Huang Yu-Yun, Liu Chang, Pressley Joyce C
1Columbia University Mailman School of Public Health Departments of Epidemiology and Health Policy and Management, 722 West 168th St, New York, NY 10032 USA.
Health Policy and Management, New York, NY USA.
Inj Epidemiol. 2019 May 29;6(Suppl 1):28. doi: 10.1186/s40621-019-0200-4. eCollection 2019.
Use of appropriate child passenger safety restraints reduces injury in infants, with rear facing restraints favored over forward facing. In 2011, the American Academy of Pediatrics (AAP) began recommending that infants and children under the age of 2 years be restrained in a rear-facing seat installed in the vehicle's rear seat. This study examines the practice of rear-facing restraints pre- and post-AAP recommendations for children under 2 years.
Data from the Fatality Analysis Reporting System (FARS) from 2008 to 2015 were used to examine restraint status and injuries in rear-seated infants and toddlers aged 0 to less than 2 years involved in fatal collisions ( = 4966). Subpopulation analyses were conducted on 1557 children with seat facing direction recorded. Multivariable logistic regression was used to generate odds ratios (OR) with 95% confidence intervals (CI). Covariates considered for inclusion in the multivariable model included passenger characteristics (age, gender, seating position), driver characteristics (age, gender, seat belt status, alcohol status, drug status, previous traffic violations), vehicle characteristics (vehicle type), and crash-level characteristics (day/night, weekday/weekend, rush hour, expressway/surface street, urban/rural).
Approximately 6.7% (330 of 4996) of infants and toddlers were unrestrained with mortality that was approximately triple that of restrained infants (40.0% vs 13.7%, < 0.0001). In multivariable adjusted models, predictors of an infant being unrestrained included unrestrained driver (OR: 3.17, 95% CI: 2.38-4.21), driver aged less than 20 years (OR: 2.18, 95% CI: 1.42-3.34), driver alcohol use (OR: 2.21, 95% CI: 1.42-3.44), center-seated infant (OR: 1.55, 95% CI: 1.19-2.03) and weekday crash (OR: 1.52, 95% CI: 1.12-2.01). Of all rear-seated children whose restraint status were reported (4966), rear-facing restraint use increased from 5.0% to 23.2% between 2008 and 2015 ( < 0.0001). The odds of rear-facing restraint use increased after introduction of the AAP guideline among infants aged 0 to < 1 year old (OR: 2.12, 95% CI: 1.46-3.10) and among toddlers aged 1 to < 2 years old (OR: 1.97, 95% CI: 1.03-3.79).
Trends in the use of rear-facing child restraints improved over the timeframe of this study, but remain low despite the introduction of AAP guidelines and the strengthening of child restraint laws.
使用合适的儿童乘客安全约束装置可减少婴儿受伤，后向式约束装置优于前向式。2011年，美国儿科学会（AAP）开始建议2岁以下的婴儿和儿童应使用安装在车辆后座的后向式座椅进行约束。本研究调查了AAP提出建议前后2岁以下儿童使用后向式约束装置的情况。
使用2008年至2015年死亡分析报告系统（FARS）的数据，研究涉及致命碰撞事故（n = 4966）的0至未满2岁后排婴儿和幼儿的约束状态及受伤情况。对记录了座椅朝向的1557名儿童进行亚组分析。采用多变量逻辑回归生成比值比（OR）及95%置信区间（CI）。多变量模型中考虑纳入的协变量包括乘客特征（年龄、性别、座位位置）、驾驶员特征（年龄、性别、安全带使用情况、饮酒情况、药物使用情况、既往交通违规记录）、车辆特征（车型）以及碰撞级别特征（白天/夜晚、工作日/周末、高峰时段、高速公路/地面街道、城市/农村）。
约6.7%（4996例中的330例）的婴儿和幼儿未使用约束装置，其死亡率约为使用约束装置婴儿的三倍（40.0%对13.7%，P < 0.0001）。在多变量调整模型中，婴儿未使用约束装置的预测因素包括驾驶员未使用约束装置（OR：3.17，95% CI：2.38 - 4.21）、年龄小于20岁的驾驶员（OR：2.18，95% CI：1.42 - 3.34）、驾驶员饮酒（OR：2.21，95% CI：1.42 - 3.44）、坐在中间位置的婴儿（OR：1.55，95% CI：1.19 - 2.03）以及工作日发生的碰撞事故（OR：1.52，95% CI：1.12 - 2.01）。在所有报告了约束状态的后排儿童（4966例）中，2008年至2015年间后向式约束装置的使用比例从5.0%增至23.2%（P < 0.0001）。AAP指南发布后，0至<1岁婴儿（OR：2.12，95% CI：1.46 - 3.10）和1至<2岁幼儿（OR：1.97，95% CI：1.03 - 3.79）使用后向式约束装置的几率增加。
在本研究期间，后向式儿童约束装置的使用趋势有所改善，但尽管有AAP指南及儿童约束法律的加强，使用率仍然较低。
