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

Eichelberger, Angela H.
Journal of Safety Research
December 2025

Abstract
Introduction: In the United States, the number of passenger vehicle drivers killed in crashes with blood alcohol concentrations (BACs) at or above 0.08% increased from 4,791 in 2019 to 5,540 in 2020 and remained elevated at 6,042 in 2022. This paper examines changes in alcohol policies, mental health factors, and law enforcement employment during 2018 to 2022 and their associations with alcohol-impaired driver deaths.
Method: Panel regressions compared high-BAC (>= 0.08%) driver deaths across states and months for all ages and ages 16–20. Predictors included state-level alcohol policy indicators (to-go and home-delivery), adult mental health indicators (past-year major depressive episodes and past-year suicide plans), and law enforcement employment levels. COVID-19 closures, vehicle miles traveled, and other variables were included as statistical controls.
Results: From 2018 to 2022, the number of states permitting to-go or home-delivery alcohol purchases from bars or restaurants doubled, law enforcement employment declined, and mental health indicators increased. In a panel regression with all ages of drivers, alcohol home delivery policies, major depressive episodes, and suicide plans were associated with significantly more high-BAC driver deaths, whereas alcohol to-go policies and law enforcement employment were associated with significantly fewer high-BAC driver deaths. Only two predictors (law enforcement employment and suicide plans) were significant predictors of high-BAC driver deaths among ages 16–20.
Conclusions: Although the number of states permitting home-delivery and to-go alcohol increased, the associations with driver deaths were not consistent. Law enforcement employment and suicidality were two independent factors consistently associated with alcohol-impaired driver deaths. As law enforcement employment levels fell and as suicidality increased, alcohol-impaired driver deaths rose. Practical applications: The relationship between mental health factors and alcohol-impaired driving suggests that a broader public health focus that incorporates prevention and treatment services could play a role in helping to reverse the alcohol-impaired driving trend.
Abstract Introduction: In the United States, the number of passenger vehicle drivers killed in crashes with blood alcohol concentrations (BACs) at or above 0.08% increased from 4,791 in 2019 to 5,540 in 2020 and remained elevated at 6,042 in 2022. This paper examines changes in alcohol policies, mental health factors, and law enforcement employment during 2018 to 2022 and their associations with alcohol-impaired driver deaths.
Method: Panel regressions compared high-BAC (>= 0.08%) driver deaths across states and months for all ages and ages 16–20. Predictors included state-level alcohol policy indicators (to-go and home-delivery), adult mental health indicators (past-year major depressive episodes and past-year suicide plans), and law enforcement employment levels. COVID-19 closures, vehicle miles traveled, and other variables were included as statistical controls.
Results: From 2018 to 2022, the number of states permitting to-go or home-delivery alcohol purchases from bars or restaurants doubled, law enforcement employment declined, and mental health indicators increased. In a panel regression with all ages of drivers, alcohol home delivery policies, major depressive episodes, and suicide plans were associated with significantly more high-BAC driver deaths, whereas alcohol to-go policies and law enforcement employment were associated with significantly fewer high-BAC driver deaths. Only two predictors (law enforcement employment and suicide plans) were significant predictors of high-BAC driver deaths among ages 16–20.
Conclusions: Although the number of states permitting home-delivery and to-go alcohol increased, the associations with driver deaths were not consistent. Law enforcement employment and suicidality were two independent factors consistently associated with alcohol-impaired driver deaths. As law enforcement employment levels fell and as suicidality increased, alcohol-impaired driver deaths rose. Practical applications: The relationship between mental health factors and alcohol-impaired driving suggests that a broader public health focus that incorporates prevention and treatment services could play a role in helping to reverse the alcohol-impaired driving trend.