633 Survey-based six-country comparison of drink driving, enforcement, crashes, and crash reporting

<h3>Background</h3> Especially in middle-income countries, crash intervention and burden analyses/policymaking often rely on assumptions supported by data from the United States (US). <h3>Objective</h3> Using survey data, to compare driver behavior and crash characteristics in the US, Belgium, Brazil, China, Mexico, and South Africa. <h3>Data Sources</h3> In each country, we conducted face-to-face interviews with the same highway safety questions (translated into six languages) using stratified samples of 1300 to 6000 adult respondents spread across two mid-sized cities, except the US survey was by mail. The survey primarily focused on alcohol consumption patterns. Survey dates: 2018/19 or 2023. <h3>Methods</h3> Survey data weighted to match local censuses. Differences between countries assessed with Fishers exact test, t-tests, logit regression. <h3>Results</h3> Driving without a license was rare except in Mexico (30%) and a Brasilia exurb (26%). Among those who drove, self-reported alcohol-impaired driving rates were: 15% Belgium, 20% Brazil, 5% China, 9% Mexico, 20% South Africa, 14% US. The percentage of those who drove drunk in the past year who police stopped for drunk driving varied widely: 53% Belgium, 21% Brazil, 60% China and Mexico, 93% South Africa, 3% (sic) in the US. Drivers passing through a sobriety checkpoint were: 27% Belgium, 53% Brazil and China, 38% Mexico, 5% US. Use of an app or social media to avoid police when driving after drinking was most common in Brazil (17% of drivers) and South Africa (13%), lowest in the US (1%). The percentage of respondents riding with someone they thought was intoxicated in the past year was: 26% Belgium, 9% China. 18%-19% Brazil and Mexico, 12% US. Crash data were not collected in South Africa. The surveys yielded data on 380 crashes. Police crash reporting rates were: 56% Brazil , 69% US, 61%-63% elsewhere. The percentage of crashes involving death or injury was: 16% US, 24% Mexico, 31%-34% elsewhere. Perceived crash alcohol involvement rates were: 19% Belgium, 32% Brazil, 41% China, 57% Mexico, 13% US. <h3>Conclusions</h3> US data are poor surrogates for driving parameters elsewhere, notably urban police crash reporting. US impaired driving enforcement is far worse than in these comparison countries.