Abstract

SummaryBackgroundDrink driving is an important risk factor for road traffic accidents (RTAs), which cause high levels of morbidity and mortality globally. Lowering the permitted blood alcohol concentration (BAC) for drivers is a common public health intervention that is enacted in countries and jurisdictions across the world. In Scotland, on Dec 5, 2014, the BAC limit for drivers was reduced from 0·08 g/dL to 0·05 g/dL. We therefore aimed to evaluate the effects of this change on RTAs and alcohol consumption.MethodsIn this natural experiment, we used an observational, comparative interrupted time-series design by use of data on RTAs and alcohol consumption in Scotland (the interventional group) and England and Wales (the control group). We obtained weekly counts of RTAs from police accident records and we estimated weekly off-trade (eg, in supermarkets and convenience stores) and 4-weekly on-trade (eg, in bars and restaurants) alcohol consumption from market research data. We also used data from automated traffic counters as denominators to calculate RTA rates. We estimated the effect of the intervention on RTAs by use of negative binomial panel regression and on alcohol consumption outcomes by use of seasonal autoregressive integrated moving average models. Our primary outcome was weekly rates of RTAs in Scotland, England, and Wales. This study is registered with ISRCTN, number ISRCTN38602189.FindingsWe assessed the weekly rate of RTAs and alcohol consumption between Jan 1, 2013, and Dec 31, 2016, before and after the BAC limit came into effect on Dec 5, 2014. After the reduction in BAC limits for drivers in Scotland, we found no significant change in weekly RTA rates after adjustment for seasonality and underlying temporal trend (rate ratio 1·01, 95% CI 0·94–1·08; p=0.77) or after adjustment for seasonality, the underlying temporal trend, and the driver characteristics of age, sex, and socioeconomic deprivation (1·00, 0·96–1·06; p=0·73). Relative to RTAs in England and Wales, where the reduction in BAC limit for drivers did not occur, we found a 7% increase in weekly RTA rates in Scotland after this reduction in BAC limit for drivers (1·07, 1·02–1·13; p=0·007 in the fully-adjusted model). Similar findings were observed for serious or fatal RTAs and single-vehicle night-time RTAs. The change in legislation in Scotland was associated with no change in alcohol consumption, measured by per-capita off-trade sales (−0·3%, −1·7 to 1·1; p=0·71), but a 0·7% decrease in alcohol consumption measured by per-capita on-trade sales (−0·7%, −0·8 to −0·5; p<0·0001).InterpretationLowering the driving BAC limit to 0·05 g/dL from 0·08 g/dL in Scotland was not associated with a reduction in RTAs, but this change was associated with a small reduction in per-capita alcohol consumption from on-trade alcohol sales. One plausible explanation is that the legislative change was not suitably enforced—for example with random breath testing measures. Our findings suggest that changing the legal BAC limit for drivers in isolation does not improve RTA outcomes. These findings have significant policy implications internationally as several countries and jurisdictions consider a similar reduction in the BAC limit for drivers.FundingNational Institute for Health Research Public Health Research Programme.

Highlights

  • Road traffic accidents (RTAs) are a major public health problem, with 1·25 million road traffic deaths globally in 2013.1 In Great Britain, there have been large reductions in RTAs over recent decades, including a 72% reduction in fatal RTAs observed between 1979 and 2017

  • We assessed the weekly rate of RTAs and alcohol consumption between Jan 1, 2013, and Dec 31, 2016, before and after the blood alcohol concentration (BAC) limit came into effect on Dec 5, 2014

  • We evaluated the effects of a change in drink-drive legislation from a BAC limit of 0·08 g/dL to 0·05 g/dL in an entire population, which reduced the risk of selection biases

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Summary

Introduction

Road traffic accidents (RTAs) are a major public health problem, with 1·25 million road traffic deaths globally in 2013.1 In Great Britain, there have been large reductions in RTAs over recent decades, including a 72% reduction in fatal RTAs observed between 1979 and 2017. RTAs remain a considerable burden on health: in 2017, 170 993 casualties from RTAs were reported.[2] Driving under the influence of alcohol is a major risk factor for RTAs, and a dose-response relation is observed between blood alcohol concentration (BAC) and RTAs. It has been estimated that the odds of fatal injury increase by 1·74 for every 0·02% increase in BAC.[3] In the UK in 2016, there were at least 6070 RTAs involving a driver with a BAC over the legal limit.[4]. Since Norway introduced a legal BAC limit for driving in 1936, other countries across Europe, North America, Japan, and Australasia have introduced BAC limits www.thelancet.com Vol 393 January 26, 2019

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