[Skip to Content]
[Skip to Content Landing]

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

Educational Objective To determine if the use of rideshare services for impaired driving was associated with changes in motor vehicle crash rates.
1 Credit CME
Key Points

Question  By decreasing impaired driving, are rideshare services associated with changes in motor vehicle trauma rates?

Findings  This multicenter cohort study obtained hospital data at both major trauma centers in Houston, Texas; convictions for impaired driving from the Harris County, Texas, District Attorney’s office; and rideshare use data from Uber and Google for Houston. Rideshare volume had a significant negative correlation with the incidence of motor vehicle–associated trauma, and this was most evident in those younger than 30 years; a significant decrease in convictions for impaired driving was associated with the introduction of rideshare services.

Meaning  By using rideshares to avoid impaired driving, young people may aid in decreasing motor vehicle trauma.


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 Participants  This 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 Measures  The 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 Relevance  In 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.

Sign in to take quiz and track your certificates

Buy This Activity

JN Learning™ is the home for CME and MOC from the JAMA Network. Search by specialty or US state and earn AMA PRA Category 1 Credit(s)™ from articles, audio, Clinical Challenges and more. Learn more about CME/MOC

CME Disclosure Statement: Unless noted, all individuals in control of content reported no relevant financial relationships. If applicable, all relevant financial relationships have been mitigated.

Article Information

Accepted for Publication: March 3, 2021.

Published Online: June 9, 2021. doi:10.1001/jamasurg.2021.2227

Corresponding Author: Christopher R. Conner, MD, PhD, Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, 6400 Fannin St, Ste 2800, Houston, TX 77030 (christopher.r.conner@uth.tmc.edu).

Open Access: This is an open access article distributed under the terms of the CC-BY License. © 2021 Conner CR et al. JAMA Surgery.

Author Contributions: Dr Conner had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Conner, Ray, McCormack, Parker, Vera, Harvin, Kitagawa.

Acquisition, analysis, or interpretation of data: Conner, Ray, McCormack, Dickey, Zhang, Harvin, Kitagawa.

Drafting of the manuscript: Conner, Ray, McCormack, Dickey, Parker, Harvin, Kitagawa.

Critical revision of the manuscript for important intellectual content: Conner, Ray, McCormack, Parker, Zhang, Vera, Harvin, Kitagawa.

Statistical analysis: Conner, McCormack, Zhang, Harvin.

Obtained funding: Conner, Kitagawa.

Administrative, technical, or material support: Conner, Ray, Parker, Harvin, Kitagawa.

Supervision: Conner, Ray, Vera, Harvin, Kitagawa.

Conflict of Interest Disclosures: None reported.

Funding/Support: The study was funded by the HeadStrong Brain Injury Foundation and Alpha Omega Alpha.

Role of the Funder/Sponsor: The funders had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional Contributions: The authors would like to thank Jonathan Hall, PhD, Jonathan Wang, BS, Dana Kraushar, BS, Uber, for assisting with rideshare data; the Harris County District Attorney’s office for information on impaired driving charges and convictions; Rebecca Crocker, BA, Red Duke Trauma Institute at Memorial Hermann Hospital–Texas Medical Center, and Robin Garza, BA, Ben Taub General Hospital, for supplying institutional trauma registry data; and Karl Schmitt, MD, University of Texas, Houston, for thoughtful discussions on trauma and neurosurgery. We thank Life Science Editors, especially Brandi Mattson, PhD, for editorial assistance. Dr Mattson was compensated for her contributions; the other named individuals were not.

Additional Information: Uber has relinquished editorial control over the manuscript, methods, and findings. A preliminary draft was provided to the company, but no substantive changes were made because of their review.

International Transport Forum. Road safety annual report 2019. Published 2019. Accessed May 6, 2021. https://www.itf-oecd.org/road-safety-annual-report-2019
Richard  CM , Magee  K , Bacon-Abdelmoteleb  P , Brown  JL . Countermeasures that work: a highway safety countermeasure guide for state highway safety offices, 9th ed. Published 2017. Accessed May 4, 2021. https://www.nhtsa.gov/sites/nhtsa.gov/files/documents/812478_countermeasures-that-work-a-highway-safety-countermeasures-guide-.pdf
James  SL , Abate  D , Abate  KH ,  et al; GBD 2017 Disease and Injury Incidence and Prevalence Collaborators.  Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017.   Lancet. 2018;392(10159):1789-1858. doi:10.1016/S0140-6736(18)32279-7 PubMedGoogle ScholarCrossref
Graf  M . Assessing the impact of ridesharing services on public health and safety outcomes. Published 2017. Accessed May 4, 2021. https://milkeninstitute.org/sites/default/files/reports-pdf/110117-Ridesharing-and-Public-Health.pdf
Blincoe  LJ , Miller  TR , Zaloshnja  E , Lawrence  BA . The economic and societal impact of motor vehicle crashes, 2010 (revised): report No. DOT HS 812 013. Published 2010. Accessed May 6, 2021. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/812013
Hingson  R , Zha  W , Smyth  D .  Magnitude and trends in heavy episodic drinking, alcohol-impaired driving, and alcohol-related mortality and overdose hospitalizations among emerging adults of college ages 18–24 in the United States, 1998–2014.   J Stud Alcohol Drugs. 2017;78(4):540-548. doi:10.15288/jsad.2017.78.540PubMedGoogle ScholarCrossref
Shannon  D , Rizzi  L , Murphy  F , Mullins  M .  Exploring the Price of Motor Vehicle Collisions—A Compensation Cost Approach. Transportation Research Interdisciplinary Perspectives; 2020:4.
Clewlow  RR , Mishra  GS . Disruptive transportation: the adoption, utilization, and impacts of ride-hailing in the United States. Published 2017. Accessed May 4, 2021. https://escholarship.org/uc/item/82w2z91j
Mothers Against Drunk Driving. Rideshare saves lives! Published 2015. Accessed May 6, 2021. https://www.madd.org/the-solution/drunk-driving/rideshare/
Greenwood  BN , Wattal  S .  Show me the way to go home: an empirical investigation of ride sharing and alcohol related motor vehicle homicide, Fox School of Business research paper No. 15-054.   SSRN. 2015. doi:10.2139/ssrn.2557612Google Scholar
Dills  AK , Mulholland  SE .  Ride-sharing, fatal crashes, and crime.   SSRN. 2016.Google Scholar
Barrios  JM , Hochberg  YV , Yi  H .  The cost of convenience: ridesharing and traffic fatalities.   SSRN. 2019;3361227.Google Scholar
Kirk  DS , Cavalli  N , Brazil  N .  The implications of ridehailing for risky driving and road accident injuries and fatalities.   Soc Sci Med. 2020;250:112793. doi:10.1016/j.socscimed.2020.112793 PubMedGoogle Scholar
Huang  JY , Majid  F , Daku  M .  Estimating effects of Uber ride-sharing service on road traffic-related deaths in South Africa: a quasi-experimental study.   J Epidemiol Community Health. 2019;73(3):263-271. doi:10.1136/jech-2018-211006PubMedGoogle ScholarCrossref
Brazil  N , Kirk  DS .  Uber and metropolitan traffic fatalities in the United States.   Am J Epidemiol. 2016;184(3):192-198. doi:10.1093/aje/kww062PubMedGoogle ScholarCrossref
Peck  JL . New York City drunk driving after Uber: working paper 13. Published 2017. Accessed May 4, 2021. https://academicworks.cuny.edu/cgi/viewcontent.cgi?article=1012&context=gc_econ_wp
Morrison  CN , Jacoby  SF , Dong  B , Delgado  MK , Wiebe  DJ .  Ridesharing and motor vehicle crashes in 4 US cities: an interrupted time-series analysis.   Am J Epidemiol. 2018;187(2):224-232. doi:10.1093/aje/kwx233 PubMedGoogle ScholarCrossref
Dills  AK , Mulholland  SE .  Ride-sharing, fatal crashes, and crime.   Southern Economic Journal. 2018;84(4):965-991. doi:10.1002/soej.12255Google ScholarCrossref
Martin-Buck  FPV . Driving safety: an empirical analysis of ridesharing’s impact on drunk driving and alcohol-related crime, University of Texas at Austin working paper. Published 2017. Accessed May 6, 2021. https://www.semanticscholar.org/paper/Driving-Safety-%3A-An-Empirical-Analysis-of-%E2%80%99-s-on-Martin-Buck/3f1eb273fcee888441147105882dd12ca811fd35
Mallett  JM . Trends in public transportation ridership: implications for federal policy. Published 2018. Accessed May 4, 2021. https://fas.org/sgp/crs/misc/R45144.pdf
von Elm  E , Altman  DG , Egger  M , Pocock  SJ , Gøtzsche  PC , Vandenbroucke  JP ; STROBE Initiative.  The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies.   Ann Intern Med. 2007;147(8):573-577. doi:10.7326/0003-4819-147-8-200710160-00010 PubMedGoogle ScholarCrossref
Osler  T , Baker  SP , Long  W .  A modification of the Injury Severity Score that both improves accuracy and simplifies scoring.   J Trauma. 1997;43(6):922-925. doi:10.1097/00005373-199712000-00009 PubMedGoogle ScholarCrossref
Hall  JD , Palsson  C , Price  J .  Is Uber a substitute or complement for public transit?   Journal of Urban Economics. 2018;10836-50. doi:10.1016/j.jue.2018.09.003Google Scholar
The R Project for Statistical Computing. Getting started. Accessed May 6, 2021. www.R-project.org
Kahle  D , Wickham  H .  ggmap: spatial visualization with ggplot2.   The R Journal. 2013;5(1):144-161. doi:10.32614/RJ-2013-014Google ScholarCrossref
Political Science Computational Laboratory. atahk/pscl. Updated April 20, 2020. Accessed May 11, 2021. http://github.com/atahk/pscl
Sarriera  JM , Álvarez  GE , Blynn  K , Alesbury  A , Scully  T , Zhao  J .  To share or not to share: investigating the social aspects of dynamic ridesharing.   Transportation Research Record. 2017;2605(1):109-117. doi:10.3141/2605-11Google ScholarCrossref
Johnson  CW , Woods  HD . 2019 Houston Livestock Show and Rodeo economic impact study. Published 2019. Accessed May 4, 2021. https://www.rodeohouston.com/Portals/0/Content/AboutUs/WhoWeAre/Economic%20Impact/2019-EconomicImpact-Summary.pdf
National Highway and Traffic Safety Administration. Time of day and demographic perspective of fatal alcohol-impaired-driving crashes: traffic safety facts DOT HS 811523. Published 2011. Accessed May 4, 2021. https://crashstats.nhtsa.dot.gov/Api/Public/ViewPublication/811523
Qian  Z.   Without zoning: urban development and land use controls in Houston.   Cities. 2010;27(1):31-41. doi:10.1016/j.cities.2009.11.006Google ScholarCrossref
AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

  • 1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
  • 1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
  • 1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
  • 1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
  • 1.00 credit toward the CME [and Self-Assessment requirements] of the American Board of Surgery’s Continuous Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.

Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
Want full access to the AMA Ed Hub?
After you sign up for AMA Membership, make sure you sign in or create a Physician account with the AMA in order to access all learning activities on the AMA Ed Hub
Buy this activity
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience
Education Center Collection Sign In Modal Right

Name Your Search

Save Search
With a personal account, you can:
  • Access free activities and track your credits
  • Personalize content alerts
  • Customize your interests
  • Fully personalize your learning experience

Lookup An Activity


My Saved Searches

You currently have no searches saved.


My Saved Courses

You currently have no courses saved.