Protecting only white children: the impact of child restraint legislation in Brazil.

Abstract

In 2010, Brazil introduced child restraint legislation (CRL). We assessed the effectiveness of CRL in reducing child (aged 0-8 years) injuries and fatalities by race. We performed an evaluation study with an interrupted time-series design. We measured the effect of CRL on two outcomes-number of child deaths and number of child injured in traffic collisions per child population, stratified by race, from 2008 to 2014. We controlled for time, unemployment rate and oil consumption (barrels/day in thousands). The CRL was associated with a 3% reduction in the rate of child injuries among whites (incidence rate ratio (IRR): 0.97; 95% CI: 0.96-0.99), but no reduction in child injuries among non-whites (IRR: 0.99; 95% CI: 0.99-1.00). In the first month after the implementation of Brazil's CRL we observed a 39% reduction in all child fatalities (IRR: 0.61; 95% CI: 0.44-0.84), including a 52% reduction among whites (IRR: 0.48; 95% CI: 0.33-0.68), but no reduction in non-white fatalities (IRR: 0.87; 95% CI: 0.55-1.37). Our results support the hypothesis that socially advantaged populations were more likely to consistently adopt and employ restraint devices following the reform. Countries should also consider complementary policies that facilitate an equitable distribution of safety devices that reach vulnerable populations.