title: Louisiana motorcycle fatalities in the wake of governmentally implemented change: a retrospective analysis of the motorcycle morbidity and mortality before, during, and after the repeal of a statewide helmet mandate.
abstract: BACKGROUND
  On August 15, 2004, Louisiana's universal motorcycle helmet mandate was reinstated. Previous studies have shown that mortality and morbidity of motorcycle riders who crashed had increased during the 5 years the mandate was repealed. The objective of this study was to discern whether the reinstatement of the universal helmet mandate has resulted in a subsequent decrease in motorcycle-related mortality and morbidity in the state of Louisiana.
  
  
  METHODS
  A retrospective analysis was performed observing the regularity of helmet use and the associated morbidity and mortality of motorcycle traffic accidents from the time before, during, and after the universal motorcycle helmet mandate was repealed in the state of Louisiana. Fatality statistics were obtained through the National Highway Safety Traffic Association. Injury, helmet use, and collision data were obtained from the Louisiana Highway Safety Commission. Motorcycle registration data were obtained from the Federal Highway Administration.
  
  
  RESULTS
  Motorcycle crash-related fatalities increased significantly when the statewide helmet mandate was repealed, and interestingly, after reinstatement, these fatality rates never returned to their previous lows. Motorcycle fatalities have increased out of proportion to the increase in motorbike registrations, even when yearly fatalities are normalized to fatalities per 10,000 registered bikes. An all-time high in fatalities was seen in 2006, a year subsequent to the mandate's reinstatement. Fatalities per collision were elevated significantly after the mandate's repeal but did not return to prerepeal lows after the mandate's reinstatement.
  
  
  CONCLUSIONS
  Although helmet use after reinstatement has reached all-time highs, fatality rates have remained elevated since the original mandate repeal in 1999. Other achievable changes in state policy and law enforcement should be explored to quell this heightened risk to motorcycle enthusiasts in Louisiana, and states considering changing their own motorcycle helmet legislation should observe keenly the aftermath of both a mandate repeal and reinstatement.
  
  
  METHODS
  Epidemiological study, level IV.
authors.affiliation: Department of Neurosurgery, Louisiana State University Health Sciences Center, Shreveport, Louisiana 7110-3932, USA.
authors.forename: Shane F
authors.initials: SF
authors.lastname: Strom
authors.forename: Sudheer
authors.initials: S
authors.lastname: Ambekar
authors.forename: Venkatesh S
authors.initials: VS
authors.lastname: Madhugiri
authors.forename: Anil
authors.initials: A
authors.lastname: Nanda
mesh_terms: D000063:Accidents, Traffic / Q000401:mortality* / Q000706:statistics & numerical data; D006260:Head Protective Devices; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D037141:Mandatory Programs; D009049:Motorcycles / Q000331:legislation & jurisprudence* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013219:State Government