The risk of dying in alcohol-related automobile crashes among habitual drunk drivers

N Engl J Med. 1994 Aug 25;331(8):513-7. doi: 10.1056/NEJM199408253310806.


Background: Reports suggest that people who drive while intoxicated by alcohol may do so repeatedly. We hypothesized that persons arrested for driving while impaired might be at increased risk for death in an alcohol-related motor vehicle crash. To evaluate this possibility, we studied the deaths of drivers in alcohol-related motor vehicle accidents in North Carolina over a 10-year period.

Methods: We compared drivers who died in motor vehicle crashes from 1980 through 1989 and who had blood alcohol concentrations of at least 20 mg per deciliter (4.3 mmol per liter), referred to as the case drivers, with those who died in crashes but had blood alcohol concentrations below 20 mg per deciliter, referred to as the control drivers. We identified case drivers and control drivers through the state Medical Examiner System. We then searched North Carolina driver-history files for the five years before each death to identify arrests for driving while impaired.

Results: We linked a total of 1646 case drivers and 1474 control drivers to their driver-history files. Case drivers were more likely than control drivers to have been arrested for driving while impaired (26 percent vs. 3 percent). After we controlled for potential confounding variables, case drivers 21 to 34 years of age were 4.3 times more likely (95 percent confidence interval, 2.7 to 6.8) than control drivers to have been arrested for driving while impaired; case drivers 35 years of age or older were 11.7 times more likely (95 percent confidence interval, 6.8 to 20.1). The strength of the association appeared to increase with the number of prior arrests. Case drivers were also more likely than the general population of currently licensed drivers to have been arrested.

Conclusions: Arrests for driving while impaired substantially increase the risk of eventual death in an alcohol-related crash. Aggressive intervention in the cases of people arrested for driving while impaired may decrease the likelihood of a future fatal alcohol-related crash.

Publication types

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

MeSH terms

  • Accidents, Traffic / mortality*
  • Adult
  • Alcoholic Intoxication / mortality*
  • Automobile Driving / legislation & jurisprudence
  • Automobile Driving / statistics & numerical data*
  • Case-Control Studies
  • Confidence Intervals
  • Confounding Factors, Epidemiologic
  • Female
  • Humans
  • Male
  • North Carolina / epidemiology
  • Odds Ratio
  • Risk