Association of Rideshare Use With Alcohol-Associated Motor Vehicle Crash Trauma

Abstract

IMPORTANCE Motor vehicle crashes (MVCs) are an important public health concern. Recent trends suggest that introducing rideshare services has decreased the incidence of MVCs. However, detailed analyses linking rideshare volume, convictions for impaired driving, and nonfatal MVC traumas remain inconclusive.OBJECTIVE To determine if there is an association between rideshare use and MVC traumas and convictions for impaired driving in Houston, Texas. DESIGN, SETTING, AND PARTICIPANTSThis multicenter cohort study was conducted between January 2007 and November 2019 with hospital data from the Red Duke Trauma Institute within the Memorial Hermann Hospital-Texas Medical Center and Ben Taub General Hospital. Rideshare data from Uber and Google covered trips taken within Houston, Texas, from February 2014 (the date of deployment of Uber to Houston) to December 2018. Impaired driving convictions included all indictments made by the Harris County, Texas, District Attorney's office from January 2007 to December 2018. All adults with MVC traumas evaluated at both centers in the study population (individuals >16 years with a mechanism of injury classified under "motor vehicle collision") were included. Impaired driving incidents were included only if the final legal outcome was conviction. MAIN OUTCOMES AND MEASURESThe primary study outcomes were the incident rate ratios for hourly MVC traumas and daily impaired driving convictions. RESULTS A total of 23 491 MVC traumas (involving patients with a mean [SD] age of 37.9 [17.8] years and 14 603 male individuals [62.1%]), 93 742 impaired driving convictions, and more than 24 million Uber rides were analyzed. Following the introduction of Uber in February 2014, MVC traumas decreased by 23.8% (from a mean [SD] of 0.26 [0.04] to 0.21 [0.06] trauma incidents per hour) during peak trauma periods (Friday and Saturday nights).The incident rate ratio of MVC traumas following Uber deployment was 0.33 (95% CI, 0.17-0.67) per 1000 indexed rides (P = .002). Furthermore, rideshare use was associated with a significant, geographically linked reduction in impaired driving convictions between January 2014 to December 2019 (incidence rate ratio, 0.76 [95% CI, 0.73-0.78]; P < .001). CONCLUSIONS AND RELEVANCEIn this study, introducing rideshare services in the Houston metropolitan area was associated with significant reductions in MVC traumas and impaired driving convictions. Increased use of rideshares may be an effective means of reducing impaired driving and decreasing rate of MVC traumas.

Decision strategies while intoxicated relate to alcohol-impaired driving attitudes and intentions.

“…Lacking a control condition did not allow us to test whether intoxicated decision strategies align with sober decision strategies which could inform interventions before a drinking episode. Early adulthood has the highest rates of AID, but middle-to-older adults may have differing views on ride services and distinct patterns of acute alcohol tolerance which could better inform interventions among an older age group (Friedman et al, 2020;Conner et al, 2021). Although we were able to classify most individuals into either compensatory or non-compensatory strategy use, future research should determine whether there are other decision making strategies being used or the absence of identifiable strategies among unclassified individuals.…”

“…Lacking a placebo condition did not allow us to test whether intoxicated decision strategies align with sober decision strategies which could inform interventions before a drinking episode. Early adulthood has the highest rates of AID, but middle-to-older adults may have differing views on ride services and distinct patterns of acute alcohol tolerance which could better inform interventions among an older age group (Conner et al, 2021; Friedman et al, 2020). We also did not collect or assess whether individuals had a history of DWI or being stopped in suspicion of impaired driving.…”

“…Perceived acceptability of AID alternatives by the general public predicts AID behavior (Fairlie et al, 2010; Turrisi & Jaccard, 1992), and facilitating the use of alternatives has long been a part of AID prevention efforts (see Fell et al, 2020 for a review). Ride service companies (e.g., Uber, Lyft) often claim that they reduce AID through decreasing the associated costs and increasing the convenience of securing a ride after drinking (Uber & Mothers Against Drunk Driving, 2015), and recent data provide some support for this argument (Conner et al, 2021; Friedman et al, 2020). Though ride service companies often offer a lower cost AID alternative, the monetary cost of ride services may still present a barrier that influences its use (McCarthy et al, 2021).…”

Implications of Ridesharing on Alcohol-Associated Motor Vehicle Crashes

“…2 In recent years, the national rate of alcohol-impaired driving fatalities has steadily declined from 0.36 per 100 million vehicle miles traveled in 2009 to 0.33 per 100 million in 2018, owing to a combination of public health and law enforcement interventions, including sobriety checkpoints, saturation patrols, and strict sanctions for those who break the law in various states. 2,3 In this issue of JAMA Surgery, Conner et al 4 study the usefulness of yet a new intervention that was less feasible a decade ago: the outcome of simply removing drivers who are potentially impaired from behind the wheel. This is essentially what ridesharing technologies such as Uber and Lyft have purportedly been able to achieve.…”

Treatment of Alcohol Use Problems Among Rural Populations: a Review of Barriers and Considerations for Increasing Access to Quality Care

“…Given limited availability and longer distance travel in rural areas, rideshare use also remains low among rural residents, with only 19% reporting they have used a rideshare app [ 22 ]. Because rideshare programs have been found to reduce alcohol-involved traffic accidents and impaired driving [ 23 , 24 ], rural residents may be more likely to engage in alcohol-impaired driving, leading them to receive court-mandated treatment at higher rates than their urban counterparts.…”