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Characteristics of 1226 Alcohol-Positive Drivers Involved in Nonfatal Traffic Crashes in Shanghai, China ab
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Yingying Sun , Zhibin Huang , Ziqin Zhao , Yan Jiang , Yonghong Ye , Tianfang Yu & Yulan Rao a
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Health Committee Office of Jilin Provincial Party Committee, Changchun, P.R. China
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Department of Forensic Medicine (Center of Forensic Science), School of Basic Medical Sciences, Fudan University, Shanghai, P.R. China c
Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, China Accepted author version posted online: 11 Oct 2013.Published online: 27 May 2014.
Click for updates To cite this article: Yingying Sun, Zhibin Huang, Ziqin Zhao, Yan Jiang, Yonghong Ye, Tianfang Yu & Yulan Rao (2014) Characteristics of 1226 Alcohol-Positive Drivers Involved in Nonfatal Traffic Crashes in Shanghai, China, Traffic Injury Prevention, 15:6, 532-536, DOI: 10.1080/15389588.2013.850162 To link to this article: http://dx.doi.org/10.1080/15389588.2013.850162
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Traffic Injury Prevention (2014) 15, 532–536 C Taylor & Francis Group, LLC Copyright ISSN: 1538-9588 print / 1538-957X online DOI: 10.1080/15389588.2013.850162
Characteristics of 1226 Alcohol-Positive Drivers Involved in Nonfatal Traffic Crashes in Shanghai, China YINGYING SUN1,2, ZHIBIN HUANG2, ZIQIN ZHAO2, YAN JIANG2, YONGHONG YE2, TIANFANG YU3, and YULAN RAO2 1
Health Committee Office of Jilin Provincial Party Committee, Changchun, P.R. China Department of Forensic Medicine (Center of Forensic Science), School of Basic Medical Sciences, Fudan University, Shanghai, P.R. China 3 Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, China
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Received 21 July 2013, Accepted 26 September 2013
Objective: The purpose of our study was to better characterize and evaluate drunk driving for governmental reference in order to further reduce alcohol-impaired driving. Method: This article reports the characteristics of 1226 alcohol-positive drivers with blood alcohol concentrations (BACs) at or over the legal limit of 0.20 mg/mL involved in nonfatal traffic accidents in Shanghai, China, from 2008 to 2011. The mean BAC, age, and gender of these drivers are discussed as well as the vehicle types and times of day when the crashes occurred. Results: The mean BAC was 1.41 mg/mL and the mean age was 38 years old, and the vast majority of drivers were male (96.9%). The mean BAC of male drivers (1.42 mg/mL) was higher than that of female drivers (1.20 mg/mL). The mean age of male drivers (38) was also higher than that of female drivers (33). Distributions of vehicle types involved were studied. Cars had the highest percentage of occurrences (56.4%), followed by motorcycles (32.8%), electric bicycles (6.8%), trucks (1.5%), and bicycles (0.8%). It was found that these alcohol-related traffic crashes most often occurred between 7:00 p.m. and 10:59 p.m., representing 48.1 percent (n = 590) of the 1226 cases. Single-vehicle crashes were overrepresented (70.3%) in all cases. The mean BAC in multivehicle crashes (1.69 mg/mL) was higher than that in single-vehicle crashes (1.30 mg/mL). Conclusions: The results indicated a notable need for more governmental attention that would prevent accidents caused by driving under the influence of alcohol. Keywords: nonfatal traffic accidents, driving under the influence of alcohol, drivers
Introduction Alcohol is considered a psychoactive drug based on its ability to affect the central nervous system. The increased risk of fatal traffic accidents generated by alcohol-impaired driving has already grasped the attention of many countries. Several studies have strengthened the fact that driving under the influence of alcohol (DUIA) causes drivers to be more inclined to be involved in road violations, suffer road trauma, or be involved in fatal accidents (Toro et al. 2005; World Health Organization 2005). In many countries, alcohol has become the most prevalent substance detected among drivers. For example, the occurrence of DUIA is about 5 percent of the general driving population in southeast Hungary (Institoris et al. 2013). This
Managing Editor David Viano oversaw the review of this article Yingying Sun and Zhibin Huang contributed equally to this work. Address correspondence to Yulan Rao, Department of Forensic Medicine (Center of Forensic Science), School of Basic Medical Sciences, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, P.R. China. E-mail: yulan [email protected]
kind of research still remains underdeveloped and inadequate in China. The high social cost from health care, welfare, and unemployment generated by traffic accidents has gained the attention of the Chinese government in recent years. The 2011 revised amendment of the People’s Republic of China’s law on Road Traffic Safety defines strict monetary punishment and detention for DUIA. This law has set 2 limits of the blood alcohol content (BAC) for driving: 0.20 and 0.80 mg/mL. The former level defines the limit of civil offense and is regarded as alcohol-positive in this study. The latter is the minimum for a criminal offense. In our study, we define “driving after drinking” as a BAC equal to or over 0.20 mg/mL but less than 0.80 mg/mL and “drunk driving” as a BAC equal to or greater than 0.80 mg/mL. Breath-testing is frequently conducted by the police in China. Drivers involved in traffic accidents are obliged to take a breath test. If the result is positive, despite possible error frequencies, the driver must take a blood test for confirmation The results of the blood alcohol analysis will determine the corresponding punishment, such as fines, suspension of driving license, and detention (see current regulations in Table A1, online supplement).
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Nonfatal Drunk Driving Crashes in China As the financial center of China, Shanghai is home to 23.5 million citizens (population density: 3702/km2) as of 2012, and traffic has undoubtedly become a major social problem. According to the data provided by the Traffic Police Corps of the Shanghai Public Security Bureau in 2011, there were 2085 road accidents among the 3.1 million civil motor vehicles, including 944 deaths and 1749 injuries (Bureau of Statistics of Shanghai 2012). However, the information on what role DUIA played in these accidents is not available. In this study, the characteristics of alcohol-positive drivers involved in nonfatal traffic accidents in Shanghai during 2008–2011 are described. Here, only alcohol-positive drivers were investigated and no information on the alcohol-positive rate was given because the breath-testing usually excludes alcohol-negative drivers (drivers with a BAC less than 0.20 mg/mL). Investigation of these individuals included age, gender, type of vehicle, and time of the day when the accident occurred. To a certain extent, this research complements a previous study on fatal accidents (Rao et al. 2013). The purpose of our study was to better characterize and evaluate drunk drivers for governmental reference in order to further reduce alcohol-impaired driving.
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Fig. 1. BAC level of alcohol-positive drivers involved in nonfatal accidents in Shanghai during 2008–2011.
more, BAC level was verified to be related to other characteristics like age, gender, and type of vehicle driven (see Table A2, online supplement).
Materials And Methods Age Samples Information on 1226 alcohol-positive drivers involved in nonfatal traffic accidents in Shanghai were collected from the Department of Forensic Medicine (Center of Forensic Science), School of Basic Medical Sciences, Fudan University, between the years of 2008 and 2011. Determination of Ethanol in Blood Headspace gas chromatography with a flame ionization detector was utilized to determine the amount of ethanol in the blood. Each blood sample was divided into 2 parts: one for testing and another for backup. Each blood specimen (0.10 mL) was diluted with t-butanol (0.50 mL) as the internal standard and then transferred into a glass vial (22 mL) with an airtight aluminum cap. The limit of detection for this method was 0.01 mg/mL, and the limit of quantification was 0.05 mg/mL. All determinations of ethanol were done in duplicate and the mean value was reported. Cases with a BAC of 0.20 mg/mL or higher were reported as alcohol-positive.
Results BAC The mean BAC of the 1226 alcohol-positive drivers involved in nonfatal traffic accidents in Shanghai was 1.41 mg/mL, which was approximately 7 times over the legal limit of 0.20 mg/mL. Figure 1 shows the distribution of BAC levels found in the study. The highest proportion had BACs between 1.4 and 2.0 mg/mL (65.1%). Notably, 82.8 percent of all cases had a BAC ≥ 0.8 mg/mL, which indicated that alcohol consumption was a dominant contributing factor in these crashes. Further-
It was found that the majority of drivers fell in the range of 20–59 years old, representing 97.1 percent (N = 1190) of all 1226 cases. According to Figure 2, the 30–39 age group covered the largest ratio of these alcohol-positive drivers in the 4 years studied (38.7, 31.4, 30.2, and 32.8% during 2008–2011), and the proportion in the 40–49 age group decreased with each year. In addition, due to improved standards of living, the number of young drivers has increased significantly. This phenomenon might contribute noticeably to our result where the proportion of drivers between 20 and 29 years increases with each year. For drivers with BAC ≥0.80 mg/mL, similar results were obtained, except for the 20–29 age group. It was found that drunk driving cases among the 40–49 age group decreased with each year, whereas the 20–29 age group increased slightly. Gender The percentage of male drivers was much higher than that of female drivers (96.2 vs. 3.8%) and females had a lower mean BAC (1.29 mg/mL vs. 1.42 mg/mL). As expected, the comparison showed that accidents involving male drivers occurred much more frequently than those involving female drivers. However, the proportion of male drivers decreased with each year (97.5% in 2008, 97.1% in 2009, 95.9% in 2010, and 94.4% in 2011), whereas that of female increased for these 4 years (2.5, 2.9, 4.1, and 5.6%). These data are consistent with the fact that more women are engaged in driving nowadays. The proportion of drivers involved in drunk driving was also higher for males; 83.1 percent of all male drivers and 74.4 percent of all e female drivers had a BAC ≥0.80 mg/mL. The average age was 38 years old for male drivers (ranging from 16 to 78 years old) and 33 years old for female drivers (ranging from 18 to
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Fig. 2. Age distribution of alcohol-positive drivers involved in nonfatal accidents in Shanghai during 2008–2011.
61 years old). The difference in the BAC between male drivers and female drivers was not statistically significant (χ 2 = 2.24, P > .05, P = .25). Vehicle Types Table 1 classifies the types of vehicles in these nonfatal traffic accidents from 2008 to 2011. A total of 5 kinds of vehicles are listed. It was found that cars showed the highest proportion (56.4%), followed by motorcycles (32.8%), electric bicycles (6.8%), trucks (1.5%), and bicycle (0.8%). The mean BACs were in the range of 0.91–1.46 mg/mL, exceeding the legal limit. The mean BAC of motorcyclists (1.46 mg/mL) represented the highest value among all vehicle types, and 86.7 percent of electric bicyclists involved in crashes had a BAC ≥ 0.80 mg/mL, showing the highest percentage of drunk driving behavior among the 5 vehicle types. Truck drivers were involved in a low percentage of all cases and showed the smallest percentage of drivers having a BAC ≥ 0.80 mg/mL (63.2%). The number of bicyclists was the smallest, but their mean age was the highest (44 years old). Time of Day Figure 3 presents a relative frequency distribution of the time periods when these cases occurred. Accidents occurring from 7:00 p.m. to 10:59 p.m. had the highest frequency (48.1%, N = 590) and accidents occurring from 5:00 a.m. to 8:59 a.m. had the lowest frequency (1.9%, N = 23). However, there was no significant difference in BAC values between these 2 groups (χ 2 = 0.94, P > .05, P = .821). Single-Vehicle vs. Multiple-Vehicle Crashes Of the 1226 cases investigated, 70.3 percent (N = 862) were classified as single-vehicle crashes and 29.7 percent (N = 364) were classified as multiple-vehicle crashes. Among single-vehicle cases, 79.9 percent (N = 689) had a BAC ≥
Sun et al.
Fig. 3. Time distribution of the nonfatal accidents involving alcohol-positive drivers in Shanghai during 2008–2011.
0.80 mg/mL, which was slightly lower than that in multiplevehicle cases (89.3%, N = 325). The BAC level of drivers differed significantly depending on the type of crash they were involved in (χ 2 = 11.95, P < .01, P = .000).
Discussion BAC In this study, the most important finding was that the mean BAC in these alcohol-positive drivers (BAC ≥ 0.20 mg/mL) involved in nonfatal traffic accidents in Shanghai was very high (1.41 mg/mL), 7 times above the statutory alcohol limit for driving in China. However, this value was still slightly lower than that found in alcohol-positive drivers killed in crashes in Shanghai (1.51 mg/mL; Rao et al. 2013). When we were trying to compare the mean BAC with other countries, it was found that although drivers with a BAC lower than 0.20 mg/mL were not counted in this study, the average BAC (1.41 mg/mL) of the 1226 alcohol-positive drivers involved in nonfatal crashes in Shanghai during 2008–2011 still appeared to be lower than that reported by researchers from other countries. The average BAC found in traffic violators in Luxembourg, Sweden, and Norway was 1.70 mg/mL (Appenzeller et al. 2005), 1.74 mg/mL (Jones and Holmgren 2009), and 1.54 mg/g (Khiabani et al. 2008), respectively BAC is used as a prediction for the likelihood of an accident. Based on several studies of relative risk, a U.S. report conducted in 1978 concluded that crash risk increased with the increase of driver’s BAC. When the driver’s BAC approached 0.80 mg/mL, the relative probability of an accident was found to begin to increase precipitously. At a BAC of 1.00 mg/mL, the probability of a fatal or serious injury crash was estimated to be 6 to 12 times that of a driver who had not consumed alcohol (U.S. Department of Transportation, NHTSA 2001). In this study, 82.8 percent of the drivers had a BAC ≥
Nonfatal Drunk Driving Crashes in China
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Table 1. Case numbers, mean BAC, mean age of drivers, and proportion over the threshold of BAC limit for drunk driving, according to vehicle types Type
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Car Motorcycle Electric bicycle Truck Bicycle
N (%)
Mean BAC (mg/mL)
Mean age
Number of drivers with a BAC ≥ 0.80 mg/mL (%)
691 (56.4) 402 (32.8) 83 (6.8) 19 (1.5) 10 (0.8)
1.15 1.46 1.39 0.91 1.16
37 36 42 36 44
569 (82.3) 333 (82.8) 72 (86.7) 12 (63.2) 8 (80.0)
0.80 mg/mL and 73.9 percent had a BAC ≥ 1.00 mg/mL. In fact, the percentages were even higher for fatal traffic accidents in Shanghai (75.6 and 69.7%, respectively; Rao et al. 2013). Our results showed that alcohol consumption was a significant contributing factor in most traffic accidents investigated in this study. It is reasonable to assert that many of these accidents would probably not have occurred if the drivers did not consume alcohol. Furthermore, it was reported that drivers with a BAC above 1.90 mg/mL were clearly suspected of being alcohol dependent (Brinkmann et al. 2002). In this study, 22.2 percent of the drivers who had a BAC ≥ 1.90 mg/mL were probably alcohol-dependent users as well. Due to regular alcohol consumption, these drivers could have developed a tolerance to the impairing effects of alcohol. For these cases, the drivers’ aptitude to drive might need to be verified and the underlying alcohol problem might be resolved with medical intervention rather than incarceration or monetary fines. Age Figure 3 shows that the majority of drivers were in the age range 30–39 (38.7, 31.4, 30.2, and 32.8% for each year from 2008–2011 inclusive). However, in fatal cases in Shanghai, the largest group of drivers were between 40 and 49 years old (Rao et al. 2013). A study from Ribeir˜ao Preto, S˜ao Paulo, Brazil demonstrated the prevalence of traffic accidents among individuals between 26 and 35 years old (Pereira et al. 2011). The percentage of alcohol-positive drivers between 20 and 29 years old increased with each year, as shown in Figure 2. Young individuals tend to be both relatively inexperienced drivers and relatively inexperienced alcohol consumers. It was found that young drinkers were involved in driving accidents at higher rates than older drivers with similar BACs, despite lower BAC levels (National Institute on Alcohol Abuse and Alcoholism 1996). Thus, the phenomenon shown in this study requires more government attention. As stated above, drivers with a BAC above 1.90 mg/mL were clearly suspected of being alcohol dependent (Brinkmann et al. 2002). It was noticed in this study that, for drivers younger than 60 years old, the percentage of drivers with BAC ≥ 1.90 mg/mL increased with age; the highest percentage (28.7%) was found in the age group 50–59. Individuals usually start to drink during their teenage years. If they continue to drink, they may become excessive drinkers later in life and have a high risk of developing alcohol dependence. Evidence shows that the onset of drinking is associated with drinking problems later in life. It was verified that individuals who began drinking at an earlier age was more likely to experience drunk driving and involvement in vehicular crashes
than respondents who had not (Hingson et al. 2009). A lack of minimum drinking age restriction in China, to some extent, contributed to the alcohol dependence showed in this study. In the state of New York, individuals under 21 are not allowed to purchase alcoholic beverages. In Sweden, it is illegal to sell spirits, strong beer, and wines to people younger than 20 years of age. However, alcohol can be bought and consumed on the premises of pubs, bars, and restaurants at the age of 18 (Jones and Holmgren 2009). In China, however, there is no such restriction for younger individuals. The problem of underage drinking reinforces the need for policies to set the legal drinking age and delay the onset of drinking. Gender There is a consistent pattern over time and across cultures that males consume more alcohol and abuse alcohol more frequently, which results in a noticeably increased involvement in DUIA (Chan et al. 2007; Wilsnack et al. 2006). This phenomenon was also verified in this study. The percentage of male drivers (96.2%) involved in nonfatal road traffic accidents was much higher than that of female drivers (3.8%). In Australia, there was less significant difference between genders (77.4% vs. 22.6%; Longo et al. 2000). The rate of male drivers involved BAC ≥ 0.80 mg/mL was higher than that of females as well (83.1% vs. 74.4%). These findings showed that men in Shanghai were much more likely than women to be involved in either driving after drinking or drunk driving. In this study, the average age was 38 years old for male drivers and 33 years old for female drivers. This is probably because more young females drive in China than previously. Other studies revealed similar average ages for men (37–39 years old) but older ages for women (41–42 years old; Jones and Holmgren 2009). Vehicle Types With respect to vehicle types, cars had the highest proportion, followed by motorcycles, electric bicycles, trucks, and bicycles. However, in fatal crashes, motorcycles had the highest proportion of all vehicles involved. No less than 36.0 percent of the vehicles involved in fatal traffic crashes in Shanghai were motorcycles (Rao et al. 2013). As observed in the study, 55.0 percent of the motorcycle cases presented a BAC over 1.4 mg/mL, though for the same BAC level the percentage was lower for other vehicles (30.0–49.7%). Electric bicyclists showed the highest percentage of drunk driving behavior (86.7%) among the 5 vehicle types. This phenomenon, to some extent, reflects the fact that people in Shanghai take
536 the electric bicycle as a low-risk traffic tackle customarily while ignoring the risk after drinking. Truck drivers had the lowest mean BAC, which might be because they are commercial vehicle drivers. However, the mean BAC of truck drivers was still as high as 0.91 mg/mL, which was higher than the limit for a criminal offense. Moreover, 63.2 percent of these truck drivers had a BAC ≥ 0.80 mg/mL. Thus, a lower BAC limit is suggested to prevent driving a commercial vehicle under the influence of alcohol.
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Time of Day Road crashes among drivers with a positive BAC were most likely to occur during the period 7:00 p.m.–10:59 p.m. (48.1%). This is because there are more alcohol-involved entertainment and social activities during night hours. A similar phenomenon was observed in fatal crashes in Shanghai (Rao et al. 2013).
Single-Vehicle Crashes vs. Multiple-Vehicle Crashes In this study, more high BACs were found in samples from drivers involved in multiple-vehicle accidents than those involved in single-vehicle accidents; 89.3 percent (N = 325) of drivers involved in multiple-vehicle crashes had a BAC ≥ 0.80 mg/mL, which was slightly higher than that in singlevehicle crashes (79.9%, N = 689). The mean BAC in multivehicle crashes was higher than that of single-vehicle crashes as well (1.69 vs. 1.30 mg/mL). A similar phenomenon was also observed in fatal crashes in Shanghai (Rao et al. 2013). However, the result in Sweden had nothing to do with the classification of single-vehicle and multivehicle crashes (mean 1.7 vs. 1.6 mg/mL; Jones and Holmgren 2009). Our study revealed that although the mean BAC was lower in Shanghai compared to other cities around the world after analyzing 1226 nonfatally injured and alcohol-positive drivers, it was still at a very high level of 7 times above the statutory alcohol limit for driving in China. This emphasizes that driving under the influence of alcohol is a serious behavior impacting road traffic safety. The results of this study confirmed and extended previous work from our laboratory regarding the effects of alcohol on drivers involved in fatal traffic accidents in Shanghai, China. To prevent and fight against drunk driving, relative laws and regulations should be strictly enforced. It is even essential to set the minimum drinking age as in the United States and many European countries. It is also essential to establish the alcohol detection brake for drunk drivers who already have criminal records (individuals who previously have had illegal BAC, refused to take a breath alcohol test, or have been cited for drunk driving multiple times; Fell et al. 2010). On the other hand, public education is of equal importance and should be taken seriously as well. Helping drivers, passengers, and potential drivers all realize the danger and cost due to drunk driving is vital, and emphasizing the importance of safe driving should be on our agenda.
Sun et al. Supplemental Material Supplemental data for this article can be accessed on the publisher’s website.
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Traffic Injury Prevention Publication details, including instructions for authors and subscription information: http://www.tandfonline.com/loi/gcpi20
Characteristics of 1226 Alcohol-Positive Drivers Involved in Nonfatal Traffic Crashes in Shanghai, China ab
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b
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Yingying Sun , Zhibin Huang , Ziqin Zhao , Yan Jiang , Yonghong Ye , Tianfang Yu & Yulan Rao a
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Health Committee Office of Jilin Provincial Party Committee, Changchun, P.R. China
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Department of Forensic Medicine (Center of Forensic Science), School of Basic Medical Sciences, Fudan University, Shanghai, P.R. China c
Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, China Accepted author version posted online: 11 Oct 2013.Published online: 27 May 2014.
Click for updates To cite this article: Yingying Sun, Zhibin Huang, Ziqin Zhao, Yan Jiang, Yonghong Ye, Tianfang Yu & Yulan Rao (2014) Characteristics of 1226 Alcohol-Positive Drivers Involved in Nonfatal Traffic Crashes in Shanghai, China, Traffic Injury Prevention, 15:6, 532-536, DOI: 10.1080/15389588.2013.850162 To link to this article: http://dx.doi.org/10.1080/15389588.2013.850162
PLEASE SCROLL DOWN FOR ARTICLE Taylor & Francis makes every effort to ensure the accuracy of all the information (the “Content”) contained in the publications on our platform. However, Taylor & Francis, our agents, and our licensors make no representations or warranties whatsoever as to the accuracy, completeness, or suitability for any purpose of the Content. Any opinions and views expressed in this publication are the opinions and views of the authors, and are not the views of or endorsed by Taylor & Francis. The accuracy of the Content should not be relied upon and should be independently verified with primary sources of information. Taylor and Francis shall not be liable for any losses, actions, claims, proceedings, demands, costs, expenses, damages, and other liabilities whatsoever or howsoever caused arising directly or indirectly in connection with, in relation to or arising out of the use of the Content. This article may be used for research, teaching, and private study purposes. Any substantial or systematic reproduction, redistribution, reselling, loan, sub-licensing, systematic supply, or distribution in any form to anyone is expressly forbidden. Terms & Conditions of access and use can be found at http:// www.tandfonline.com/page/terms-and-conditions
Traffic Injury Prevention (2014) 15, 532–536 C Taylor & Francis Group, LLC Copyright ISSN: 1538-9588 print / 1538-957X online DOI: 10.1080/15389588.2013.850162
Characteristics of 1226 Alcohol-Positive Drivers Involved in Nonfatal Traffic Crashes in Shanghai, China YINGYING SUN1,2, ZHIBIN HUANG2, ZIQIN ZHAO2, YAN JIANG2, YONGHONG YE2, TIANFANG YU3, and YULAN RAO2 1
Health Committee Office of Jilin Provincial Party Committee, Changchun, P.R. China Department of Forensic Medicine (Center of Forensic Science), School of Basic Medical Sciences, Fudan University, Shanghai, P.R. China 3 Department of Clinical Medicine, Shanghai Medical College, Fudan University, Shanghai, China
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Received 21 July 2013, Accepted 26 September 2013
Objective: The purpose of our study was to better characterize and evaluate drunk driving for governmental reference in order to further reduce alcohol-impaired driving. Method: This article reports the characteristics of 1226 alcohol-positive drivers with blood alcohol concentrations (BACs) at or over the legal limit of 0.20 mg/mL involved in nonfatal traffic accidents in Shanghai, China, from 2008 to 2011. The mean BAC, age, and gender of these drivers are discussed as well as the vehicle types and times of day when the crashes occurred. Results: The mean BAC was 1.41 mg/mL and the mean age was 38 years old, and the vast majority of drivers were male (96.9%). The mean BAC of male drivers (1.42 mg/mL) was higher than that of female drivers (1.20 mg/mL). The mean age of male drivers (38) was also higher than that of female drivers (33). Distributions of vehicle types involved were studied. Cars had the highest percentage of occurrences (56.4%), followed by motorcycles (32.8%), electric bicycles (6.8%), trucks (1.5%), and bicycles (0.8%). It was found that these alcohol-related traffic crashes most often occurred between 7:00 p.m. and 10:59 p.m., representing 48.1 percent (n = 590) of the 1226 cases. Single-vehicle crashes were overrepresented (70.3%) in all cases. The mean BAC in multivehicle crashes (1.69 mg/mL) was higher than that in single-vehicle crashes (1.30 mg/mL). Conclusions: The results indicated a notable need for more governmental attention that would prevent accidents caused by driving under the influence of alcohol. Keywords: nonfatal traffic accidents, driving under the influence of alcohol, drivers
Introduction Alcohol is considered a psychoactive drug based on its ability to affect the central nervous system. The increased risk of fatal traffic accidents generated by alcohol-impaired driving has already grasped the attention of many countries. Several studies have strengthened the fact that driving under the influence of alcohol (DUIA) causes drivers to be more inclined to be involved in road violations, suffer road trauma, or be involved in fatal accidents (Toro et al. 2005; World Health Organization 2005). In many countries, alcohol has become the most prevalent substance detected among drivers. For example, the occurrence of DUIA is about 5 percent of the general driving population in southeast Hungary (Institoris et al. 2013). This
Managing Editor David Viano oversaw the review of this article Yingying Sun and Zhibin Huang contributed equally to this work. Address correspondence to Yulan Rao, Department of Forensic Medicine (Center of Forensic Science), School of Basic Medical Sciences, Fudan University, 138 Yi Xue Yuan Road, Shanghai 200032, P.R. China. E-mail: yulan [email protected]
kind of research still remains underdeveloped and inadequate in China. The high social cost from health care, welfare, and unemployment generated by traffic accidents has gained the attention of the Chinese government in recent years. The 2011 revised amendment of the People’s Republic of China’s law on Road Traffic Safety defines strict monetary punishment and detention for DUIA. This law has set 2 limits of the blood alcohol content (BAC) for driving: 0.20 and 0.80 mg/mL. The former level defines the limit of civil offense and is regarded as alcohol-positive in this study. The latter is the minimum for a criminal offense. In our study, we define “driving after drinking” as a BAC equal to or over 0.20 mg/mL but less than 0.80 mg/mL and “drunk driving” as a BAC equal to or greater than 0.80 mg/mL. Breath-testing is frequently conducted by the police in China. Drivers involved in traffic accidents are obliged to take a breath test. If the result is positive, despite possible error frequencies, the driver must take a blood test for confirmation The results of the blood alcohol analysis will determine the corresponding punishment, such as fines, suspension of driving license, and detention (see current regulations in Table A1, online supplement).
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Nonfatal Drunk Driving Crashes in China As the financial center of China, Shanghai is home to 23.5 million citizens (population density: 3702/km2) as of 2012, and traffic has undoubtedly become a major social problem. According to the data provided by the Traffic Police Corps of the Shanghai Public Security Bureau in 2011, there were 2085 road accidents among the 3.1 million civil motor vehicles, including 944 deaths and 1749 injuries (Bureau of Statistics of Shanghai 2012). However, the information on what role DUIA played in these accidents is not available. In this study, the characteristics of alcohol-positive drivers involved in nonfatal traffic accidents in Shanghai during 2008–2011 are described. Here, only alcohol-positive drivers were investigated and no information on the alcohol-positive rate was given because the breath-testing usually excludes alcohol-negative drivers (drivers with a BAC less than 0.20 mg/mL). Investigation of these individuals included age, gender, type of vehicle, and time of the day when the accident occurred. To a certain extent, this research complements a previous study on fatal accidents (Rao et al. 2013). The purpose of our study was to better characterize and evaluate drunk drivers for governmental reference in order to further reduce alcohol-impaired driving.
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Fig. 1. BAC level of alcohol-positive drivers involved in nonfatal accidents in Shanghai during 2008–2011.
more, BAC level was verified to be related to other characteristics like age, gender, and type of vehicle driven (see Table A2, online supplement).
Materials And Methods Age Samples Information on 1226 alcohol-positive drivers involved in nonfatal traffic accidents in Shanghai were collected from the Department of Forensic Medicine (Center of Forensic Science), School of Basic Medical Sciences, Fudan University, between the years of 2008 and 2011. Determination of Ethanol in Blood Headspace gas chromatography with a flame ionization detector was utilized to determine the amount of ethanol in the blood. Each blood sample was divided into 2 parts: one for testing and another for backup. Each blood specimen (0.10 mL) was diluted with t-butanol (0.50 mL) as the internal standard and then transferred into a glass vial (22 mL) with an airtight aluminum cap. The limit of detection for this method was 0.01 mg/mL, and the limit of quantification was 0.05 mg/mL. All determinations of ethanol were done in duplicate and the mean value was reported. Cases with a BAC of 0.20 mg/mL or higher were reported as alcohol-positive.
Results BAC The mean BAC of the 1226 alcohol-positive drivers involved in nonfatal traffic accidents in Shanghai was 1.41 mg/mL, which was approximately 7 times over the legal limit of 0.20 mg/mL. Figure 1 shows the distribution of BAC levels found in the study. The highest proportion had BACs between 1.4 and 2.0 mg/mL (65.1%). Notably, 82.8 percent of all cases had a BAC ≥ 0.8 mg/mL, which indicated that alcohol consumption was a dominant contributing factor in these crashes. Further-
It was found that the majority of drivers fell in the range of 20–59 years old, representing 97.1 percent (N = 1190) of all 1226 cases. According to Figure 2, the 30–39 age group covered the largest ratio of these alcohol-positive drivers in the 4 years studied (38.7, 31.4, 30.2, and 32.8% during 2008–2011), and the proportion in the 40–49 age group decreased with each year. In addition, due to improved standards of living, the number of young drivers has increased significantly. This phenomenon might contribute noticeably to our result where the proportion of drivers between 20 and 29 years increases with each year. For drivers with BAC ≥0.80 mg/mL, similar results were obtained, except for the 20–29 age group. It was found that drunk driving cases among the 40–49 age group decreased with each year, whereas the 20–29 age group increased slightly. Gender The percentage of male drivers was much higher than that of female drivers (96.2 vs. 3.8%) and females had a lower mean BAC (1.29 mg/mL vs. 1.42 mg/mL). As expected, the comparison showed that accidents involving male drivers occurred much more frequently than those involving female drivers. However, the proportion of male drivers decreased with each year (97.5% in 2008, 97.1% in 2009, 95.9% in 2010, and 94.4% in 2011), whereas that of female increased for these 4 years (2.5, 2.9, 4.1, and 5.6%). These data are consistent with the fact that more women are engaged in driving nowadays. The proportion of drivers involved in drunk driving was also higher for males; 83.1 percent of all male drivers and 74.4 percent of all e female drivers had a BAC ≥0.80 mg/mL. The average age was 38 years old for male drivers (ranging from 16 to 78 years old) and 33 years old for female drivers (ranging from 18 to
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Fig. 2. Age distribution of alcohol-positive drivers involved in nonfatal accidents in Shanghai during 2008–2011.
61 years old). The difference in the BAC between male drivers and female drivers was not statistically significant (χ 2 = 2.24, P > .05, P = .25). Vehicle Types Table 1 classifies the types of vehicles in these nonfatal traffic accidents from 2008 to 2011. A total of 5 kinds of vehicles are listed. It was found that cars showed the highest proportion (56.4%), followed by motorcycles (32.8%), electric bicycles (6.8%), trucks (1.5%), and bicycle (0.8%). The mean BACs were in the range of 0.91–1.46 mg/mL, exceeding the legal limit. The mean BAC of motorcyclists (1.46 mg/mL) represented the highest value among all vehicle types, and 86.7 percent of electric bicyclists involved in crashes had a BAC ≥ 0.80 mg/mL, showing the highest percentage of drunk driving behavior among the 5 vehicle types. Truck drivers were involved in a low percentage of all cases and showed the smallest percentage of drivers having a BAC ≥ 0.80 mg/mL (63.2%). The number of bicyclists was the smallest, but their mean age was the highest (44 years old). Time of Day Figure 3 presents a relative frequency distribution of the time periods when these cases occurred. Accidents occurring from 7:00 p.m. to 10:59 p.m. had the highest frequency (48.1%, N = 590) and accidents occurring from 5:00 a.m. to 8:59 a.m. had the lowest frequency (1.9%, N = 23). However, there was no significant difference in BAC values between these 2 groups (χ 2 = 0.94, P > .05, P = .821). Single-Vehicle vs. Multiple-Vehicle Crashes Of the 1226 cases investigated, 70.3 percent (N = 862) were classified as single-vehicle crashes and 29.7 percent (N = 364) were classified as multiple-vehicle crashes. Among single-vehicle cases, 79.9 percent (N = 689) had a BAC ≥
Sun et al.
Fig. 3. Time distribution of the nonfatal accidents involving alcohol-positive drivers in Shanghai during 2008–2011.
0.80 mg/mL, which was slightly lower than that in multiplevehicle cases (89.3%, N = 325). The BAC level of drivers differed significantly depending on the type of crash they were involved in (χ 2 = 11.95, P < .01, P = .000).
Discussion BAC In this study, the most important finding was that the mean BAC in these alcohol-positive drivers (BAC ≥ 0.20 mg/mL) involved in nonfatal traffic accidents in Shanghai was very high (1.41 mg/mL), 7 times above the statutory alcohol limit for driving in China. However, this value was still slightly lower than that found in alcohol-positive drivers killed in crashes in Shanghai (1.51 mg/mL; Rao et al. 2013). When we were trying to compare the mean BAC with other countries, it was found that although drivers with a BAC lower than 0.20 mg/mL were not counted in this study, the average BAC (1.41 mg/mL) of the 1226 alcohol-positive drivers involved in nonfatal crashes in Shanghai during 2008–2011 still appeared to be lower than that reported by researchers from other countries. The average BAC found in traffic violators in Luxembourg, Sweden, and Norway was 1.70 mg/mL (Appenzeller et al. 2005), 1.74 mg/mL (Jones and Holmgren 2009), and 1.54 mg/g (Khiabani et al. 2008), respectively BAC is used as a prediction for the likelihood of an accident. Based on several studies of relative risk, a U.S. report conducted in 1978 concluded that crash risk increased with the increase of driver’s BAC. When the driver’s BAC approached 0.80 mg/mL, the relative probability of an accident was found to begin to increase precipitously. At a BAC of 1.00 mg/mL, the probability of a fatal or serious injury crash was estimated to be 6 to 12 times that of a driver who had not consumed alcohol (U.S. Department of Transportation, NHTSA 2001). In this study, 82.8 percent of the drivers had a BAC ≥
Nonfatal Drunk Driving Crashes in China
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Table 1. Case numbers, mean BAC, mean age of drivers, and proportion over the threshold of BAC limit for drunk driving, according to vehicle types Type
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Car Motorcycle Electric bicycle Truck Bicycle
N (%)
Mean BAC (mg/mL)
Mean age
Number of drivers with a BAC ≥ 0.80 mg/mL (%)
691 (56.4) 402 (32.8) 83 (6.8) 19 (1.5) 10 (0.8)
1.15 1.46 1.39 0.91 1.16
37 36 42 36 44
569 (82.3) 333 (82.8) 72 (86.7) 12 (63.2) 8 (80.0)
0.80 mg/mL and 73.9 percent had a BAC ≥ 1.00 mg/mL. In fact, the percentages were even higher for fatal traffic accidents in Shanghai (75.6 and 69.7%, respectively; Rao et al. 2013). Our results showed that alcohol consumption was a significant contributing factor in most traffic accidents investigated in this study. It is reasonable to assert that many of these accidents would probably not have occurred if the drivers did not consume alcohol. Furthermore, it was reported that drivers with a BAC above 1.90 mg/mL were clearly suspected of being alcohol dependent (Brinkmann et al. 2002). In this study, 22.2 percent of the drivers who had a BAC ≥ 1.90 mg/mL were probably alcohol-dependent users as well. Due to regular alcohol consumption, these drivers could have developed a tolerance to the impairing effects of alcohol. For these cases, the drivers’ aptitude to drive might need to be verified and the underlying alcohol problem might be resolved with medical intervention rather than incarceration or monetary fines. Age Figure 3 shows that the majority of drivers were in the age range 30–39 (38.7, 31.4, 30.2, and 32.8% for each year from 2008–2011 inclusive). However, in fatal cases in Shanghai, the largest group of drivers were between 40 and 49 years old (Rao et al. 2013). A study from Ribeir˜ao Preto, S˜ao Paulo, Brazil demonstrated the prevalence of traffic accidents among individuals between 26 and 35 years old (Pereira et al. 2011). The percentage of alcohol-positive drivers between 20 and 29 years old increased with each year, as shown in Figure 2. Young individuals tend to be both relatively inexperienced drivers and relatively inexperienced alcohol consumers. It was found that young drinkers were involved in driving accidents at higher rates than older drivers with similar BACs, despite lower BAC levels (National Institute on Alcohol Abuse and Alcoholism 1996). Thus, the phenomenon shown in this study requires more government attention. As stated above, drivers with a BAC above 1.90 mg/mL were clearly suspected of being alcohol dependent (Brinkmann et al. 2002). It was noticed in this study that, for drivers younger than 60 years old, the percentage of drivers with BAC ≥ 1.90 mg/mL increased with age; the highest percentage (28.7%) was found in the age group 50–59. Individuals usually start to drink during their teenage years. If they continue to drink, they may become excessive drinkers later in life and have a high risk of developing alcohol dependence. Evidence shows that the onset of drinking is associated with drinking problems later in life. It was verified that individuals who began drinking at an earlier age was more likely to experience drunk driving and involvement in vehicular crashes
than respondents who had not (Hingson et al. 2009). A lack of minimum drinking age restriction in China, to some extent, contributed to the alcohol dependence showed in this study. In the state of New York, individuals under 21 are not allowed to purchase alcoholic beverages. In Sweden, it is illegal to sell spirits, strong beer, and wines to people younger than 20 years of age. However, alcohol can be bought and consumed on the premises of pubs, bars, and restaurants at the age of 18 (Jones and Holmgren 2009). In China, however, there is no such restriction for younger individuals. The problem of underage drinking reinforces the need for policies to set the legal drinking age and delay the onset of drinking. Gender There is a consistent pattern over time and across cultures that males consume more alcohol and abuse alcohol more frequently, which results in a noticeably increased involvement in DUIA (Chan et al. 2007; Wilsnack et al. 2006). This phenomenon was also verified in this study. The percentage of male drivers (96.2%) involved in nonfatal road traffic accidents was much higher than that of female drivers (3.8%). In Australia, there was less significant difference between genders (77.4% vs. 22.6%; Longo et al. 2000). The rate of male drivers involved BAC ≥ 0.80 mg/mL was higher than that of females as well (83.1% vs. 74.4%). These findings showed that men in Shanghai were much more likely than women to be involved in either driving after drinking or drunk driving. In this study, the average age was 38 years old for male drivers and 33 years old for female drivers. This is probably because more young females drive in China than previously. Other studies revealed similar average ages for men (37–39 years old) but older ages for women (41–42 years old; Jones and Holmgren 2009). Vehicle Types With respect to vehicle types, cars had the highest proportion, followed by motorcycles, electric bicycles, trucks, and bicycles. However, in fatal crashes, motorcycles had the highest proportion of all vehicles involved. No less than 36.0 percent of the vehicles involved in fatal traffic crashes in Shanghai were motorcycles (Rao et al. 2013). As observed in the study, 55.0 percent of the motorcycle cases presented a BAC over 1.4 mg/mL, though for the same BAC level the percentage was lower for other vehicles (30.0–49.7%). Electric bicyclists showed the highest percentage of drunk driving behavior (86.7%) among the 5 vehicle types. This phenomenon, to some extent, reflects the fact that people in Shanghai take
536 the electric bicycle as a low-risk traffic tackle customarily while ignoring the risk after drinking. Truck drivers had the lowest mean BAC, which might be because they are commercial vehicle drivers. However, the mean BAC of truck drivers was still as high as 0.91 mg/mL, which was higher than the limit for a criminal offense. Moreover, 63.2 percent of these truck drivers had a BAC ≥ 0.80 mg/mL. Thus, a lower BAC limit is suggested to prevent driving a commercial vehicle under the influence of alcohol.
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Time of Day Road crashes among drivers with a positive BAC were most likely to occur during the period 7:00 p.m.–10:59 p.m. (48.1%). This is because there are more alcohol-involved entertainment and social activities during night hours. A similar phenomenon was observed in fatal crashes in Shanghai (Rao et al. 2013).
Single-Vehicle Crashes vs. Multiple-Vehicle Crashes In this study, more high BACs were found in samples from drivers involved in multiple-vehicle accidents than those involved in single-vehicle accidents; 89.3 percent (N = 325) of drivers involved in multiple-vehicle crashes had a BAC ≥ 0.80 mg/mL, which was slightly higher than that in singlevehicle crashes (79.9%, N = 689). The mean BAC in multivehicle crashes was higher than that of single-vehicle crashes as well (1.69 vs. 1.30 mg/mL). A similar phenomenon was also observed in fatal crashes in Shanghai (Rao et al. 2013). However, the result in Sweden had nothing to do with the classification of single-vehicle and multivehicle crashes (mean 1.7 vs. 1.6 mg/mL; Jones and Holmgren 2009). Our study revealed that although the mean BAC was lower in Shanghai compared to other cities around the world after analyzing 1226 nonfatally injured and alcohol-positive drivers, it was still at a very high level of 7 times above the statutory alcohol limit for driving in China. This emphasizes that driving under the influence of alcohol is a serious behavior impacting road traffic safety. The results of this study confirmed and extended previous work from our laboratory regarding the effects of alcohol on drivers involved in fatal traffic accidents in Shanghai, China. To prevent and fight against drunk driving, relative laws and regulations should be strictly enforced. It is even essential to set the minimum drinking age as in the United States and many European countries. It is also essential to establish the alcohol detection brake for drunk drivers who already have criminal records (individuals who previously have had illegal BAC, refused to take a breath alcohol test, or have been cited for drunk driving multiple times; Fell et al. 2010). On the other hand, public education is of equal importance and should be taken seriously as well. Helping drivers, passengers, and potential drivers all realize the danger and cost due to drunk driving is vital, and emphasizing the importance of safe driving should be on our agenda.
Sun et al. Supplemental Material Supplemental data for this article can be accessed on the publisher’s website.
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