The Association between Booster Seat Use and Risk of Death among Motor Vehicle Occupants Aged 4–8: A Matched Cohort Study

This paper seeks to estimate the effectiveness of booster seats and of seatbelts in reducing the risk of child fatalities during traffic collisions. The study also examines possible effect modification by various collision and vehicle characteristics. A matched cohort study was conducted using data from the Fatality Analysis Reporting System. Death risk ratios were estimated with conditional Poisson regression, bootstrapped coefficient standard errors, and multiply imputed missing values using chained equations. Results showed that estimated death risk ratios for booster seats used with seatbelts were 0.33 (95% CI 0.28 to 0.40) for children age 4-5 years and 0.45 (0.31 to 0.63) for children aged 6-8 years (Wald test of homogeneity p<0.005). The estimated risk ratios for seatbelt used alone were similar for the two age groups, 0.37 (0.32 to 0.43) and 0.39 (0.34 to 0.44) for ages 4-5 and 6-8, respectively (Wald p=0.61). Estimated booster seat effectiveness was significantly greater for inbound seating positions (Wald p=0.05) and during rollovers collisions (Wald p=0.01). Significant variability in risk ratio estimates was not observed across levels of calendar year, vehicle model year, vehicle type, or land use. Although previous studies have shown that booster seats reduce nonfatal injury severity, the findings from this study indicate that booster seats do not appear to improve the performance of seatbelts with respect to preventing death.


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  • Accession Number: 01149209
  • Record Type: Publication
  • Files: TRIS
  • Created Date: Jan 26 2010 9:55PM