Electronic Stability Control (ESC) was introduced on the mass market in 1998. Since then, several studies showing the positive effects of ESC have been presented. OBJECTIVE: In this study, data from crashes occurring in Sweden during 1998 to 2004 were used to evaluate the effectiveness of ESC on real life crashes. The effectiveness was analyzed for different road conditions, and some accident types and injury levels. METHODS: The study used statistical analysis. To control for exposure, induced exposure methods were used, where ESC-sensitive to ESC-insensitive crashes and road conditions were matched in relation to cars equipped with and without ESC. Cars of similar or, in some cases, identical make and model were used to isolate the role of ESC. RESULTS: The study shows a positive and consistent effect of ESC overall and in circumstances where the road has low friction. The overall effectiveness on all injury crash types, except rear end crashes, was 16.7 +/- 9.3%, while for serious and fatal crashes; the effectiveness was 21.6 +/- 12.8%. The corresponding estimates for crashes with injured car occupants were 23.0 +/- 9.2% and 26.9 +/- 13.9%.For serious and fatal loss-of-control type crashes on wet roads the effectiveness was 56.2 +/- 23.5% and for roads covered with ice or snow the effectiveness was 49.2 +/- 30.2%. It was estimated that for Sweden, with a total of 500 vehicle related deaths annually, that 80-100 fatalities could be saved annually if all cars had ESC.CONCLUSIONS: ESC was found to reduce crashes with personal injuries, especially serious and fatal injuries. The effectiveness ranged from at least 13% for car occupants in all types of crashes with serious or fatal outcome to a minimum of 35% effectiveness for single/oncoming/overtaking serious and fatal crashes on wet or icy road surface. No difference in deformation pattern was found for cars with or without ESC.