Moderate-to-severe anxiety and drink-driving in Korean adults

Objectives To estimate the association between moderate-to-severe generalized anxiety and past-year drink-driving in Korean adults and test whether this association differs by sex. The study addresses a road-safety question that is not captured by alcohol-use measures alone: whether a standardized anxiety signal is visible in population-level drink-driving surveillance.Methods We conducted a cross-sectional complex-survey analysis of pooled 2021–2024 Korea National Health and Nutrition Examination Survey microdata. The analytic sample included 20,859 adults aged 19 years or older. The exposure was a GAD-7 score of 10 or higher, with sensitivity analyses using the 8 or higher cut point and continuous GAD-7 score. The outcome was self-reported past-12-month drink-driving, recoded as binary. Adjusted odds ratios (aORs) and 95% confidence intervals (CIs) were estimated using KNHANES strata, primary sampling units, and interview weights. Models adjusted for sex, age, urban or rural residence, income, education, occupation, marital status, and family-relationship status; additional analyses examined sex interaction, depressive-symptom co-adjustment, alcohol-use adjustment, multiple imputation for missing data, and restriction to past-year drinkers.Results Weighted drink-driving prevalence was 1.6%, and GAD-7 score of 10 or higher prevalence was 4.6%. Moderate-to-severe anxiety was associated with higher adjusted odds of drink-driving after demographic, socioeconomic, and family-context adjustment (aOR, 2.20; 95% CI, 1.08–4.45; p = 0.03). The GAD-7 by sex interaction was not statistically significant (p = 0.13). The association was directionally consistent using a GAD-7 cut point of 8 or higher (aOR, 2.06; 95% CI, 1.17–3.62; p = 0.01), a continuous GAD-7 score per 5-point increase (aOR, 1.58; 95% CI, 1.35–1.84; p < 0.001), multiple imputation of missing data (aOR, 2.23; 95% CI, 1.14–4.35; p = 0.02), and depressive-symptom co-adjustment (aOR, 3.30; 95% CI, 1.50–7.25; p = 0.003). Additional alcohol-use adjustment attenuated the estimate (aOR, 1.95; 95% CI, 0.93–4.10; p = 0.08), and the past-year-drinker analysis produced a similar point estimate. Thus, the anxiety signal weakened after alcohol-use adjustment but remained near twofold in magnitude.Conclusions Moderate-to-severe anxiety was associated with higher odds of self-reported drink-driving in Korean adults, but the association weakened after alcohol-use adjustment. These findings should be interpreted as hypothesis-generating rather than causal. They do not imply that anxiety alone predicts drink-driving or that anxiety screening should be used for enforcement. Instead, they suggest that drink-driving may be one point where alcohol use, anxiety, and risk behavior meet. Future drink-driving prevention research should measure anxiety, alcohol use, and driving exposure together rather than treating drink-driving only as an alcohol-use problem.