Factors associated with alcohol-impaired driver crash deaths in the United States, 2018-2022.

Alcohol-impaired driver deaths increased substantially from 2019 to 2022 in the United States.

• Passenger vehicle drivers killed in crashes with BACs at or above 0.08% increased from 4,791 in 2019 to 5,540 in 2020.
• Deaths remained elevated and continued rising to 6,042 in 2022.
• The study period covered 2018–2022 across all U.S. states.

The number of states permitting to-go or home-delivery alcohol purchases from bars or restaurants doubled between 2018 and 2022.

• This expansion in alcohol access policy occurred across the study period.
• The doubling of permitting states represents a major policy shift, partly associated with COVID-19 pandemic responses.
• Both to-go and home-delivery policies were tracked as separate state-level alcohol policy indicators.

Law enforcement employment declined and mental health indicators worsened from 2018 to 2022.

• Law enforcement employment levels fell over the study period.
• Adult mental health indicators measured included past-year major depressive episodes and past-year suicide plans.
• Both mental health indicators increased during 2018–2022.

In a panel regression for all driver ages, alcohol home delivery policies, major depressive episodes, and suicide plans were each significantly associated with more high-BAC driver deaths.

• The outcome variable was high-BAC (≥0.08%) driver deaths across states and months.
• Home delivery alcohol policies showed a positive and statistically significant association with driver deaths.
• Past-year major depressive episodes and past-year suicide plans were both statistically significant positive predictors.
• COVID-19 closures, vehicle miles traveled, and other variables were included as statistical controls.

Alcohol to-go policies and law enforcement employment were significantly associated with fewer high-BAC driver deaths in the all-ages model.

• To-go alcohol policies showed a negative and statistically significant association with high-BAC driver deaths.
• Law enforcement employment levels were negatively and significantly associated with driver deaths.
• The direction of associations for to-go versus home-delivery policies was opposite, indicating inconsistent overall effects of expanded alcohol access.

Among drivers aged 16–20, only law enforcement employment and suicide plans were significant predictors of high-BAC driver deaths.

• The young driver model used the same panel regression approach restricted to ages 16–20.
• Alcohol policy indicators (home delivery and to-go) were not significant predictors in this age group.
• Major depressive episodes were not a significant predictor for the 16–20 age group, unlike in the all-ages model.
• Law enforcement employment and suicidality were consistent predictors across both age models.

The associations between alcohol availability policies and driver deaths were not consistent across model specifications.

• Home delivery was associated with more deaths but to-go policies were associated with fewer deaths in the all-ages model.
• Neither policy variable was significant in the 16–20 age group model.
• The authors note that 'although the number of states permitting home-delivery and to-go alcohol increased, the associations with driver deaths were not consistent.'

The relationship between mental health factors and alcohol-impaired driving suggests a public health approach could complement traffic safety efforts.

• The paper recommends 'a broader public health focus that incorporates prevention and treatment services could play a role in helping to reverse the alcohol-impaired driving trend.'
• Suicidality (past-year suicide plans) was a consistent predictor across both age groups examined.
• The authors frame mental health indicators as independent factors from alcohol policy and law enforcement.