Drinking and recreational boating fatalities: a population-based case-control study

JAMA. 2001 Dec 19;286(23):2974-80.


Context: Alcohol is increasingly recognized as a factor in many boating fatalities, but the association between alcohol consumption and mortality among boaters has not been well quantified.

Objectives: To determine the association of alcohol use with passengers' and operators' estimated relative risk (RR) of dying while boating.

Design, setting, and participants: Case-control study of recreational boating deaths among persons aged 18 years or older from 1990-1998 in Maryland and North Carolina (n = 221), compared with control interviews obtained from a multistage probability sample of boaters in each state from 1997-1999 (n = 3943).

Main outcome measure: Estimated RR of fatality associated with different levels of blood alcohol concentration (BAC) among boaters.

Results: Compared with the referent of a BAC of 0, the estimated RR of death increased even with a BAC of 10 mg/dL (odds ratio [OR], 1.3; 95% confidence interval [CI], 1.2-1.4). The OR was 52.4 (95% CI, 25.9-106.1) at a BAC of 250 mg/dL. The estimated RR associated with alcohol use was similar for passengers and operators and did not vary by boat type or whether the boat was moving or stationary.

Conclusions: Drinking increases the RR of dying while boating, which becomes apparent at low levels of BAC and increases as BAC increases. Prevention efforts targeted only at those operating a boat are ignoring many boaters at high risk. Countermeasures that reduce drinking by all boat occupants are therefore more likely to effectively reduce boating fatalities.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Accidents / mortality*
  • Accidents / statistics & numerical data
  • Adult
  • Alcohol Drinking / epidemiology*
  • Alcoholic Intoxication / epidemiology
  • Case-Control Studies
  • Ethanol / blood
  • Humans
  • Maryland / epidemiology
  • North Carolina / epidemiology
  • Recreation*
  • Risk
  • Ships*


  • Ethanol