title: Impact of Helmet Use on Injury and Financial Burden of Motorcycle and Moped Crashes in Hawai'i: Analysis of a Linked Statewide Database.
abstract: Helmet use reduces injury severity, disability, hospital length of stay, and hospital charges in motorcycle riders. The public absorbs billions of dollars annually in hospital charges for unhelmeted, uninsured motorcycle riders. We sought to quantify, on a statewide level, the healthcare burden of unhelmeted motorcycle and moped riders. We examined 1,965 emergency medical service (EMS) reports from motorcycle and moped crashes in Hawai'i between 2007-2009. EMS records were linked to hospital medical records to assess associations between vehicle type, helmet use, medical charges, diagnoses, and final disposition. Unhelmeted riders of either type of vehicle suffered more head injuries, especially skull fractures (adjusted odds ratio (OR) of 4.48,P< .001, compared to helmeted riders). Motorcyclists without helmets were nearly three times more likely to die (adjusted OR 2.85,P= .001). Average medical charges were almost 50% higher for unhelmeted motorcycle and moped riders, with a significant (P= .006) difference between helmeted ($27,176) and unhelmeted ($40,217) motorcycle riders. Unhelmeted riders were twice as likely to self-pay (19.3%, versus 9.8% of helmeted riders), and more likely to have Medicaid or a similar income-qualifying insurance plan (13.5% versus 5.0%, respectively). Protective associations with helmet use are stronger among motorcyclists than moped riders, suggesting the protective effect is augmented in higher speed crashes. The public financial burden is higher from unhelmeted riders who sustain more severe injuries and are less likely to be insured.
authors.affiliation: EMS & Injury Prevention System Branch, Hawai'i Department of Health, Honolulu, HI (DJG).
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Galanis
authors.affiliation: EMS & Injury Prevention System Branch, Hawai'i Department of Health, Honolulu, HI (DJG).
authors.forename: Nikki A
authors.initials: NA
authors.lastname: Castel
authors.affiliation: EMS & Injury Prevention System Branch, Hawai'i Department of Health, Honolulu, HI (DJG).
authors.forename: Linda L
authors.initials: LL
authors.lastname: Wong
authors.affiliation: EMS & Injury Prevention System Branch, Hawai'i Department of Health, Honolulu, HI (DJG).
authors.forename: Susan
authors.initials: S
authors.lastname: Steinemann
mesh_terms: D000063:Accidents, Traffic / Q000191:economics* / Q000706:statistics & numerical data; D000328:Adult; D001334:Automobile Driving / Q000706:statistics & numerical data; D006259:Craniocerebral Trauma / Q000150:complications / Q000191:economics / Q000453:epidemiology; D004632:Emergency Medical Services / Q000706:statistics & numerical data; D005260:Female; D006254:Hawaii / Q000453:epidemiology; D006260:Head Protective Devices / Q000191:economics / Q000706:statistics & numerical data*; D017048:Health Care Costs / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009049:Motorcycles / Q000191:economics / Q000706:statistics & numerical data*
keywords: Helmet; Hospital charges; Insurance; Moped; Motorcycle