The prevalence of seat belt use among drivers and passengers: a systematic review and meta-analysis

Kargar et al. Journal of the Egyptian Public Health Association https://doi.org/10.1186/s42506-023-00139-3 Journal of the Egyptian Public Health Association (2023) 98:14 Open Access REVIEW The prevalence of seat belt use among drivers and passengers: a systematic review and meta‑analysis Shiva Kargar1* , Alireza Ansari‑Moghaddam1 and Hossein Ansari1 Abstract Background Seat belts might save people’s lives in car accidents by preventing severe collision damage and keep‑ ing passengers safe from critical injuries. This meta-analysis was performed to assess the prevalence of seat belt use among drivers and passengers. Methods The databases of PubMed, Web of Science (WOS), and Google Scholar were searched from the begin‑ ning of 2000 to late December 2020 to identify studies that investigated the prevalence of seat belt use among driv‑ ers and passengers. The pooled prevalence was calculated using a random-effects model. The STATA-v14 software was used to perform data analysis. Results Sixty-eight studies that met the inclusion criteria and were suitable for this meta-analysis were identified. The pooled prevalence of seat belt use was 43.94% (95% CI: 42.23–45.73) among drivers, 38.47% (95% CI: 34.89–42.42) among front-seat passengers, and 15.32% (95% CI: 12.33–19.03) among rear-seat passengers. The lowest seat belt use among drivers and passengers was observed in Asia, the Middle East, and Africa, while the highest use was reported in Europe and America. Moreover, the prevalence of seat belt use was higher among women drivers [51.47% (95% CI: 48.62–54.48)] than men drivers [38.27% (95% CI: 34.98–41.87)] (P < 0.001). Furthermore, the highest prevalence of seat belt use was seen among drivers (68.9%) and front-seat passengers (50.5%) of sports utility vehicles (SUVs); in con‑ trast, the lowest prevalence was observed among drivers and passengers of public vehicles such as buses, minibuses, and taxis. Conclusions In general, the prevalence of seat belt use was not high among drivers and was even lower among pas‑ sengers. Moreover, drivers and passengers in Asia, the Middle East, and Africa had the lowest prevalence of seat belt usage. Additionally, drivers and passengers of public transportation (buses, minibuses, and taxis) had a lower rate of seat belt use, especially among men. Therefore, effective interventional programs to improve seat belt use should be designed and implemented, particularly among these at-risk populations in Asia, the Middle East, and Africa. Keywords Prevalence, Seat belt usage, Drivers, Passengers, Meta-analysis *Correspondence: Shiva Kargar 1 Health Promotion Research Centre, Zahedan University of Medical Sciences, Zahedan, Iran 1 Introduction Motor vehicle crashes are one of the significant causes of morbidity and mortality worldwide [1]. According to the World Health Organization, around 1.3 million people lose their lives every year, and between 20 and 50 million are injured as a result of road traffic accidents [2]. Road injuries create an enormous economic burden for countries. The global economy is estimated to incur © The Author(s) 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. Kargar et al. Journal of the Egyptian Public Health Association (2023) 98:14 a cost of US $1.8 trillion (constant 2010 US dollars) due to road injuries in 2015–2030, equivalent to 0.12% of the global gross domestic product (GDP) annually [3]. As a result, it is crucial to establish motor vehicle crashes prevention programs worldwide. Most deaths from motor vehicle crashes occur among the car’s occupants [4]. Therefore, seat belts are a costeffective preventive measure for reducing the severity of injury, disability, and death caused by road accidents [5]. By wearing a seat belt, the risk of death among drivers and passengers in the front seat decreases by 45–50%, and the risk of death and serious injury among passengers in the rear seat decreases by about 25% [2]. The prevalence of seat belt use varies across different countries of the world and depends to some extent on the regulations in place. Seat belt use in low- and middleincome countries is not high, despite strict driving laws and fines for those who do not use seat belts [6, 7]. Studies have shown that men, young people (18–34 years old), obese individuals, rear seat occupants, and villagers have lower rates of seat belt use [8–10]. Accordingly, estimating the prevalence of seat belt use is very important for public health policymakers to implement programs aiming at reducing mortality and morbidity from motor vehicle crashes. Moreover, there were no recent systematic reviews on seat belt use in the previous 5 years. Therefore, this study was conducted to determine the prevalence of seat belt use among drivers, front-seat passengers, and rear-seat passengers from the beginning of 2000 to late December 2020. 2 Methods 2.1 Search strategy and study selection 1. This meta-analysis was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines [11]. Relevant articles were identified through the databases of PubMed, Web of Science (WOS), and Google Scholar from the beginning of 2000 to late December 2020 using combined keywords and Medical Subject Headings (MESH) heading strategies such as "Seatbelt, "Safety belt, "Seat Belt Usage, "Prevalence," "Frequency, "Driver," "Vehicle," and "Passenger." Additionally, references from previous reviews were scanned to identify other relevant articles. Studies that met the following criteria were selected for the current meta-analysis: 1. Cross-sectional studies that reported data on seat belt use in commercial or personal vehicles for both drivers and front or rear seat passengers separately. Page 2 of 18 2. Studies performed on passengers over the age of 12, as the seat belt use is suggested for those aged 12 and above, and passengers under the age of 12 should use child restraints [12]. 3. The target population was either the general population or a specific population, such as high school and university students, drivers, or passengers involved in motor vehicle crashes. The exclusion criteria were as fol (...truncated)