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Weekly time-series plots for the proportion of all alcohol-related crash fatalities and injuries in Concepción (1 January 2010 to 30 December 2017). The predicted values for Concepción are obtained from an interrupted time-series model (ARMA (2,0)) from Equation 3 (full model).
Source publication
Background
It is estimated that more than 270 000 people die yearly in alcohol-related crashes globally. To tackle this burden, government interventions, such as laws which restrict blood alcohol concentration (BAC) levels and increase penalties for drunk drivers, have been implemented. The introduction of private-sector measures, such as rideshari...
Citations
... In this study, crashes that involve pedestrians under the influence of the alcohol represent only 3% of all pedestrian crashes, however there is a significant increase in the probability of crash fatal severity for this contributing cause when focusing on the whole dataset. This result is particularly interesting since previous studies have identified that legislation enacted in Chile during the analyzed period for increasing penalties for drivers under the influence of alcohol and decreasing the maximum blood alcohol limit from 0.05 to 0.03 g/dL was associated with considerable reduction in alcohol-related traffic fatalities and injuries [76,77]. However, these studies only focus on overall traffic crashes rather than on pedestrian crashes, which suggests that these laws may have been particularly relevant in targeting a specific group of drivers rather than protecting pedestrians. ...
Pedestrians are vulnerable road users that are directly exposed to road traffic crashes with high odds of resulting in serious injuries and fatalities. Therefore, there is a critical need to identify the risk factors associated with injury severity in pedestrian crashes to promote safe and friendly walking environments for pedestrians. This study investigates the risk factors related to pedestrian, crash, and built environment characteristics that contribute to different injury severity levels in pedestrian crashes in Santiago, Chile from a spatial and statistical perspective. First, a GIS kernel density technique was used to identify spatial clusters with high concentrations of pedestrian crash fatalities and severe injuries. Subsequently, partial proportional odds models were developed using the crash dataset for the whole city and the identified spatial clusters to examine and compare the risk factors that significantly affect pedestrian crash injury severity. The model results reveal higher increases in the fatality probability within the spatial clusters for statistically significant contributing factors related to drunk driving, traffic signage disobedience, and imprudence of the pedestrian. The findings may be utilized in the development and implementation of effective public policies and preventive measures to help improve pedestrian safety in Santiago.
... Brazil and Kirk's work is an instructive example of the state of the science, because most studies published in the intervening 5 years have used similar data and methods to examine similar outcomes. Most were set in the United States (10-24), apart from a handful of others conducted in Brazil (25), Chile (26)(27)(28), South Africa (29), Spain (30), and the United Kingdom (31). Other authors also examined associations with overall injury or fatal crash incidence (13, 15, 16, 18-23, 25-27, 29, 31) or with alcohol-involved injury or fatal crash incidence (10-15, 18, 22, 24, 26, 27, 30). ...
... Like Brazil and Kirk, authors of most of the other studies used a DD approach (11, 12, 14-19, 25, 26, 29, 31), which measures intervention effects while accounting for global time trends that affect ride-hailing and non-ridehailing sites alike. In other studies, researchers used 1dimensional structures to cleverly assess associations within a single location over time, for example, using interrupted time-series analyses (13,27). ...
... Although published studies share many methodological traits, the results of analyses examining overall incidence of injury and fatal crashes are surprisingly mixed. In several studies in the United States (8,13,18) and the United Kingdom (30), authors found Uber's presence was not associated with crash fatalities; but authors of the studies from Brazil (25), Chile (26)(27)(28), South Africa (29), and 2 from the United States (15,22) found the presence of ride-hailing services were negatively associated with crash fatalities. In another analysis of US cities (19) and in a small-area study in New York City (20), researchers found positive relationships for injury and fatal crashes. ...
Ridehailing businesses, including Uber and Lyft, have reshaped road traffic use since they first began operating in the US around a decade ago. It follows that ridehailing may also alter the incidence and distribution of road traffic crash injuries and deaths. This paper critically reviews the available evidence relating ridehailing to crashes. We present a theoretical model that synthesizes the hypothesized mechanisms, identify common methodological challenges, and suggest priorities for future research. Studies report mixed results for the overall incidence of road traffic crash injuries and deaths, likely due to heterogeneous impacts on vehicular traffic flow (e.g., increasing the volume of vehicles); on vehicle-level, person-level and event-level characteristics (e.g., reducing alcohol-impaired driver crashes); on road user types (e.g., increasing pedestrian crashes); and on environmental conditions (e.g., reducing crashes most substantially where public transit access is poorest). The lack of a well-developed theory of human mobility and methodological challenges that are common to many ecological studies impede exploration of these sources of moderation. Innovative solutions are required to explicate ridehailing’s heterogeneous impacts, to guide policy that can take advantage of its public health benefits, and to ensure that research keeps pace with technological advances that continue to reshape road traffic use.
... On the one hand, research suggests this service has decreased the likelihood of crimes (Park et al., 2017), alcohol-related traffic crashes (Brazil & Kirk, 2016;Morrison et al., 2017;Humphreys et al., 2020) and traffic fatalities . However, other work suggests it has also been associated with increases in congestion and pollution (Erhardt et al., 2019), greater incidence of traffic injuries and fatalities (Barrios et al., 2019;Kirk et al., 2020), decreases in public transit (Hall et al., 2018), and no associations with alcohol-related traffic crashes (Nazif-Muñoz et al., 2020) or traffic fatalities (Huang et al., 2019). ...
Background
Annually, more than 379 000 motorcycle occupants across the world die in motor-vehicle collisions—84% of these fatalities occurred in Low- and Middle-Income countries. Recent studies suggest that the Uber’s four-wheeler ride-sharing service (UberCAR) may reduce traffic fatalities. However, research has not considered how Uber’s two-wheeler ridesharing service (UberMOTO) might affect traffic-motorcycle fatalities.
Methods
Monthly counts of car occupant and motorcycle fatalities from the Dominican Republic, a country in which both Uber services have been introduced, were collected from the Ministry of Public Health. We conducted interrupted time-series analyses using monthly traffic fatalities per 100,000 population for the period 2012-2018. We studied Santo Domingo and Santiago, the only two cities in which UberCAR and UberMOTO were launched in different times.
Results
The introduction of UberMOTO was associated with a 0.16 short-term decrease (95% CI -.29 to -0.05) in the level of monthly motorcycle fatalities per 100,000 population in Santo Domingo, and a 0.34 decrease (95% CI -0.68, 0.00) in Santiago. UberCAR was associated with an increase of 0.03 (95% CI -0.06 to 0.13) in the level of monthly car occupant fatalities per 100,000 population in Santo Domingo, and with a 0.20 increase (95% CI 0.05 to 0.35) in Santiago.
Conclusion
After Santo Domingo and Santiago introduced UberMOTO and UberCAR services, we observed short-term decreases in motorcycle fatalities and abrupt increases in car fatalities, respectively. These associations of ridesharing services with traffic fatalities vary between cities and over time, which might reflect differences in specific city features, including characteristics of the vehicle fleet and public transportation systems.
... To extend its use, many ridesharing applications have been complemented with in-cash payments [26,27]. Second, another group of studies have indicated that ridesharing services could be also associated with decreasing of congestion [28], decreasing in public transit use [29], reduction of air quality [30], and declining of alcohol-related crashes [31][32][33][34][35][36]. More specifically, in terms of alcohol-related crashes variation, it has been argued that ridesharing provides a valuable alternative to drinking and driving when access to public transport is limited (i.e., low frequency of provision during late hours) and/or traditional taxis costs may be unknown (i.e., high fluctuation of prices for similar trips). ...
... Greenwood and Wattal [32], Peck [33], Morrison et al. [34], and Martin-Buck [37] have indicated reductions in alcohol-related crashes after ridesharing increased over time. Conversely, Brazil and Kirk [31,38], Dills and Mulholland [39], and Nazif-Munoz et al. [36] did not observe any change in the occurrence of these crashes, even after exploring potential increments. The absence of significant variation in these former studies possibly mask either short terms associations or changes in specific groups-such as innovators and/or early adopters. ...
... The case of Santiago is interesting due to the following reasons. First, a previous study [36] has indeed suggested the absence of effects between Uber and alcohol-related traffic crashes in this city. However, this study did not consider adoption pattern differences when assessing the impact of this service. ...
Background
An emergent group of studies have examined the extent under which ridesharing may decrease alcohol-related crashes in countries such as United States, United Kingdom, Brazil, and Chile. Virtually all existent studies have assumed that ridesharing is equally distributed across socioeconomic groups, potentially masking differences across them. We contribute to this literature by studying how socioeconomic status at the municipal level impacts Uber’s effect on alcohol-related crashes.
Methods
We use data provided by Chile’s Road Safety Commission considering all alcohol-related crashes, and fatal and severe alcohol-related injuries that occurred between January 2013 and September 2013 (before Uber) and January and September 2014 (with Uber) in Santiago. We first apply spatial autocorrelation techniques to examine the level of spatial dependence between the location of alcohol-related crashes with and without Uber. We then apply random-effects meta-analysis to obtain risk ratios of alcohol-related crashes by considering socioeconomic municipality differences before and after the introduction of Uber.
Results
In both analyses, we find that the first 9 months of Uber in Santiago is associated with significant rate ratio decreases (RR = 0.71 [95% Confidence Interval (C.I.) 0.56, 0.89]) in high socioeconomic municipalities in all alcohol-related crashes and null (RR = 1.10 [95% C.I. 0.97, 1.23]) increases in low socioeconomic municipalities. No concomitant associations were observed in fatal alcohol-related crashes regardless of the socioeconomic municipality group.
Conclusions
One interpretation for the decline in alcohol-related crashes in high socioeconomic municipalities is that Uber may be a substitute form of transport for those individuals who have access to credit cards, and thus, could afford to pay for this service at the time they have consumed alcohol. Slight increases of alcohol-related crashes in low socioeconomic municipalities should be studied further since this could be related to different phenomena such as increases in alcohol sales and consumption, less access to the provision of public transport services in these jurisdictions, or biases in police reports.
... Chile, and United States and China [6][7][8][9]. These previous studies commonly used the autoregressive integrated moving average with exogenous variable (i.e. ...
... These previous studies commonly used the autoregressive integrated moving average with exogenous variable (i.e. ARIMAX) model [6,7,10] or generalized additive model [11][12][13] to evaluate the impact of drunk driving laws. The generalized additive model is a more flexible alternative to ARIMAX. ...
... For instance, various distributions that are appropriate for counts data can be chosen, such as quasi-Poisson distribution and negative binomial distribution [11,14]. In addition, existing studies often examined the time-invariant intervention effect based on weekly/ monthly/annual instead of daily road traffic-related data [7,8,15]. However, the effect of drunk driving regulations is very likely to change over time as relevant regulations may be introduced successively and the strength of regulation enforcement might vary across time. ...
Background
China has introduced a series of stricter policies to criminalize drunk driving and increase penalties since May 2011. However, there is no previous study examining the time-varying impacts of drunk driving regulations on road traffic fatalities based on daily data.
Methods
We collected 6536 individual data of road traffic deaths (RTDs) in Guangzhou from 2008 to 2018. The quasi-Poisson regression models with an inclusion of the intervention variable and the interaction of intervention variable and a function of time were used to quantify the time-varying effects of these regulations.
Results
During the 11-year study period, the number of population and motor vehicles showed a steady upward trend. However, the population- and motor vehicles- standardized RTDs rose steadily before May 2011, the criminalizing drunk driving intervention was implemented and gradually declined after that. The new drunk driving intervention were associated with an average risk reduction of RTDs (ER = -9.01, 95% eCI: − 10.05% to − 7.62%) during the 7.7 years after May 2011. On average, 75.82 (95% eCI, 54.06 to 92.04) RTDs per 1 million population annually were prevented due to the drunk driving intervention.
Conclusion
These findings would provide important implications for the development of integrated intervention measures in China and other countries attempting to reduce traffic fatalities by stricter regulations on drunk driving.
... In addition, the challenge of implementing such legislations with often limited law enforcement resources creates a scenario in which lawmakers may be forced to decide which policies will be given priority. This effect could explain the findings of Nazif-Muñoz and colleagues in which the benefit of road safety legislations diminished over time as law enforcement assets were reallocated to other areas [53,54]. Our data would suggest that policy makers should give the highest priority to enforcing helmet legislations, given the very high potential for preventing mortality and morbidity in young road users. ...
Background
The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. Even though over 90% of fatal road traffic injuries occur in low- and middle-income countries (LMICs) primarily affecting motorcyclists, the utility of helmet laws outside of high-income settings has not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels.
Methods and findings
A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle–Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg’s and Egger’s tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case–control study, and 5 pre–post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p -value comparing both strata < 0.0001. There were significantly lower odds of motorcycle fatalities after enactment of helmet legislation (OR: 0.71; 95% CI: 0.61; 0.83) with no significant difference by income classification, p -value: 0.27. Odds of TBI were statistically significantly lower in HICs (OR: 0.61, 95% CI 0.54 to 0.69) than in LMICs (0.79, 95% CI 0.72 to 0.86) after enactment of law ( p -value: 0.0001). Limitations of this study include variability in the methodologies and data sources in the studies included in the meta-analysis as well as the lack of available literature from the lowest income countries or from the African WHO region, in which helmet laws are least commonly present.
Conclusions
In this study, we observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in LMIC settings where additional measures such as public education and law enforcement might play critical roles.
Alcohol is used by more people in the United States than tobacco, electronic nicotine delivery systems, or illicit drugs. Several health conditions, including cancer, cardiovascular disease, and liver disease, are associated with excessive alcohol use and alcohol use disorder. Nearly 30 million people aged 12 years or older in the United States reported past-year alcohol use disorder in 2022, but-despite its prevalence-alcohol use disorder is undertreated. In this policy brief, the American College of Physicians outlines the health effects of excessive alcohol use and alcohol use disorder, calls for policy changes to increase the availability of treatment of alcohol use disorder and excessive alcohol use, and recommends alcohol-related public health interventions.
Objective:
Alcohol or drug impairment is a major risk factor for road traffic crashes, and studies on this issue are essential to provide evidence-based data for policymakers. In low- and middle-income countries (LMICs), such studies are often conducted in partnership with one or more organizations in high-income countries (HICs). The aim of this article is to provide recommendations for improving project planning and decision-making processes in epidemiological studies on alcohol, drug and traffic safety in LMICs involving HICs.
Methods:
We searched Pubmed, Google Scholar, and Google Search for articles and reports in English about lessons learned when conducting collaborative research in LMIC as well as papers presenting recommendations for effective research collaboration with partners in LMICs.
Results:
Based on the search results, we selected 200 papers for full text examination. Few were related to studies on the effect of alcohol or drug use on road traffic safety. However, several conclusions and recommendations from other studies were found to be relevant. We combined the findings with our own experience in a narrative review. We also present a checklist for risk and quality assessment.
Conclusions:
Many papers presented similar recommendations, which included the importance of addressing local needs, ensuring adequate resources, local project ownership and leadership, establishing strong partnerships among all involved stakeholders, promoting shared decision-making and planning, and implementing strategies to translate research findings into policy, practice, and publications. It is also important to avoid HIC bias, which prioritizes the interests or perspectives of HICs over those of LMICs.
Background
In China, road traffic injury (RTI) is the seventh-leading cause of death More than 1.5 million adults in China live with permanent disabilities due to road traffic accidents. In 2011, the Chinese government implemented a more severe law that increased the penalty points and fines for persons charged with drink-driving as a criminal offence.
Objectives
This study evaluated the short-term and long-term effects of the drink-driving law. It also aimed to establish whether punishments of increased severity resulted in greater reductions in RTI mortality.
Methods
RTI mortality data was obtained from the Disease Surveillance Points System. A two-level interrupted time series model was used to analyse daily and monthly road traffic mortality rates, accounting for the varying trends among counties.
Results
The overall RTI mortality rate showed a decreasing trend from 2007 to 2015 in mainland China, especially after 2011, and similarly decreasing trends were noted among males and females and in urban and rural areas. After the Criminal Law and Road Traffic Law amendment was implemented in 2011, charging drink-driving as a criminal offence, the immediate daily RTI mortality rate reduced by 1.57% (RR=0.9843, 95% CI: 0.9444 to 1.0259), while the slope change significantly decreased by 0.04% (RR=0.9996, 95% CI: 0.9994 to 0.9997) compared with the period before the Law was revised. Stratified analysis showed that the effect size of the law was higher for males in urban and high socioeconomic circumstances (SEC) than females in rural and low and moderate SEC. Meanwhile, the increase in penalty points for dangerous driving behaviours showed no significant effects.
Conclusion
Evidence was found that charging criminal responsibility for drink-driving is associated with reducing RTI deaths in China.
Objective:
Rideshare companies such as Uber and Lyft have substantially changed transportation markets in the United States and globally. The aim of this study was to examine whether ridesharing is associated with reductions in alcohol-involved crashes.
Method:
This case-series study used highly spatially and temporally resolved trip-level rideshare data and motor vehicle crash data from the Chicago Data Portal from November 2018 to December 2019. The units of analysis were motor vehicle crashes in Chicago. Events of interest were 962 crashes that police indicated were alcohol involved. The comparison group was 962 non-alcohol-involved crashes that occurred in the same census tract, matched 1:1. The exposure of interest was the density per square mile of rideshare trips that were in progress at the time of the crash, calculated using a kernel density function around the estimated route paths of active trips. A conditional logistic regression compared alcohol involvement to rideshare trip density while adjusting for matching and relevant time-varying covariates (taxi trips, precipitation, temperature, holidays).
Results:
Mean rideshare trip density was 69.0 per square mile (SD = 129.7) at the time and location of alcohol-involved crashes and 105.7 per square mile (SD = 192.6) at the time and location of non-alcohol-involved crashes. After controlling for covariates, the conditional logistic regression model identified that a standard deviation increase in rideshare trips per square mile at the crash location was associated with 23% decreased odds that the crash location was alcohol involved (odds ratio = 0.771; 95% confidence interval [0.594, 0.878]).
Conclusions:
Ridesharing may replace motor vehicle trips by alcohol-impaired drivers.
