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State or market? How to effectively decrease alcohol-related crash fatalities and injuries
  1. Jose I Nazif-Muñoz1,2,
  2. Brice Batomen3,
  3. Youssef Oulhote4,
  4. Jack Spengler2,
  5. Arijit Nandi3
  1. 1Université de Sherbrooke, Longueuil, Canada
  2. 2Harvard University, Boston, Massachusetts, USA
  3. 3McGill University, Montreal, Canada
  4. 4University of Massachusetts, Amherst, Massachusetts, USA
  1. Correspondence to Jose Ignacio Nazif-Munoz, Harvard University, Boston, MA 02215, USA; jnazifmunoz{at}


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 ridesharing, is regarded as alternatives to reduce drunk driving and related sequelae. However, it is unclear whether state and private efforts complement each other to reduce this public health challenge.

Methods We conducted interrupted time-series analyses using weekly alcohol-related traffic fatalities and injuries per 1 000 000 population in three urban conglomerates (Santiago, Valparaíso and Concepción) in Chile for the period 2010–2017. We selected cities in which two state interventions—the ‘zero tolerance law’ (ZTL), which decreased BAC, and the ‘Emilia law’ (EL), which increased penalties for drunk drivers—were implemented to decrease alcohol-related crashes, and where Uber ridesharing was launched.

Results In Santiago, the ZTL was associated with a 29.1% decrease (95% CI 1.2 to 70.2), the EL with a 41.0% decrease (95% CI 5.5 to 93.2) and Uber with a non-significant 28.0% decrease (95% CI −6.4 to 78.5) in the level of weekly alcohol-related traffic fatalities and injuries per 1 000 000 population series. In Concepción, the EL was associated with a 28.9% reduction (95% CI 4.3 to 62.7) in the level of the same outcome. In Valparaíso, the ZTL had a −0.01 decrease (95% CI −0.02 to −0.00) in the trend of weekly alcohol-related crashes per 1 000 000 population series.

Conclusion In Chile, concomitant decreases of alcohol-related crashes were observed after two state interventions were implemented but not with the introduction of Uber. Relationships between public policy interventions, ridesharing and motor vehicle alcohol-related crashes differ between cities and over time, which might reflect differences in specific local characteristics.

  • Alcohol
  • Chile
  • interrupted time-series
  • injuries
  • policy evaluation
  • Uber

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  • Contributors JINM designed the study, designed data collection tools, wrote the statistical analysis plan, analysed the data in STATA and wrote the draft paper and revised the final paper to incorporate other co-authors', reviewers' and editors' insights. BB designed the study, wrote the statistical analysis plan, cleaned and analysed the data in SAS and R, created the figures of models and revised and corrected multiple versions of the paper. JS revised and corrected the draft paper and collaborated in the application of new methods. YO revised and corrected the draft paper and collaborated in the application of new methods. AN designed the study and drafted and revised multiple versions of the paper.

  • Funding This research was funded by the Canadian Institutes of Health Research award number 39587.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request.

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