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Risk of 30-day mortality and its association with alcohol concentration level among driver victims of motor vehicle crashes: comparison of population- and hospital-based designs
  1. Ya-Hui Chang1,
  2. Tsung-Hsueh Lu1,
  3. I-Lin Hsu2,
  4. Bae-Ling Chen3,
  5. Chung-Yi Li1,4,5
  1. 1Department of Public Health, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  2. 2Department of Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  3. 3College of Intelligence, National Taichung University of Science and Technology, Taichung, Taiwan
  4. 4Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan
  5. 5Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
  1. Correspondence to Chung-Yi Li, Department of Public Health College of Medicine, National Cheng Kung University, Tainan 701, Taiwan; cyli99{at}


Background Although blood alcohol concentration (BAC) is undoubtedly associated with increased risk of injury among driver victims involved in motor vehicle crashes (MVCs), some studies noted that high BAC was associated with reduced risk of mortality after injury. In addition, most of the previous studies included only injured patients admitted, which may lead to potential selection bias arising from exclusion of those with minor injury and those who died at the accident scene of MVC.

Method The population-based design included 2586 driver victims with BAC equivalent >0 and 10 307 matched controls (BAC equivalent =0) selected from the Police-reported Traffic Accident Registry from 1 July to 31 December 2016 in Taiwan. The hospital-based design comprised a subset sample, which included 517 driver victims with BAC equivalent >0 and 662 with BAC equivalent =0 hospitalised on the same day the MVCs occurred. Conditional logistic regression models with adjustment for potential confounders were used to estimate the ORs and 95% CIs of 30-day mortality associated with BAC equivalent level.

Results In the population-based design, a positive dose–gradient relationship was observed between BAC equivalent level and 30-day mortality, with a covariate-adjusted OR of 3.77 (95% CI 1.84 to 7.72), 6.19 (95% CI 3.13 to 12.26) and 7.75 (95% CI 4.51 to 13.32) for low, moderate and high BAC equivalent levels, respectively. By contrast, the hospital-based design revealed no significant association between 30-day mortality and alcohol concentration regardless of the BAC equivalent level.

Conclusion The association between BAC equivalent level and short-term mortality could have been overlooked in hospital-based studies that excluded MVC-related deaths outside hospital settings.

  • Mortality
  • Injury
  • Health services
  • Environmental epidemiology
  • Alcohol
  • Research design

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  • Contributors YH Chang, TH Lu, IL Hsu, BL Chen and CY Li designed the study, performed the statistical analyses, contributed to the interpretation of results, drafted the initial manuscript and revised its contents. CY Li is the guarantor of this work, has full access to all study data and is responsible for the integrity of the data and accuracy of the data analysis.

  • Funding This study was supported by a grant from the Ministry of Science and Technology (MOST 107-2314-B-006-057-MY2). The funder had no role in conducting and submitting this work.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.