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

July 2025

Objective: In the United States, the proportion of passenger vehicle drivers killed in crashes with blood alcohol concentrations (BACs) at or above 0.08% increased from 28% in 2019 to 30% in 2020 and remained elevated at 31% in 2022. This paper examines alcohol policies, mental health factors, and law enforcement employment reductions as potential explanations for the increase in alcohol-related deaths. Method: Panel regressions were used to compare two outcomes across states and months (2018–2022): deaths of passenger vehicle drivers with high BACs (>= 0.08%) and deaths of passenger vehicle drivers in single-vehicle nighttime crashes. Analyses were conducted for all ages and for ages 16–20. Predictors included state-level indicator variables for to-go and home-delivery alcohol policies, mental health indicators, and law enforcement employment. COVID-19 closures, vehicle miles traveled, and other variables were included as statistical controls. Results: During the study period, the number of states with policies permitting to-go or home-delivery alcohol purchases approximately doubled, law enforcement employment levels declined, and mental health indicators for depression and suicidality increased. The policy indicator for home delivery of alcohol from bars or restaurants was associated with more high-BAC driver deaths; in all other analyses, alcohol policy indicators were not significant or were associated with fewer high-BAC driver deaths and single-vehicle nighttime driver deaths. In analyses of all ages, higher statewide law enforcement employment was associated with fewer high-BAC driver deaths and fewer single-vehicle nighttime driver deaths. One mental health indicator, percentage of adults reporting past-year suicide plans, was a significant predictor of driver deaths in all analyses. Conclusions: Alcohol home delivery was associated with high-BAC driver deaths, but the mixed results and limitations of the alcohol policy analysis suggest further research is needed to understand the impact of these policies. Law enforcement employment and adult mental health were two additional independent factors associated with high-BAC driver deaths. Ongoing efforts to address alcohol-impaired driving should consider these factors.