Highlights • States vary in terms of their success in reducing alcohol-related crash fatalities. • DUI arrests and alcohol-related crash fatalities are nonlinearly correlated. • Joint effect of DUI arrests and impaired driving laws are significant. • States with restrictive laws that enforce them are likely to reduce such fatalities.

Abstract In the United States, nearly 28 people die in alcohol–related motor vehicle crashes every day (1 fatality every 52 min). Over decades, states have enacted multiple laws to reduce such fatalities. From 1982 to 2019, the proportion of drivers in fatal crashes with a blood alcohol concentration (BAC) above 0.01 g/dl declined from 41% to 22%. States vary in terms of their success in reducing alcohol–related crash fatalities. The purpose of this study was to examine factors associated with changes in fatalities related to alcohol–impaired driving at the state level. We created a panel dataset of 50 states from 1985 to 2019 by merging different data sources and used fixed–effect linear regression models to analyze the data. Our two outcome variables were the ratio of drivers in fatal crashes with BAC ≥ 0.01 g/dl to those with BAC = 0.00, and the ratio of those with BAC ≥ 0.08 g/dl to those with BAC < 0.08 g/dl. Our independent variables included four laws (0.08 g/dl BAC per se law, administrative license revocation law, minimum legal drinking age law, and zero tolerance law), number of arrests due to impaired driving, alcohol consumption per capita, unemployment rate, and vehicle miles traveled. We found that the 0.08 g/dl per se law was significantly associated with lower alcohol–related crash fatalities while alcohol consumption per capita was significantly and positively associated with crash–related fatalities. Arrests due to driving under the influence (DUI) and crash fatalities were nonlinearly correlated. In addition, interaction of DUI arrests and two laws (0.08 g/dl BAC per se law, and zero tolerance) were significantly associated with lower crash–related fatalities. Our findings suggest that states which have more restrictive laws and enforce them are more likely to significantly reduce alcohol–related crash fatalities.