When we lived in Uganda I carried two spares and a patch kit. One trip in N. Uganda I used all my patches and had to resort to “drive 10 km, pump up tire(s). drive 10 km...”. to get back to the mission station. The next morning I found I had three flats on the ground and a flat spare. It took 34 patches to fix those. (LOTS of BIG thorns in Karamoja!)
OTOH, I cannot remember when I have had a flat in the USA. We live on a rough, rocky mountain road. Our Honda CR-V has 160K miles and the “nubs” are still on the spare. The Outback has 230K and I’ve never used the spare.
I could live without a spare in the USA and I’m a “belt AND suspenders” type of guy.
There’s no accounting for luck - good or bad. I’ve had to change my flat tire (on an American car on American roads) four times, and I maintain my car! So I never go anywhere without a full bore spare tire and rim.