older to younger drivers were also lower (0.220 vs. 0.306, p = 0.067). Overall crash rates trended lower in states with ≥ 6-month restrictions in both per licensed driver (p = 0.054) and per population (p = 0.099). No significant differences were observed in fatality rates.

Conclusions: Longer post-syncope driving restriction durations (≥ 6 months) are associated with reduced crash risk among older drivers and a narrowing of age-related disparities in crash rates. These findings suggest potential public health value in adopting more uniform, evidence-based restriction policies following syncopal events for older drivers.