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Original Investigation
July 2018

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

Author Affiliations
  • 1Section of General Internal Medicine, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
  • 2Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts
  • 3Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston, Massachusetts
  • 4Division of Epidemiology and Biostatistics, Georgia State University School of Public Health, Atlanta
  • 5Pacific Institute for Research and Evaluation, Calverton, Maryland
  • 6Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts
JAMA Intern Med. 2018;178(7):894-901. doi:10.1001/jamainternmed.2018.1406
Key Points

Question  Are alcohol-related motor vehicle crash fatalities less likely in states with more restrictive alcohol policy environments?

Findings  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).

Meaning  Strengthening alcohol policies could reduce alcohol-related crash fatalities.


Importance  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.

Objective  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.

Design, Setting, and Participants  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.

Main Outcomes and Measures  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%).

Results  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).

Conclusions and Relevance  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.

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