1 figure omitted
Motor-vehicle crashes are the leading cause of death in the United States
for persons aged 16-24 years, and a substantial proportion of these crashes
are alcohol-related. Alcohol-impaired driving is highest among persons aged
21-24 years,1 and the percentage of fatal
crashes that are alcohol-related is highest for this age group.2 However,
alcohol-related crashes are a serious problem even for the youngest drivers.
Not only are drivers aged <21 years more likely than older drivers to be
involved in fatal crashes, but their added risk for fatal crash involvement
increases more sharply at all levels of alcohol use.3 To
characterize the rate of alcohol-related fatal crashes among young drivers,
CDC analyzed unpublished data from the Fatality Analysis Reporting System
(FARS), a national database of information on fatal crashes. The findings
indicate that the largest decrease in alcohol-related fatal crashes during
1982-2001 was among drivers aged <21 years, who have been the target of
several interventions to reduce alcohol-impaired driving. Public health and
traffic safety professionals should ensure that communities implement comprehensive
and effective strategies to reduce alcohol-impaired driving.
FARS contains data on a census of fatal traffic crashes within the United
States. To be included in FARS, a crash must occur on a public road and result
in a death within 30 days of the crash. Trend data for alcohol-related fatal
crash rates for 1982-2001 are presented for four age groups: 16-17 years,
18-20 years, 21-24 years, and ≥25 years. Data on older drivers are presented
for comparison. Drivers are considered alcohol-involved if their blood alcohol
concentration (BAC) was ≥0.01 g/dL. When BACs are unavailable, they are
imputed from driver and crash characteristics by using a two-stage estimation
procedure.4* Crash rates are calculated
by dividing the number of alcohol-involved crashes for each age group by the
census estimate for the number of U.S. residents in that age group (per 100,000
During 1982-2001, fatal crash involvement by drinking drivers decreased
46% (95% confidence interval [CI] = −48%-−5%). The most dramatic
decreases were among drivers aged <21 years. Fatal alcohol-related crash
rates decreased 60% (95% CI = −65%-−56%) for drivers aged 16-17
years, 55% (95% CI = −58%-−52%) for drivers aged 18-20 years,
41% (95% CI = −44%-−38%) for drivers aged 21-24 years, and 39%
(95% CI = −41%-−38%) for drivers aged ≥25 years. These decreases
had been achieved by 1997 (48% overall decrease, 95% CI = −49%-−47%),
when the trend began to level off. Since 1999, rates have increased slightly
for all age groups except those aged 16-17 years (16-17 years: −3%,
95% CI = −16%-11%; 18-20 years: 6%, 95% CI = −2%-14%; 21-24 years:
10%, 95% CI = 3%-16%; ≥25 years: 4%, 95% CI = 1%-7%). Despite the overall
decreases, alcohol-related crashes resulted in 17,448 fatalities during 2001.
The risks for involvement in alcohol-related fatal crashes remain high
for young drivers, particularly when driving exposure is considered. For example,
in 1996, rates of involvement in alcohol-related fatal crashes were similar
for drivers aged 16-17 years and those aged ≥25 years (5.8 versus 6.0 per
100,000 population); in comparison, their risk was approximately three times
greater per mile driven (1.6 per 100,000,000 vehicle miles traveled [VMT]
versus 0.6 VMT).6,7
RW Elder, MEd, RA Shults, PhD, Div of Unintentional Injury Prevention,
National Center for Injury Prevention and Control, CDC.
During 1982-2001, rates of alcohol-related fatal crashes decreased substantially
across all age groups, with the largest decrease among drivers aged <21
years. These drivers were recognized increasingly as a high-risk group during
the 1970s, when many states lowered their legal drinking age and alcohol-related
crashes increased. Subsequently, targeted interventions were implemented to
reduce rates of alcohol-impaired driving. The 1984 Uniform Drinking Age Act
required states to adopt a minimum legal drinking age of 21 years by 1988.
Other interventions targeted directly at young drivers include "zero tolerance"
BAC standards for drivers under the legal drinking age and graduated driver
licensing programs, which require new drivers to progress through stages,
allowing them increased driving priviledges as they gain experience. Other
factors that have probably reduced overall levels of drinking and driving
include new laws and policies, stronger law enforcement, community-based education
and advocacy programs, and shifts in social norms about alcohol consumption
and the acceptability of alcohol-impaired driving.8
The findings in this report are subject to at least two limitations.
First, BAC data are imputed for approximately 60% of FARS cases in any given
year,4 decreasing the precision of the alcohol-related
crash rates used in this analysis. Second, although alcohol is an important
risk factor for traffic crashes, it is not necessarily the primary cause of
every crash in which it is measured or imputed. Despite these limitations,
the alcohol-related crashes reported in FARS are among the best available
indices for measuring progress in reducing alcohol-impaired driving.
To further decrease alcohol-related fatal crashes among both young drivers
and the general population, communities need to implement interventions that
are known to be effective. CDC, in cooperation with the Task Force on Community
Preventive Services, has completed a series of systematic reviews of several
interventions for reducing alcohol-impaired driving. The Task Force has recommended
that states maintain and enforce minimum legal drinking age laws and "zero
tolerance" laws for young drivers. It also recommended the implementation
of sobriety checkpoints, 0.08% BAC laws, and training programs for servers
of alcoholic beverages.9,10 Public
health and traffic safety professionals should collaborate to ensure that
every community has a comprehensive and effective strategy to resume the downward
trend in alcohol-impaired driving.
*This model produces estimates that are not comparable to those produced
by the imputation procedure used by FARS before 2002.5
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The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
The Rational Clinical Examination: Evidence-Based Clinical Diagnosis
Original Article: A Primer on the Precision and Accuracy of the Clinical Examination
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