Abstract
There are large disparities in American Indian pediatric motor vehicle (MV) mortality with reports that several factors may contribute. The Fatality Analysis Reporting System for 2000–2014 was used to examine restraint use for occupants aged 0–19 years involved in fatal MV crashes on Indian lands (n = 1667) and non-Indian lands in adjacent states (n = 126,080). SAS GLIMMIX logistic regression with random effects was used to generate odds ratios (OR) with 95% confidence intervals (CI). Restraint use increased in both areas over the study period with restraint use on Indian lands being just over half that of non-Indian lands for drivers (36.8% vs. 67.8%, p < 0.0001) and for pediatric passengers (33.1% vs. 59.3%, p < 0.0001). Driver restraint was the strongest predictor of passenger restraint on both Indian and non-Indian lands exerting a stronger effect in ages 13–19 than in 0–12 year olds. Valid licensed driver was a significant predictor of restraint use in ages 0–12 years. Passengers in non-cars (SUVs, vans and pickup trucks) were less likely to be restrained. Restraint use improved over the study period in both areas, but disparities failed to narrow as restraint use remains lower and driver, vehicle and crash risk factors higher for MV mortality on Indian lands.
Highlights
Motor vehicle (MV) crashes are the leading cause of unintentional injury in the U.S for ages 0 to 19 years [1]
Appropriate restraining of children in motor vehicles is effective in lowering child MV crash mortality [4,5,6], but American Indian pediatric passengers are reported to be less likely to be properly restrained [3,7,8,9,10], potentially increasing the risk of mortality
Percentages of missing data for most variables were consistently higher for crashes on Indian lands than for crashes on non-Indian lands. This suggests the need for improvement in data collection in both jurisdictions but on Indian lands. These findings suggest that there are marked differences in crash characteristics between the Indian lands and non-Indian lands with regard to vehicle, passenger, driver and crash characteristics that have been linked to higher MV mortality and morbidity
Summary
Motor vehicle (MV) crashes are the leading cause of unintentional injury in the U.S for ages 0 to 19 years [1]. Historical trends have generally shown maintenance or widening of these disparities despite a lowering of the actual mortality rate in all race and ethnic groups [3]. This occurred as MV mortality rates fell in all race and ethnic groups, but with smaller improvements for American Indian/Alaskan Natives that produced an actual widening of MV occupant disparities [3]. Public Health 2017, 14, 1287; doi:10.3390/ijerph14111287 www.mdpi.com/journal/ijerph
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