Association of State Alcohol Policies With Alcohol-Related Motor Vehicle Crash Fatalities Among US Adults

Abstract

<div class="section"> <a class="named-anchor" id="ab-ioi180026-1"> <!-- named anchor --> </a> <h5 class="section-title" id="d3648364e364">Question</h5> <p id="d3648364e366">Are alcohol-related motor vehicle crash fatalities less likely in states with more restrictive alcohol policy environments? </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi180026-2"> <!-- named anchor --> </a> <h5 class="section-title" id="d3648364e369">Findings</h5> <p id="d3648364e371">This repeated cross-sectional study examined the association between an aggregate measure of state alcohol policies and 505 614 adult motor vehicle crash fatalities in the United States from 2000 to 2015. A 10–percentage point increase in the restrictiveness of the state alcohol policy environment was associated with a 10% reduced odds that a crash fatality was alcohol related; policies were similarly protective for alcohol involvement at blood alcohol levels below 0.08% (the current legal limit in the United States). </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi180026-3"> <!-- named anchor --> </a> <h5 class="section-title" id="d3648364e374">Meaning</h5> <p id="d3648364e376">Strengthening alcohol policies could reduce alcohol-related crash fatalities.</p> </div><div class="section"> <a class="named-anchor" id="ab-ioi180026-4"> <!-- named anchor --> </a> <h5 class="section-title" id="d3648364e380">Importance</h5> <p id="d3648364e382">Motor vehicle crashes are a leading cause of mortality. However, the association between the restrictiveness of the alcohol policy environment (ie, based on multiple existing policies) and alcohol-related crash fatalities has not been characterized previously to date. </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi180026-5"> <!-- named anchor --> </a> <h5 class="section-title" id="d3648364e385">Objective</h5> <p id="d3648364e387">To examine the association between the restrictiveness of state alcohol policy environments and the likelihood of alcohol involvement among those dying in motor vehicle crashes in the United States. </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi180026-6"> <!-- named anchor --> </a> <h5 class="section-title" id="d3648364e390">Design, Setting, and Participants</h5> <p id="d3648364e392">This investigation was a repeated cross-sectional study in which state alcohol policies (operationalized by the Alcohol Policy Scale [APS]) from 1999 to 2014 were related to motor vehicle crash fatalities from 2000 to 2015 using data from the Fatality Analysis Reporting System (1-year lag). Alternating logistic regression models and generalized estimating equations were used to account for clustering of multiple deaths within a crash and of multiple crashes occurring within states. The study also examined independent associations of mutually exclusive subgroups of policies, including consumption-oriented policies vs driving-oriented policies. The study setting was the 50 US states. Participants were 505 614 decedents aged at least 21 years from motor vehicle crashes from 2000 to 2015. </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi180026-7"> <!-- named anchor --> </a> <h5 class="section-title" id="d3648364e395">Main Outcomes and Measures</h5> <p id="d3648364e397">Odds that a crash fatality was alcohol related (fatality stemmed from a crash in which ≥1 driver had a blood alcohol concentration [BAC] ≥0.08%). </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi180026-8"> <!-- named anchor --> </a> <h5 class="section-title" id="d3648364e400">Results</h5> <p id="d3648364e402">From 2000 to 2015, there were 505 614 adult motor vehicle crash fatalities in the United States, of which 178 795 (35.4%) were alcohol related. Each 10–percentage point increase in the APS score (corresponding to more restrictive state policies) was associated with reduced individual-level odds of alcohol involvement in a crash fatality (adjusted odds ratio [aOR], 0.90; 95% CI, 0.89-0.91); results were consistent among most demographic and crash-type strata. More restrictive policies also had protective associations with alcohol involvement among crash fatalities associated with BACs from greater than 0.00% to less than 0.08%. After accounting for driving-oriented policies, consumption-oriented policies were independently protective for alcohol-related crash fatalities (aOR, 0.97; 95% CI, 0.96-0.98 based on a 10–percentage point increased APS score). </p> </div><div class="section"> <a class="named-anchor" id="ab-ioi180026-9"> <!-- named anchor --> </a> <h5 class="section-title" id="d3648364e405">Conclusions and Relevance</h5> <p id="d3648364e407">Strengthening alcohol policies, including those that do not specifically target impaired driving, could reduce alcohol-related crash fatalities. Policies may also protect against crash fatalities involving BAC levels below the current legal limit for driving in the United States. </p> </div><p class="first" id="d3648364e410">This repeated cross-sectional study examines the association between the restrictiveness of state alcohol policies with the likelihood of alcohol involvement among adults dying in motor vehicle crashes in the United States. </p>