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Despite years of public messaging about the dangers of drinking and driving, Canada ranks No. 1 among 19 wealthy countries for percentage of roadway deaths linked to alcohol impairment, according to a new study.

The finding by the U.S. Centers for Disease Control should serve as a warning to lawmakers that new strategies are needed to combat impaired driving, which remains the top criminal cause of death in Canada, safety advocates say.

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“The CDC does the best studies; their information is undebatable,” said Andy Murie, CEO of MADD Canada. “It’s a wake-up call. We need to do more.”

The study found that while fewer people were dying from motor vehicle crashes in Canada (the crash death rate in 2013 was 5.4 per 100,000 people, a drop of 43 per cent from 2000), the proportion of deaths linked to alcohol impairment was 34 per cent, higher than any of the other countries in the survey.

The United States came in next at 31 per cent, followed by Australia (30 per cent), and France (29 per cent). Countries with the lowest percentage of fatal crashes tied to alcohol were Israel (3.2 per cent), Japan (6.2 per cent), and Austria (6.8 per cent).