Seatbelt Compliance in Singapore: How Useful are Trauma Registry Data for Injury Prevention? Dr Wong Ting Hway Department of General Surgery Singapore General Hospital TH Wong1, Zaw NN2, HC Chin3, S Koh4, SF Lim5, PL Ng4, H Hassan4, N Sani4, S T Chin6, S Yeo6, P Teo6, WW Lim7, K Go8, M T Chiu9, MJ Norhayati10 ,P L Chong10, CK Cheong5, V Ong11, P Iau12, HH Li2, MEH Ong13 1. Department of Surgery, Singapore General Hospital, Singapore 2. Health Service Research - Division of Research, Singapore General Hospital, Singapore 3. Department of Civil and Environmental Engineering, National University of Singapore, Singapore 4. Trauma Service, Changi General Hospital, Singapore 5. Department of Surgery, Changi General Hospital, Singapore 6. Trauma Service, National University Hospital, Singapore 7. Trauma Service, Khoo Teck Puat Hospital, Singapore 8. Trauma Service, Tan Tock Seng Hospital, Singapore 9. Department of General Surgery, Tan Tock Seng Hospital, Singapore 10. Trauma Service, Singapore General Hospital, Singapore 11. Department of Emergency Medicine, National University Hospital, Singapore 12. Department of General Surgery, National University Hospital, Singapore 13. Department of Emergency Medicine, Singapore General Hospital, Singapore

Disclosures -National Trauma Registry

Background National Trauma Registry in Singapore started in 2011 Goal was to collect injury-related data for policy and clinical use Epidemiological data – demographics, mechanism of injury Clinical data – injury severity score, revised trauma score Outcomes – mortality, length of stay, functional scores Optional “add-ons” include injury prevention fields Each public hospital in Singapore has trauma data coordinators

Methods Seat belt data collected at 5 of the 6 adult public hospitals in Singapore, different inclusion criteria 4866 known seat belt status (2011 to 2014) Demographics (age, gender, race, residency status, work related ,drinking status and time ) Seat position-front seat, back seat or driver Type of vehicle- Large Vehicle /Van/Truck ,Taxi or private)

Non-compliance of Seat Belt Use - Seat Positions Non-compliance rate of seat belt in Singapore is 23.2 %. Higher in rear seat passengers (66.5%) But lower in rear front seat passengers (12.7%). Drivers are most seat belt users as their non-compliance rate is only 8.6 %.

Among type of vehicles Large vehicle /truck/van have highest non-compliance rate (43%) Taxi have slightly higher non-compliance rate (26%) and Lowest (14.7%) in private car

Age Seat belt non wearer were generally have 6 year lower median age (33 year) compare to user (39 year). Non-compliance is highest in lower age group (33%) Became lower as age increased Reached lowest in over 45 year group (46 to 55) with 16.7% Increased again to over 55 and 65 groups with 19% and 22% respectively.

Sex ,work related and Citizens Females tend to be more non-compliant seat belt user 29% compared to male (20%). Work related vehicle occupant wear seatbelt more then non-work related vehicle trips-non-compliant rate is 16.3% compared to 23.3% respectively Non-citizen have about twice the non-seatbelt use rate of 44.7% then citizen (20.5%).

Work Related and Citizen vs Non-Citizen

Race and Rush Hours Indian and other races have higher non-compliance Seat belt use is only 35.8% in Indian compared to other races 50.1%

People tend to not use during rush hours in the morning (7-9 AM) 39.7% don’t use seatbelt in rush hours compared to other hours of the day (21.2%). Weekend effect

Multivariable binary logistic regression analysis Large Vehicle /Ven /Truck is significant Compared to Taxi Large Vehicle /Ven /Truck occupants were seat belt 0.309 times less All seat positions are significant Back seat occupant were seatbelt least Drivers are 14.017 time wear seatbelt than back seat occupants Front seat occupants wear seatbelt 10.729 time more than back seat occupants Seat Position Driver 2577 244   91.4% 8.6% Adjusted OR/chi-square 14.017 .000 Front Seat Occupant 719 105 87.3% 12.7% 10.729 ---------REFERENCE Rear Seat Occupant 379 753 33.5% 66.5%

Conclusion and Q&A Seat belt campaign should prioritize their target to Large Vehicle/Van/Truck and Rear Seat Occupants Should be aware of specific time point and on particular day of weeks to get maximum result for prevention/ education Recommend to do population based study to understand more about noncompliance