Injury Prevention Research Center, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
Department of Epidemiology, The University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA; College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE 68198, USA.
Accid Anal Prev. 2024 Mar;197:107449. doi: 10.1016/j.aap.2023.107449. Epub 2024 Jan 10.
BACKGROUND/PURPOSE: License suspensions are a strategy to address alcohol-impaired driving behavior and recidivism following an alcohol driving while impaired (alcohol-DWI) conviction. Little is known about the specific impacts of conviction-related suspensions on safety outcomes and given recent fluctuations in alcohol-impaired driving behavior, crashes, and suspension trends, updated and focused assessments of this intervention are necessary. This study aimed to 1) examine the association between type of recent alcohol-DWI suspension and having a secondary alcohol-related license outcome and/or future crash event in North Carolina (NC) between 2007 and 2016; and 2) assess potential modification of these associations by race/ethnicity.
We used linked NC licensing data, NC crash data, and county-level contextual data from a variety of data sources. We compared individuals ages 21 to 64 who sustained initial (1-year) versus repeat (4-year) suspensions for alcohol-related license and crash involvement outcomes. We estimated unadjusted and adjusted hazard ratios (aHRs) using Cox proportional hazards models and produced Kaplan-Meier (KM) survival curves using a three-year follow-up period. After observing statistically significant modification by race/ethnicity, we calculated stratified aHRs for each outcome (Black and White subgroups only, as other subgroups had low numbers of outcomes).
122,002 individuals sustained at least one alcohol-DWI conviction suspension (117,244 initial, 4,758 repeat). Adjusted KM survival curves indicated that within three years of the index suspension, the predicted risks of having a license outcome and crash outcome were about 8 % and 15 %, respectively, among individuals with an initial suspension and 5 % and 10 %, respectively, among individuals with a repeat suspension. After adjusting for potential confounding, we found that compared to those with an initial suspension, those with repeat suspensions had a lower incidence of future license (aHR: 0.49; 95 % CI: 0.42, 0.57) and crash outcomes (aHR: 0.67; 95 % CI: 0.60, 0.75). Among Black individuals, license outcome incidence was 162 % lower among repeat versus initial index suspension groups (aHR: 0.38; 95 % CI: 0.26, 0.55), while for White individuals, the incidence was 87 % lower (aHR: 0.54; 95 % CI: 0.45, 0.64). Similarly, crash incidence for repeat versus initial suspensions among Black individuals was 56 % lower (aHR: 0.64; 95 % CI: 0.50, 0.83), while only 39 % lower among White individuals (aHR: 0.72; 95 % CI: 0.63, 0.81).
Decreased incidence of both license and crash outcomes were observed among repeat versus initial index suspensions. The magnitude of these differences varied by race/ethnicity, with larger decreases in incidence among Black compared to White individuals. Future research should examine the underlying mechanisms leading to alcohol-impaired driving behavior, convictions, recidivism, and crashes from a holistic social-ecological perspective so that interventions are designed to both improve road safety and maximize other critical public health outcomes, such as access to essential needs and services (e.g., healthcare and employment).
背景/目的：吊销驾驶执照是一种策略，旨在解决酒后驾驶行为，并在酒后驾驶（酒后驾驶）定罪后减少再次犯罪。对于与定罪相关的吊销对安全结果的具体影响知之甚少，鉴于最近酒后驾驶行为、撞车事故和吊销趋势的波动，有必要对这一干预措施进行更新和重点评估。本研究旨在：1）检验 2007 年至 2016 年期间，北卡罗来纳州（NC）最近的酒精-DWI 吊销类型与二次酒精相关的驾照结果和/或未来撞车事件之间的关联；2）评估种族/族裔对这些关联的潜在影响。
我们使用了来自各种数据源的北卡罗来纳州许可数据、北卡罗来纳州撞车数据和县级背景数据。我们比较了年龄在 21 至 64 岁之间的个体，这些个体首次（1 年）和重复（4 年）因酒精相关的驾照和撞车事故而受到吊销。我们使用 Cox 比例风险模型估计了未调整和调整后的风险比（aHR），并使用三年的随访期生成了 Kaplan-Meier（KM）生存曲线。在观察到种族/族裔存在统计学显著差异后，我们为每个结果（黑人和白人亚组，因为其他亚组的结果数量较少）计算了分层 aHR。
122002 人至少有一次酒精-DWI 定罪吊销（117244 次首次吊销，4758 次重复吊销）。调整后的 KM 生存曲线表明，在索引吊销后的三年内，初次吊销个体的许可证结果和撞车结果的预测风险分别约为 8%和 15%，而重复吊销个体的预测风险分别约为 5%和 10%。在调整了潜在混杂因素后，我们发现与初次吊销相比，重复吊销的个体发生未来驾照（aHR：0.49；95%CI：0.42，0.57）和撞车结果（aHR：0.67；95%CI：0.60，0.75）的发生率较低。在黑人个体中，重复与初次索引吊销组相比，驾照结果的发生率低 162%（aHR：0.38；95%CI：0.26，0.55），而白人个体的发生率低 87%（aHR：0.54；95%CI：0.45，0.64）。同样，黑人个体中重复与初次吊销的撞车发生率低 56%（aHR：0.64；95%CI：0.50，0.83），而白人个体的撞车发生率低 39%（aHR：0.72；95%CI：0.63，0.81）。
与初次索引吊销相比，重复吊销与驾照和撞车结果发生率的降低有关。这些差异的幅度因种族/族裔而异，与白人相比，黑人的降幅更大。未来的研究应该从整体社会生态的角度来研究导致酒后驾驶行为、定罪、再次犯罪和撞车的潜在机制，以便设计干预措施，既能提高道路安全，又能最大限度地提高其他关键公共卫生成果，如获得基本需求和服务（如医疗保健和就业）。
