{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T18:39:49Z","timestamp":1771007989884,"version":"3.50.1"},"reference-count":37,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2022,10,21]],"date-time":"2022-10-21T00:00:00Z","timestamp":1666310400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention","award":["R49 CE002096"],"award-info":[{"award-number":["R49 CE002096"]}]},{"name":"National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention","award":["R49 CE003094"],"award-info":[{"award-number":["R49 CE003094"]}]},{"name":"National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention","award":["HS1-2023-HRI\/NYS DOH-00202-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00202-(088)"]}]},{"name":"National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention","award":["NU17CE010055"],"award-info":[{"award-number":["NU17CE010055"]}]},{"name":"National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention","award":["HS1-2023-HRI\/NYS DOH-00200-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00200-(088)"]}]},{"name":"National Center for Injury Prevention and Control of the Centers for Disease Control and Prevention","award":["HS1-2023-HRI\/NYS DOH-00202-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00202-(088)"]}]},{"name":"New York State Governor\u2019s Traffic Committee","award":["R49 CE002096"],"award-info":[{"award-number":["R49 CE002096"]}]},{"name":"New York State Governor\u2019s Traffic Committee","award":["R49 CE003094"],"award-info":[{"award-number":["R49 CE003094"]}]},{"name":"New York State Governor\u2019s Traffic Committee","award":["HS1-2023-HRI\/NYS DOH-00202-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00202-(088)"]}]},{"name":"New York State Governor\u2019s Traffic Committee","award":["NU17CE010055"],"award-info":[{"award-number":["NU17CE010055"]}]},{"name":"New York State Governor\u2019s Traffic Committee","award":["HS1-2023-HRI\/NYS DOH-00200-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00200-(088)"]}]},{"name":"New York State Governor\u2019s Traffic Committee","award":["HS1-2023-HRI\/NYS DOH-00202-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00202-(088)"]}]},{"name":"Centers for Disease Control and Prevention","award":["R49 CE002096"],"award-info":[{"award-number":["R49 CE002096"]}]},{"name":"Centers for Disease Control and Prevention","award":["R49 CE003094"],"award-info":[{"award-number":["R49 CE003094"]}]},{"name":"Centers for Disease Control and Prevention","award":["HS1-2023-HRI\/NYS DOH-00202-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00202-(088)"]}]},{"name":"Centers for Disease Control and Prevention","award":["NU17CE010055"],"award-info":[{"award-number":["NU17CE010055"]}]},{"name":"Centers for Disease Control and Prevention","award":["HS1-2023-HRI\/NYS DOH-00200-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00200-(088)"]}]},{"name":"Centers for Disease Control and Prevention","award":["HS1-2023-HRI\/NYS DOH-00202-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00202-(088)"]}]},{"name":"New York State Governor\u2019s Traffic Safety Committee","award":["R49 CE002096"],"award-info":[{"award-number":["R49 CE002096"]}]},{"name":"New York State Governor\u2019s Traffic Safety Committee","award":["R49 CE003094"],"award-info":[{"award-number":["R49 CE003094"]}]},{"name":"New York State Governor\u2019s Traffic Safety Committee","award":["HS1-2023-HRI\/NYS DOH-00202-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00202-(088)"]}]},{"name":"New York State Governor\u2019s Traffic Safety Committee","award":["NU17CE010055"],"award-info":[{"award-number":["NU17CE010055"]}]},{"name":"New York State Governor\u2019s Traffic Safety Committee","award":["HS1-2023-HRI\/NYS DOH-00200-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00200-(088)"]}]},{"name":"New York State Governor\u2019s Traffic Safety Committee","award":["HS1-2023-HRI\/NYS DOH-00202-(088)"],"award-info":[{"award-number":["HS1-2023-HRI\/NYS DOH-00202-(088)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>There are reports that historically higher mortality observed for front- compared to rear-seated adult motor vehicle (MV) occupants has narrowed. Vast improvements have been made in strengthening laws and restraint use in front-, but not rear-seated occupants suggesting there may be value in expanding the science on rear-seat safety. Methods. A linked 2016\u20132017 hospital and MV crash data set, the Crash Outcomes Data Evaluation System (CODES), was used to compare characteristics of front-seated (n = 115,939) and rear-seated (n = 5729) adults aged 18 years and older involved in a MV crash in New York State (NYS). A primary enforced seat belt law existed for front-seated, but not rear-seated occupants. Statistical analysis employed SAS 9.4. Results. Compared to front-seated occupants, those rear-seated were more likely to be unrestrained (21.2% vs. 4.3%, p &lt; 0.0001) and to have more moderate-to-severe injury\/death (11.9% vs. 11.3%, p &lt; 0.0001). Compared to restrained rear-seated occupants, unrestrained rear-seated occupants had higher moderate-to-severe injury\/death (21.5% vs. 7.5%, p &lt; 0.0001) and 4-fold higher hospitalization. More than 95% of ejections were unrestrained and had 7-fold higher medical charges. Unrestrained occupants\u2019 hospital stays were longer, charges and societal financial costs higher. Conclusions. These findings extend the science of rear-seat safety in seriously injured rear-seated occupants, document increased medical charges and support the need to educate consumers and policy makers on the health and financial risks of adults riding unrestrained in the rear seat. The lack of restraint use in adult rear-seated motor vehicle occupants consumes scarce health care dollars for treatment of this serious, but largely preventable injury.<\/jats:p>","DOI":"10.3390\/ijerph192013674","type":"journal-article","created":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T02:31:03Z","timestamp":1666578663000},"page":"13674","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Motor Vehicle Crash and Hospital Charges in Front- and Rear-Seated Restrained and Unrestrained Adult Motor Vehicle Occupants"],"prefix":"10.3390","volume":"19","author":[{"given":"Joyce C.","family":"Pressley","sequence":"first","affiliation":[{"name":"Departments of Epidemiology and Health Policy and Management, Columbia University, New York, NY 10032, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Emilia","family":"Pawlowski","sequence":"additional","affiliation":[{"name":"New York State Department of Health, Bureau of Occupational Health and Injury Prevention, Albany, NY 12237, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0302-0421","authenticated-orcid":false,"given":"Leah M.","family":"Hines","sequence":"additional","affiliation":[{"name":"New York State Department of Health, Bureau of Occupational Health and Injury Prevention, Albany, NY 12237, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sabana","family":"Bhatta","sequence":"additional","affiliation":[{"name":"New York State Department of Health, Bureau of Occupational Health and Injury Prevention, Albany, NY 12237, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael J.","family":"Bauer","sequence":"additional","affiliation":[{"name":"New York State Department of Health, Bureau of Occupational Health and Injury Prevention, Albany, NY 12237, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1186\/s40621-015-0036-5","article-title":"Factors associated with mortality in rear-seated adult passengers involved in fatal motor vehicle crashes on US roadways","volume":"2","author":"Raneses","year":"2015","journal-title":"Inj. Epidemiol."},{"key":"ref_2","first-page":"427","article-title":"A comprehensive statewide analysis of seatbelt non-use with injury and hospital admissions: New data, old problem","volume":"13","author":"Allen","year":"2006","journal-title":"Acad. Emerg. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1456","DOI":"10.2105\/AJPH.78.11.1456","article-title":"Seating position in cars and fatality risk","volume":"78","author":"Evans","year":"1988","journal-title":"Am. J. Public Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1016\/0001-4575(88)90029-2","article-title":"Rear seat restraint system effectiveness in preventing fatalities","volume":"20","author":"Evans","year":"1988","journal-title":"Accid. Anal. Prev."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"369","DOI":"10.1016\/S0140-6736(89)91735-2","article-title":"Protective effect of rear-seat restraints during car collisions","volume":"1","author":"Bodiwala","year":"1989","journal-title":"Lancet"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"545","DOI":"10.1016\/j.jsr.2007.06.002","article-title":"Is seat belt usage by front seat passengers related to seat belt usage by their drivers?","volume":"38","author":"Nambisan","year":"2007","journal-title":"J. Saf. Res."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"S36","DOI":"10.1097\/TA.0000000000001178","article-title":"Rear seat belt laws and restraint use in rear-seated teen passengers traveling in passenger vehicles involved in a fatal collision on a U.S. roadway","volume":"81","author":"Pressley","year":"2016","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1136\/ip.2005.010306","article-title":"Passenger seating position and the risk of passenger death in traffic crashes: A matched cohort study","volume":"12","author":"Smith","year":"2006","journal-title":"Inj. Prev."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1136\/ip.2006.012153","article-title":"Association of rear seat safety belt use with death in a traffic crash: A matched cohort study","volume":"13","author":"Zhu","year":"2007","journal-title":"J. Int. Soc. Child Adolesc. Inj. Prev."},{"key":"ref_10","first-page":"1681","article-title":"Vital signs: Nonfatal, motor vehicle-occupant injuries (2009) and seat belt use (2008) among adults\u2014United States","volume":"59","author":"Beck","year":"2011","journal-title":"MMWR Morb. Mortal. Wkly. Rep."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"569","DOI":"10.1177\/000313480206800611","article-title":"The economic impact of motor vehicle crashes: The cost of restrained versus unrestrained occupants in South Carolina","volume":"68","author":"Gill","year":"2002","journal-title":"Am. Surg."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1173","DOI":"10.1097\/00005373-198908000-00018","article-title":"Injury and cost comparison of restrained and unrestrained motor vehicle crash victims","volume":"29","author":"Reath","year":"1989","journal-title":"J. Trauma"},{"key":"ref_13","unstructured":"Governors Highway Safety Association (2020, February 25). State Laws by Issue: Seat Belts, June 2019. Available online: http:\/\/www.ghsa.org\/state-laws\/issues\/Seat-Belts."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1016\/S0001-4575(03)00002-2","article-title":"Passenger seating position and the risk of passenger death or injury in traffic crashes","volume":"36","author":"Smith","year":"2004","journal-title":"Accid. Anal. Prev."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"433","DOI":"10.1016\/j.jsr.2008.06.003","article-title":"The safest seat: Effect of seating position on occupant mortality","volume":"39","author":"Mayrose","year":"2008","journal-title":"J. Saf. Res."},{"key":"ref_16","unstructured":"National Center for Statistics and Analysis (2021, October 10). Traffic Safety Facts: Seat Belt Use in 2019. National Highway Traffic Association 2019, Available online: https:\/\/crashstats.nhtsa.dot.gov\/Api\/Public\/ViewPublication\/812115."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"1974","DOI":"10.1016\/j.aap.2010.06.002","article-title":"A matched-cohort analysis of belted front and rear seat occupants in newer and older model vehicles shows that gains in front occupant safety have outpaced gains for rear seat occupants","volume":"42","author":"Bilston","year":"2010","journal-title":"Accid. Anal. Prev."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"23","DOI":"10.1186\/s40621-016-0088-1","article-title":"Side impact motor vehicle crashes: Driver, passenger, vehicle and crash characteristics for fatally and nonfatally injured rear-seated adults","volume":"3","author":"Liu","year":"2016","journal-title":"Inj. Epidemiol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"185","DOI":"10.1016\/j.aap.2015.04.006","article-title":"Rear seat safety: Variation in protection by occupant, crash and vehicle characteristics","volume":"80","author":"Durbin","year":"2015","journal-title":"Accid. Anal. Prev."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1177\/0361198119843091","article-title":"Pediatric restraint use and injury in New York City taxis compared to other passenger vehicles","volume":"2673","author":"Prince","year":"2019","journal-title":"Transp. Res. Rec."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s40621-021-00328-8","article-title":"Using crash outcome data evaluation system (CODES) to examine injury in front- vs. rear-seated infants and children involved in a motor vehicle crash in New York State","volume":"8","author":"Bauer","year":"2021","journal-title":"Inj. Epidemiol."},{"key":"ref_22","unstructured":"McGlincy, M.H. (2004, January 8\u201312). A Bayesian Record Linkage Methodology for Multiple Imputation of Missing Links; Section on Survey Research Methods. Proceeding of the ASA Proceedings of the Joint Statistical Meetings, Toronto, ON, Canada."},{"key":"ref_23","unstructured":"NHTSA (2020, February 01). The Crash Outcome Data Evaluation System (CODES) and Applications to Improve Traffic Safety Decision-Making. DOT HS 811 181. April 2010, Available online: https:\/\/crashstats.nhtsa.dot.gov\/Api\/Public\/ViewPublication\/811181."},{"key":"ref_24","unstructured":"National Highway Traffic Safety Administration (2020, February 27). Estimating Median Hospital Charge in the CODES Crash Outcome Data Evaluation System, DOT HS 811 217, October 2009, Available online: https:\/\/crashstats.nhtsa.dot.gov\/Api\/Public\/ViewPublication\/811217."},{"key":"ref_25","unstructured":"(2020, February 26). Statewide Planning and Research Cooperative System (SPARCS), Available online: https:\/\/www.health.ny.gov\/statistics\/sparcs\/download.htm."},{"key":"ref_26","unstructured":"National Highway Traffic Safety Administration (NHTSA) (2021, October 15). FARS\/NASS GES Coding and Validation Manual, Available online: https:\/\/static.nhtsa.gov\/nhtsa\/downloads\/GES\/GES14\/2014%20FARS%20NASS%20GES%20C&V%20Manual.pdf."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1097\/TA.0b013e3181615626","article-title":"Expected differences and unexpected commonalities in mortality, injury severity and injury patterns between near verses far occupants of side impact crashes","volume":"66","author":"Ryb","year":"2009","journal-title":"J. Trauma Acute Care Surg."},{"key":"ref_28","unstructured":"Federal Highway Administration (2019, April 03). Manual for Selecting Safety Improvements on High Risk Rural Roads, Available online: https:\/\/safety.fhwa.dot.gov\/hsip\/hrrr\/manual\/hrrr_2014.pdf."},{"key":"ref_29","unstructured":"(2018). SAS\/STAT\u00ae 15.1 User\u2019s Guide: The MIANALYZE Procedure, SAS Institute Inc.. Available online: https:\/\/documentation.sas.com\/api\/collections\/pgmsascdc\/9.4_3.4\/docsets\/statug\/content\/mianalyze.pdf?locale=en."},{"key":"ref_30","unstructured":"(2018, February 20). SAS Support; SAS Institute: Cary, NC, USA. Available online: http:\/\/support.sas.com\/kb\/43522.html."},{"key":"ref_31","first-page":"161","article-title":"Safety restraint use linked to hospital use and charges in Arkansas","volume":"104","author":"Aitken","year":"2008","journal-title":"J. Ark. Med. Soc."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1016\/S0001-4575(97)00093-6","article-title":"Highway crash costs in the United States by driver age, blood alcohol level, victim age, and restraint use","volume":"30","author":"Miller","year":"1998","journal-title":"Accid. Anal. Prev."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"521","DOI":"10.1016\/0001-4575(93)90003-F","article-title":"Cost savings associated with increased safety belt use in Iowa, 1987\u20131988","volume":"25","author":"Nelson","year":"1993","journal-title":"Accid. Anal. Prev."},{"key":"ref_34","first-page":"328","article-title":"Safety belt use and hospital charge differences among motor vehicle crash victims","volume":"89","author":"Sokolosky","year":"1993","journal-title":"W V Med. J."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1097\/00000658-199302000-00005","article-title":"The cost of not wearing seat belts. A comparison of outcome in 3396 patients","volume":"217","author":"Rutledge","year":"1993","journal-title":"Ann. Surg."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"3598","DOI":"10.1001\/jama.1988.03410240068034","article-title":"Prospective study of the effect of safety belts on morbidity and health care costs in motor-vehicle accidents","volume":"260","author":"Orsay","year":"1988","journal-title":"JAMA"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1016\/j.ienj.2016.04.004","article-title":"Seatbelt use to save money: Impact on hospital costs of occupants who are involved in motor vehicle crashes","volume":"31","author":"Han","year":"2017","journal-title":"Int. Emerg. Nurs."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13674\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T00:58:53Z","timestamp":1760144333000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/20\/13674"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,21]]},"references-count":37,"journal-issue":{"issue":"20","published-online":{"date-parts":[[2022,10]]}},"alternative-id":["ijerph192013674"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192013674","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,21]]}}}