China seatbelt intervention
Over the past 45 years, road traffic fatalities and serious injuries in China have increased four-fold and ten-fold, respectively, with an estimated 100,000 people dying from road traffic injury each year. Clearly, the burden from road traffic injuries in China is overwhelming and there is an urgency to implement known and effective interventions particularly in the urban centres such as Beijing, Shanghai, Tianjin, Chongqing and Guangzhou, where motorisation is taking place at an exponential rate.
An array of road safety strategies is available for implementation in many cities throughout China. For example,despite the known benefits associated with seat belt use and national legislation requiring their use by drivers and front seat passengers, the level of seat belt use is very low.
The China Seat Belt Intervention involved the implementation of an intervention that comprised health promotion (including social marketing and health education), training and enhanced traffic police enforcement.
The aim of the intervention was to increase the prevalence of seat belt use for drivers and front seat passengers in Guangzhou, a mega city in southern China. The intervention was evaluated using a comparison group pre/post-test design which also included an extensive cost effectiveness evaluation.
Prevalence of seat belt use
Following the 12 month intervention period, the prevalence of seat belt use increased significantly, from a prevalence of 50% (range: 30-62%) to a prevalence of 62% (range: 60-67%) in the intervention city. In contrast, the prevalence of seat belt use declined (significantly) by 6% in the comparison city, an overall difference in prevalence between the intervention and the comparison city of 18%.
Importantly, the prevalence of seat belt use increased, significantly (p<0.01), from pre- to post-intervention in the intervention city across all factors namely, seat belt use by male or female drivers, whether a driver or front seat passenger, and across road types and vehicle types. The greatest increase in the prevalence of seat belt use was among drivers and passengers of taxis in the intervention city. The prevalence of seat belt use among taxis drivers increased by 21% (p<0.01) (pretest 30% [Range: 10%-58%] to 51% post-test [Range: 45%-60%]). In contrast, the prevalence of seat belt use significantly declined (p<0.01) in the comparison city over the observational period across the same factors.
Based on the increased prevalence of seat belt use observed as part of the intervention, the estimated total number of Disability Adjusted Life Years (DALY s) saved as a result of the intervention was 530. Taking account of the cost of implementing the intervention along with the associated cost savings, the incremental cost effectiveness ratio (ICER) of the intervention compared with no enhanced program to increase the prevalence of seat belt use was CNY3,246 per DALY saved (or the equivalent US$418 per DALY saved). Importantly, when the 'most likely' case of the ICER following sensitivity analysis is considered, the intervention is highly cost effective (US$171 per DALY saved).
Building local capacity
The intervention provided the government with the opportunity to build capacity in road safety and at the same time, provided information on the opportunity to target financial resources in order to reduce the burden of road traffic injury. Given the speed at which motorisation is taking place throughout China, there are limited opportunities to apply and rigorously evaluate best-practice in road safety.
Importantly, the study brought together the key stakeholders for road safety - the government, road safety researchers and industry. Seldom are there opportunities where governments can implement an intervention that involves collaboration between scientists and industry and at the same time, deliver cost-effective outcomes such as increased seat belt use.
The study provided outcomes such as changes to police enforcement practice and comprehensive road safety communication strategies which will be a legacy of this project and will be invaluable to both Central and Provincial-level governments who are responsible for road safety in China.
Related unit: Injury