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Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis

Author

Listed:
  • Jacob R Lepard
  • Riccardo Spagiari
  • Jacquelyn Corley
  • Ernest J Barthélemy
  • Eliana Kim
  • Rolvix Patterson
  • Sara Venturini
  • Megan E H Still
  • Yu Tung Lo
  • Gail Rosseau
  • Rania A Mekary
  • Kee B Park

Abstract

Background: The recent Lancet Commission on Legal Determinants of Global Health argues that governance can provide the framework for achieving sustainable development goals. 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 not been well characterized. We sought to evaluate the differences in outcomes of mandatory motorcycle helmet legislation and determine whether these varied across country income levels. Methods and findings: A systematic review and meta-analysis were completed using the PRISMA checklist. A search for relevant articles was conducted using the PubMed, Embase, and Web of Science databases from January 1, 1990 to August 8, 2021. Studies were included if they evaluated helmet usage, mortality from motorcycle crash, or traumatic brain injury (TBI) incidence, with and without enactment of a mandatory helmet law as the intervention. The Newcastle–Ottawa Scale (NOS) was used to rate study quality and funnel plots, and Begg’s and Egger’s tests were used to assess for small study bias. Pooled odds ratios (ORs) and their 95% confidence intervals (CIs) were stratified by high-income countries (HICs) versus LMICs using the random-effects model. Twenty-five articles were included in the final analysis encompassing a total study population of 31,949,418 people. There were 17 retrospective cohort studies, 2 prospective cohort studies, 1 case–control study, and 5 pre–post design studies. There were 16 studies from HICs and 9 from LMICs. The median NOS score was 6 with a range of 4 to 9. All studies demonstrated higher odds of helmet usage after implementation of helmet law; however, the results were statistically significantly greater in HICs (OR: 53.5; 95% CI: 28.4; 100.7) than in LMICs (OR: 4.82; 95% CI: 3.58; 6.49), p-value comparing both strata

Suggested Citation

  • Jacob R Lepard & Riccardo Spagiari & Jacquelyn Corley & Ernest J Barthélemy & Eliana Kim & Rolvix Patterson & Sara Venturini & Megan E H Still & Yu Tung Lo & Gail Rosseau & Rania A Mekary & Kee B Park, 2021. "Differences in outcomes of mandatory motorcycle helmet legislation by country income level: A systematic review and meta-analysis," PLOS Medicine, Public Library of Science, vol. 18(9), pages 1-18, September.
    • Handle: RePEc:plo:pmed00:1003795
    DOI: 10.1371/journal.pmed.1003795
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    References listed on IDEAS

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    1. French, Michael T. & Gumus, Gulcin & Homer, Jenny F., 2012. "Motorcycle fatalities among out-of-state riders and the role of universal helmet laws," Social Science & Medicine, Elsevier, vol. 75(10), pages 1855-1863.
    2. Kraus, J.F. & Peek, C. & Williams, A., 1995. "Compliance with the 1992 California motorcycle helmet use law," American Journal of Public Health, American Public Health Association, vol. 85(1), pages 96-99.
    3. Auman, K.M. & Kufera, J.A. & Ballesteros, M.F. & Smialek, J.E. & Dischinger, P.C., 2002. "Autopsy study of motorcyclist fatalities: The effect of the 1992 Maryland motorcycle helmet use law," American Journal of Public Health, American Public Health Association, vol. 92(8), pages 1352-1355.
    4. David Moher & Alessandro Liberati & Jennifer Tetzlaff & Douglas G Altman & The PRISMA Group, 2009. "Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement," PLOS Medicine, Public Library of Science, vol. 6(7), pages 1-6, July.
    5. TuanDat Nguyen & João Ricardo Nickenig Vissoci & Treasure Joelson & Msafiri Pesambili & Michael Haglund & Charles J Gerardo & Mark Mvungi & Catherine A Staton, 2018. "Injury prevalence and safety habits of boda boda drivers in Moshi, Tanzania: A mixed methods study," PLOS ONE, Public Library of Science, vol. 13(11), pages 1-16, November.
    6. Chiu, W.-T. & Kuo, C.-Y. & Hung, C.-C. & Chen, M., 2000. "The effect of the Taiwan motorcycle helmet use law on head injuries," American Journal of Public Health, American Public Health Association, vol. 90(5), pages 793-796.
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