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Substance Use and Addiction Medicine

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

JAMA Surgery

Published Online: June 9, 2021

Original Investigation

Article Information and Disclosures

Christopher R. Conner, MD, PhD¹;

Hunter M. Ray, MD²;

Ryan M. McCormack, MD, PhD¹;

Jacqueline S. Dickey, BSA^1,3;

Samantha L. Parker, MD¹;

Xu Zhang, PhD⁴;

Roberto M. Vera, MD⁵;

John A. Harvin, MD, MS⁶;

Ryan S. Kitagawa, MD¹

Author Affiliations

¹Department of Neurosurgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston
²Department of Cardiothoracic and Vascular Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston
³University of Texas Health Science Center at Houston School of Public Health, Houston
⁴Center for Clinical and Translational Sciences, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston
⁵Department of Surgery, Baylor College of Medicine, Houston, Texas
⁶Department of Surgery, McGovern Medical School at the University of Texas Health Science Center at Houston, Houston

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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.

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 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.

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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.

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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.