Seatbelt wearing rate in a Chinese city: Results from multi-round cross-sectional studies

Objective: Road traffic crashes impose a heavy burden in China's most populous city, Shanghai. Since early 2016, Shanghai police have started deploying high-resolution cameras and an object-detection algorithm in seatbelt enforcement. Around the same time, an international consortium on road safety launched a series of capacity trainings for law enforcement accompanied by infrastructure renovation and social marketing campaigns in Shanghai. Our objective is to assess the level and trend of seatbelt use in Shanghai over 2015-2017. Methods: Ongoing observational studies evaluate seatbelt use within the city. Data are collected at eight randomly selected locations throughout the city, stratified by road type and geographic locations. Data collection covers most times of the day on both business days and weekends, providing a full representation of varying traffic models during both rush hours and non-rush hours. At each site, trained field workers observe seatbelt use of occupants in all passing motorized vehicles. A multivariate logistic regression model was developed to analyze the data. Findings: From October 2015 to December 2017, six rounds of data collection were completed with a total sample size of 77,641 drivers and passengers of motor vehicles. The seatbelt use rate has steadily increased over time, from 60.8% (95% CI: 59.9%–61.7%) in round 1 to 84.9% (84.3%–85.4%) in round 6 (p-value < 0.01). The increase is substantial and statistically significant for both drivers and passengers (p-value < 0.01). Results from the multivariate logistic regression show an annual growth rate of seatbelt use of 8.8% (8.4%–9.1%); the wearing rate was 49.8% (49.0%–50.5%) lower among passengers than drivers; 3.5% (2.9%–4.1%) lower in peri-urban areas than central urban areas; 16.3% (14.3%–18.4%) higher among 18–24-year and 18.9% (17.0%–20.9%) higher among 25–59-year olds than other age groups. Conclusion and policy implications: Seatbelt use in Shanghai has been boosted during a short period of time through a combined strategy that includes training of police, social marketing campaign, and the deployment of computer vision assisted enforcement. Large cities in China and other countries facing similar challenges with seatbelt wearing may learn from Shanghai's experience.