title: Buckling up in Singapore: residency and other risk factors for seatbelt non-compliance - a cross-sectional study based on trauma registry data.
abstract: Seatbelt non-compliance is a problem in middle income countries, and little is known about seatbelt compliance in populations with a high proportion of non-residents. This study analyses the profile of seatbelt non-compliance in Singapore based on trauma registry data from five of the six public hospitals.
  
  
  
  This is a cross-sectional study of seatbelt compliance of patients aged over 18 years, attending the emergency departments of five public hospitals in Singapore after road collisions from 2011-2014. Seatbelt data was obtained from paramedic and patient history.
  
  
  
  There were 4,576 patients studied. Most were Singapore citizens (83.4 %) or permanent residents (2.4 %), with the largest non-resident groups from Malaysia, India, and China. Overall seatbelt compliance was 82.1 %. On univariate analysis, seatbelt compliance was higher in older patients (OR 1.02, 95 % CI 1.001-1.021, p < 0.0001); drivers, followed by front passengers (OR 0.65, 95 % CI 0.51-0.83, p < 0.0001), were more compliant than rear passengers (OR 0.08, 0.06-0.09, p < 0.0001); occupants of larger vehicle types (buses, heavy transport vehicles, minibuses and vans) were more non-compliant compared to occupants of private cars and taxis. Morning peak travel (0700 h-0900 h) and being a non-resident were other risk factors for non-compliance. On multivariable analysis, older age (OR 1.01, 95 % CI 1.001-1.014, p = 0.03) was associated with compliance, while non-residents from China (OR 0.43, 95 % CI 0.18-0.99, p = 0.05), seat position (front passenger compared to driver, OR 0.64, 95 % CI 0.48-0.85, p = 0.002; rear passenger compared to driver, OR 0.067, 95 % CI 0.05-0.09, p < 0.0001), vehicle type (bus compared to car, OR 0.04, 95 % CI 0.017-0.11, p < 0.0001, van compared to car, OR 0.55, 95 % CI 0.36-0.83, p = 0.004), and travel at morning peak periods were independent predictors of seatbelt non-compliance. When the sub-group of drivers was analysed, only vehicle type was a significant predictor of seatbelt compliance, with bus drivers least likely to be compliant to seatbelts (multivariable analysis, OR 0.057 compared to cars, 95 % CI 0.019-0.18, p < 0.0001).
  
  
  
  While overall seatbelt compliance in our study is high, efforts can be made to increase compliance for morning rush hour passengers, rear seat passengers, and occupants of buses, heavy transport vehicles, and vans or pickups.
authors.affiliation: Department of General Surgery, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore. wong.ting.hway@singhealth.com.sg.|Duke-National University of Singapore Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore. wong.ting.hway@singhealth.com.sg.
authors.forename: Ting Hway
authors.initials: TH
authors.lastname: Wong
authors.affiliation: Health Promotion Board, 3 Second Hospital Ave, Singapore, 168937, Singapore.
authors.forename: Gek Hsiang
authors.initials: GH
authors.lastname: Lim
authors.affiliation: Health Promotion Board, 3 Second Hospital Ave, Singapore, 168937, Singapore.
authors.forename: Khuan Yew
authors.initials: KY
authors.lastname: Chow
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.
authors.forename: Nyi Nyi
authors.initials: NN
authors.lastname: Zaw
authors.affiliation: Duke-National University of Singapore Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore.
authors.forename: Hai Van
authors.initials: HV
authors.lastname: Nguyen
authors.affiliation: National University of Singapore, 10 Kent Ridge Crescent, Singapore, 119260, Singapore.
authors.forename: Hoong Chor
authors.initials: HC
authors.lastname: Chin
authors.affiliation: Department of Emergency Medicine, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore.|Duke-National University of Singapore Graduate Medical School, 8 College Rd, Singapore, 169857, Singapore.
authors.forename: Marcus Eng Hock
authors.initials: ME
authors.lastname: Ong
mesh_terms: D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D000328:Adult; D001336:Automobiles / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018986:Motor Vehicles / Q000706:statistics & numerical data; D012042:Registries; D012307:Risk Factors; D012622:Seat Belts / Q000706:statistics & numerical data*; D012846:Singapore
keywords: Asia; Immigrant behaviour; Seatbelt compliance; Singapore; Trauma registry