Motor vehicle occupant injury and hospital expenditures in children aged 3 to 8 years injured in states covered vs. not covered by booster seat legislation

Background. Although most states have infant restraint laws, booster seat legislation for older children has not been implemented universally despite evidence of effectiveness. We examined incidence and expenditures for motor vehicle (MV) occupant injury among 3 to 8 year olds covered vs. uncovered by booster seat legislation.

Methods. Age, state of residence/hospitalization, and month of injury were used to examine injury, deaths, and expenditures due to MV occupant injury in states with vs. without legislation. Unweighted KID-HCUP 2003 (hospitalizations), WISQARS (fatalities), and census-based denominators were used to estimate outcomes and hospital expenditures by law coverage.

Results. Children covered by booster seat legislation were less likely to be hospitalized for MV occupant injury than non-covered children (Odds ratio, 95% CI, 0.78, 0.69-0.88). The majority of mortality (71.7%) occurred in those below median income in both uncovered and covered children (76.4% vs. 58.4%, Fisher's exact, p= 0.14). The ratio of MV occupant injury expenditures to total injury expenditures was 29.0% lower in states with versus without legislation (4.9% vs. 6.9%, p<0.0001). The proportion of injury dollars spent for MV occupant injury was higher in both covered and non-covered uninsured/self pay patients (7.9% vs. 8.9%, respectively). Incidence but not cost per injury was lower in covered vs. noncovered children.

Conclusions. Children covered by booster seat legislation were less likely to be hospitalized with MV occupant injury and states with booster seat laws spent a smaller proportion of their total injury dollars on MV occupant injury for this age group than states without legislation.