Implementation of a Motorcycle Helmet Law in Taiwan and Traffic Deaths Over 18 Years FREE

To the Editor: In 1994, a trial law was passed in Taipei City requiring motorcycle riders to wear helmets. A pilot study showed an increase in helmet use from 21% to 79% and a 56% reduction in motor vehicle–related deaths.¹ The law was terminated after 4 months, associated with an increase in deaths. In June 1997, a national helmet law was passed by the Taiwanese legislature. A public information campaign was conducted in the year before passage and strict enforcement followed with fines for noncompliance among riders and passengers. We studied motor vehicle–related deaths from 1991 through 2008 in Taiwan.

A population-based study was conducted of motorcycles registered, motor vehicle crashes, and motor vehicle-related deaths. Persons who died at the scene, on arrival at the hospital, or during hospitalization from a crash involving a bus, car, or motorcycle were obtained from the Death Certificate Registry of the Department of Health.² Pedestrian deaths were excluded. Death certificates are issued by both prosecutor and coroner and audited monthly. Registries of motorcycles were obtained from the Ministry of Transportation, including all new and used motorcycles.³ Motor vehicle crash data were collected between 2000 and 2008 from the National Police Agency.⁴ These data were complete for all years of this study. The linear trend model (SPSS version 12.0; SPSS Inc, Chicago, Illinois) was used to determine whether changes of each trend over time were significant, with P < .05 indicating significance. This study was approved by the Taipei Medical University institutional review board.

A reduction in the total number of motor vehicle–related deaths occurred in 1994, followed by an increase in 1995, coincident with the implementation and subsequent termination of the trial law in Taipei City; a sustained reduction started in 1996 with the publicity campaign for the national helmet law. The number of motor vehicle–related deaths decreased from 7322 in 1991 to 3646 in 2008 (mean annual decrease, 238.6; 95% confidence interval [CI], 198.8-278.5; P < .001), in spite of a marked increase in motor vehicle crashes from 52 952 in 2000 to 165 982 in 2008 (mean annual increase, 15 601.8; 95% CI, 11 361.6-19 842.0; P < .001) (Figure 1). The overall number of motorcycles registered increased from 7 409 175 in 1991 to 14 324 437 in 2008 (mean annual increase, 427 774.0; 95% CI, 404 675.2-450 872.9, P < .001) (Figure 2).

Implementation of a motorcycle helmet law was associated with a 50.2% reduction in motor vehicle–related deaths in Taiwan over 18 years, despite a 93.3% increase in the number of motorcycles. About 65% to 70% of all motor vehicles in Taiwan are motorcycles,^3,5 which suggests why the helmet law was associated with such a reduction in motor vehicle–related deaths. The pattern of motor vehicle–related deaths reported previously^1,5- 6 continues to show a decrease without any plateau, as might be expected, during the latest 8-year period, despite the 213.5% increase in the number of crashes. We do not have data specifically on the motorcycle-related deaths or information on the type of crash, such as motorcycle to car or motorcycle to motorcycle. Another limitation is the study's ecological nature. Social, environmental, and regulatory factors, as well as emergency care improvements, may have accounted for some of the reduction in motor vehicle–related deaths,¹ but we could not identify any specific changes in legislation, weather conditions, highway speeds, motorcycle design, or treatment practices that would have altered exposure to a crash or risk of death.¹ The generalizability to other countries may be limited. Because of cultural and other differences, implementation of helmet laws in other countries may not be associated with similar reductions in mortality.