Reply

We thank Dr Akrami for his interest in our recently published article1 and highlighting the importance of the seatbelt law to reduce road traffic collision (RTC)-related deaths. Nevertheless, Dr Akrami should have read our paper more critically if he wants to transfer our findings to his setting. Actually the methods of our paper are so detailed that he could have easily approached the data and repeated the analysis. Adding Iran for comparison would have made his communication more meaningful. I hope the following comments will help Dr Akrami in critically planning his future research. It is important to notice that seatbelts will affect only the occupants’ death rate as it has no impact on cyclists, motorcyclists or pedestrians. That is why it is important to see the effect of seatbelt usage on car occupants’ death rate and not on the overall RTC-related deaths. A linear regression model between vehicle occupants’ death rate and seatbelt noncompliance in our published data was highly significant (P<.00001) (Figure 1). The linear regression model was: Occupant death rate/100 000 population=2.71+0.172×(seatbelt noncompliance). The most recent reported seatbelt compliance in Iran was 75% to 80%.2 Assuming noncompliance to be 23% then the calculated predicted mortality for occupant death rate in Iran would be 6.67 per 100 000 population. The reported number of traffic deaths in Iran during 2007 were 22 918 in a population of 71 208 384; 44.9% of these deaths were of car occupants giving an occupants’ death rate of 14.45 per 100 000 population2 (Figure 1), which is much higher than the predicted mortality of 6.67 per 100 000 population by our model. This indicates that Iran is not doing so well in preventing road traffic-related deaths compared with high-income countries. Factors affecting RTCrelated death are a complex issue. The reported significant decrease in RTC-related death after implementing the seatbelt law in Iran was not attributed only to mandatory seatbelt use but also to other factors like motorcycle helmet usage, enforcement of traffic law, and educational campaigns.3 Furthermore, Iran is a middle income country which per se increases the RTCrelated deaths.2 Majority of road traffic related deaths occur in the prehospital setting4 and Iran has a very wide area with anticipated difficult pre-hospital care. Finally, there is enough evidence in the literature showing the reduction of disability and mortality of road traffic collision injured patients following the implementaFigure 1. Car occupant death rate in Iran during year 2007 (black circle) plotted against seatbelt noncompliance compared with other high-income countries (empty circles). tion of strict seatbelt laws5 and our recent published paper was only an addition to that evidence.1 It is worthy to mention that we have recently performed a prospective study involving all trauma hospitalized road traffic collision vehicle occupants of Al-Ain city during a period of 18 months.6 The seatbelt compliance in our patients was only 17.6%. Seatbelt usage significantly reduced the severity of injury, hospital stay and operations in our injured patients.6