Abstract
Background: 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 been undermined. We sought to evaluate the effects of mandatory motorcycle helmet legislation and determine whether the effectiveness differed across country-income levels. Methods: A systematic review and meta-analysis were completed using the PRISMA criteria to evaluate studies on helmet usage, mortality from motorcycle accident, or traumatic brain injury (TBI) incidence, before and after enactment of a mandatory helmet law. Pooled odds ratios and their 95% confidence intervals (CI) were stratified by high-income countries (HICs) vs. LMICs using the random-effects model. Findings: Twenty-four studies were included in the final analysis. All studies demonstrated higher odds of helmet usage; however, the effect was statistically significantly greater in HICs (OR: 73.2; 95% CI: 46.9; 114.3) than in LMICs (OR: 5.05; 95% CI: 2.93; 8.70), p-interaction comparing both strata < 0×01. There was a significantly lower rate of motorcycle fatalities after enactment of helmet legislation (OR: 0×67; 95% CI: 0×56; 0×81with no significant difference by income classification, p-interaction: 0×36. TBI incidence was statistically significantly lower in HICs (OR: 0×53, 95% CI 0×46-0×61) than in LMICs (0×77, 95% CI 0×59-1×01) (p-interaction: 0.01). Interpretation: The recent Lancet Commission on Legal Determinants of Global Health argues that effective law can provide the framework for achieving sustainable development goals. Our findings support that the potential public health impact that could follow implementation of mandatory helmet laws typifies this sentiment and should be a priority of international policy. Funding Statement: None. Declaration of Interests: None.
Highlights
Road traffic injuries represent a leading cause of death worldwide, taking the lives of more than 1.2 million people each year
We observed that mandatory helmet laws had substantial public health benefits in all income contexts, but some outcomes were diminished in low- and middle-income countries (LMICs) settings where additional measures such as public education and law enforcement might play critical roles
We identified a disparity in legislative benefit, showing lower usage of motorcycle helmets and less reduction in brain injuries, including severe traumatic brain injury (TBI) in LMICs compared with high-income countries (HICs)
Summary
Road traffic injuries represent a leading cause of death worldwide, taking the lives of more than 1.2 million people each year. According to the World Health Organization (WHO), the majority of countries worldwide (94%) have a law in place that mandates helmet usage among motorcyclists; only 49 countries have comprehensive helmet laws that meet the WHO standards, which require that both drivers and passengers wear them, fastened, for all motorized 2-wheelers. The majority of these laws are present in high-income countries (HICs), with 38.4% (15/39) of HICs and only 13.9% (6/43) of lowincome countries (LICs) having a comprehensive helmet law [2]. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels
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