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Table 1 Summary of the studies included in the meta-analysis

From: The prevalence of seat belt use among drivers and passengers: a systematic review and meta-analysis

Authors

Year of publication

Country

Setting

Sampling

Driver

Front seat passengers

Rear seat passengers

How often

Age

Method

Sex

N

 

Prevalence (95% CI)

Prevalence (95% CI)

Prevalence (95% CI)

Kim [14]

2003

Hawaii

 

 ≥ 18

_

FM

3457

FM

77.5 (76.1–78.9)

78.2 (75.5–80.9)

_

_

La [15]

2013

Vietnam

Hanoi

31.9 (6.8)

_

FM

1214

FM

50.7 (47.8–53.5)

_

_

Always

FM

11.7 (10.0–13.7)

_

_

Usually

FM

10.7 (9.10–12.6)

_

_

Sometimes

Routley [16]

2009

China

Nanjing

_

Interview survey

FM

234

FM

56.4 (49.8–62.9)

_

_

Always/mostly

FM

20.5 (15.5–26.3)

_

_

Sometimes

Roadside observation

FM

9294

FM

31.7 (30.7–32.6)

_

_

_

In-taxi observation

FM

285

FM

20.4 (15.8–25.5)

_

_

_

Mohammadi [17]

2011

Iran

Kerman

18–24

_

FM

250

FM

18.0 (13.4–23.3)

_

_

Always

FM

1.06 (11.6–21.1)

_

_

Most of the time

FM

20.0 (15.2–25.50)

_

_

Sometimes

M

179

M

10.6 (6.05–16.0)

_

_

Always

M

15.6 (10.6–21.8)

_

_

Most of the time

M

19.9 (14.0–26.1)

_

_

Sometimes

F

71

F

36.6 (25.5–48.9)

_

_

Always

F

16.90 (9.0–27.6)

_

_

Most of the time

F

21.1 (12.3–32.4)

_

_

Sometimes

Allena [18]

2019

Virginia

 

 ≥ 65

Stratified sampling

FM

751

FM

96.4 (94.8–97.6)

_

_

Always

M

392

FM

2.10 (1.20–3.40)

_

_

Nearly always

F

350

FM

0.50 (0.10–1.30)

_

_

Sometimes

Pérez-Núñez [19]

2013

Mexico

 

 ≥ 10

Randomly, observational

FM

12,064

FM

45.0 (44.3–45.7)

_

_

_

García-España [20]

2012

USA

 

_

Randomly selected

FM

3126

FM

81.5 (77.0–85.2)

68.9 (64.5–72.9)

_

Often/always

Chen [21]

2015

USA

 

47.8

 

FM

1265

FM

86.1 (81.6–90.7)

_

_

Often

M

1183

FM

7.80 (6.50–9.10)

_

_

Sometimes

F

86

  

_

_

-

Bener [22]

2013

Qatar

 

 ≥ 20

Multistage stratified cluster

FM

1824

FM

17.6 (15.9–19.4)

_

_

Always

        

FM

29.6 (27.5–31.8)

_

_

_

_

More than half of the trip

M

1362

M

17.3 (15.3–19.4)

_

_

Always

  

M

28.7 (26.3–31.2)

_

_

More than half of the trip

F

462

F

18.6 (15.1–22.4)

_

_

Always

  

F

32.2 (28.0–36.7)

_

_

More than half of the trip

Kritsotakis [23]

2019

Greece

 

18–20

Random sample

FM

536

FM

72.1 (67.9–76.1)

72.1 (68.1–75.9)

19.7 (16.4–23.3)

Very often, regularly

FM

15.4 (12.3–18.9)

20.6 (17.3–24.3)

23.3 (19.7–27.1)

Occasionally

M

375

M

71.4 (66.4–76.1)

_

_

Very often, regularly

M

17.8 (13.9–22.3)

_

_

Occasionally

F

161

F

73.9 (65.7–81.0)

_

_

Very often, regularly

F

9.40 (5.10–15.5)

_

_

Occasionally

Mohammadi [24]

2015

Iran

Sistan and Baluchistan

_

_

FM

1427

FM

58.2 (55.7–61.0)

73.3 (60.3–83.9)

_

_

M

1393

M

58.3 (55.6–60.9)

32.3 (26.9–38.2)

_

_

F

11

F

72.7 (39.0–93.9)

62.3 (51.1–72.6)

_

_

Popoola [25]

2013

Nigeria

Makurdi

_

Observational

FM

500

FM

57.0 (52.4–61.4)

40.3 (37.4–43.2)

3.00 (1.90–4.50)

_

M

1137

M

31.2 (28.5–34.0)

_

_

_

F

637

F

22.6 (19.4–26.0)

_

_

_

Sangowawa [26]

2010

Nigeria

Ibadan

_

Cluster sampling technique, observational

FM

5757

FM

31.7 (30.0–33.4)

10.3 (8.60–11.6)

0.40 (0.10–0.90)

_

M

2627

M

30.2 (28.5–32.0)

_

_

_

F

3130

F

47.3 (40.9–53.8)

_

_

_

Mohammadzadeh [27]

2015

Iran

Kashan

 

_

FM

822

FM

68.1 (64.8–71.3)

65.5 (58.2–72.3)

30.2 (20.2–41.8)

_

Praveen [28]

2020

India

  

Observational

FM

3345

FM

51.3 (49.6–53.1)

_

5.90 (5.00–6.80)

_

M

3121

M

50.1 (48.4–51.9)

_

6.20 (5.00–7.50)

_

F

224

F

63.8 (57.1–70.1)

_

5.60 (4.40–7.10)

_

Bener [29]

2008

Qatar

 

18–65

A multistage stratified cluster

FM

1110

  

_

_

 

FM

35.4 (32.5–38.3)

_

_

More than half of the trips

FM

19.4 (17.1–21.9)

_

_

Always

M

847

M

34.3 (31.1–37.6)

_

_

More than half of the trips

M

18.3 (15.7–21.0)

_

_

Always

F

263

F

38.7 (32.844.9)

_

_

More than half of the trips

F

23.1 (18.2–28.7)

_

_

Always

Briggs [30]

2008

USA

 

 ≥ 16

Stratified three-stage cluster

FM

12,731

FM

59.0 (55.3–62.6)

_

_

Always

M

 

M

52.1 (48.4–55.8)

_

_

Always

F

 

F

66.7 (62.7–70.5)

_

_

Always

Fernandez [31]

2006

USA

Massachusetts

 ≥ 18

Systematic sampling

FM

381

FM

50.1 (45.0–55.2)

_

_

_

M

 

M

42.0 (34.9–49.4)

_

_

_

F

 

F

58.0 (51.3–65.8)

_

_

_

Alomari [32]

2020

Jordan

Amman, Irbid, Zarqa

 ≥ 18

Observational

FM

2098

FM

13.0 (11.3–13.7)

8.00 (6.00–9.20)

_

_

M

 

M

9.90 (8.80–11.0)

6.80 (5.00–8.90)

_

_

F

 

F

28.6 (24.5–33.1)

8.90 (6.20–12.2)

_

_

Gebresenbet [33]

2019

Ethiopia

Addis Ababa

May—55

Systematic sampling

FM

167

FM

59.2 (38.8–77.6)

_

_

_

M

122

 

_

_

_

 

F

42

 

_

_

_

 

Raman [34]

2014

Kuwait

 

 ≥ 18

_

FM

741

FM

41.5 (37.9–45.2)

30.4 (27.1–33.9)

_

Always

M

415

FM

31.7 (28.3–35.2)

32.9 (29.5–36.4)

_

Mostly/sometimes

F

325

 

_

_

_

_

Jermakian [35]

2018

USA

 

 ≥ 18

_

FM

1163

FM

_

_

72.1 (70.1–75.3)

Always

M

_

M

_

_

67.7 (62.8–72.6)

 

F

_

F

_

_

75.4 (71.679.2)

 

FM

1163

FM

_

_

16.2 (14.1–18.5)

Part time

M

 

M

_

_

17.4 (9.40–25.4)

 

F

 

F

_

_

15.3 (8.20–22.4)

 

Koushki [36]

2006

Kuwait

 

 ≥ 18

Random sample

FM

1467

FM

36.6 (34.1–39.1)

_

_

Always

  

FM

13.5 (11.8–15.3)

_

_

Often

M

881

M

18.2 (15.7–20.9)

_

_

Always

  

M

16.0 (13.6–18.6)

_

_

Often

F

586

F

64.0 (60.1–68.0)

_

_

Always

  

F

9.70 (7.40–12.4)

_

_

Often

Wong [37]

2016

Asia

Singapore, Malaysia, India, China

 ≥ 18

_

FM

4576

FM

91.4 (90.3–92.4)

87.4 (85.0–89.6)

44.7 (41.2–48.2)

_

Vaughn [38]

2012

USA

_

 ≥ 18

Multistage area probability

FM

75,782

 

_

_

_

 

M

 

M

97.2 (96.8–97.5)

96.85 (96.5–97.2)

_

_

F

 

F

98.4 (98.1–98.8)

98.3 (98.0–98.6)

_

_

Taylor [39]

2019

USA

_

 ≥ 18

_

FM

5292

FM

_

68.0 (66.6–69.3)

63.0 (62.7–65.3)

Full time

M

2465

M

_

_

64.0 (62.0–65.9)

Full time

F

2796

F

_

_

62.9 (61.1–64.7)

Full time

Tavafian [40]

2011

Iran

Bandar Abbas

Mean 31.6 ± 8.7

Convenience

FM

251

FM

53.3 (47.0–59.6)

_

_

Often

FM

32.6 (26.9–38.8)

_

_

Sometimes

Siviroj [41]

2012

Thailand

_

_

Quota sampling

FM

13,722

FM

71.7 (70.9–72.4)

_

_

_

M

10,603

M

70.2 (69.3–71.0)

_

_

_

F

3095

F

76.7 (75.2–78.2)

_

_

_

Densu [42]

2013

Ghana

_

_

_

FM

9868

FM

33.4 (32.4–34.3)

10.1 (9.40–10.9)

_

_

M

9421

M

32.3 (31.3–33.2)

10.5 (9.60–11.4)

_

_

F

447

F

56.8 (52.0–61.4)

9.30 (7.90–10.8)

_

_

Jawadi [43]

2017

Saudi Arabia

_

 ≥ 18

_

FM

695

FM

48.6 (44.8–52.4)

_

_

_

M

345

 

_

_

_

_

F

350

 

_

_

_

_

Mahfoud [44]

2015

Qatar

Doha

 

Observational

FM

2011

FM

72.7 (70.8–74.7)

_

_

_

M

1885

M

72.5 (70.5–74.5)

_

_

_

F

126

F

75.4 (66.9–82.6)

_

_

_

Routley [45]

2008

China

Nanjing and Zhoushan

_

Observational

FM

15,2128

FM

49.0 (47.2–50.0)

6.40 (6.00–6.70)

0.40 (0.30–0.50)

_

M

76,591

M

48.6 (48.1–49.0)

5.60 (5.20–5.90)

0.30 (0.20–0.40)

_

F

18,697

F

53.2 (51.8–54.5)

8.00 (7.40–8.60)

0.40 (0.20–0.50)

_

Routley [46]

2007

China

Nanjing

_

Observational

FM

31,700

FM

67.3 (66.6–68.0)

19.0 (18.00–19.8)

0.50 (0.30–0.70)

_

M

24,672

M

67.0 (66.3–67.8)

17.7 (16.6–18.7)

0.60 (0.40–0.90)

_

F

6678

F

68.9 (66.5–71.2)

21.2 (19.7–22.8)

0.50 (0.20–0.90)

_

Xiao [47]

2017

China

_

 ≥ 18

Randomly sampled

FM

98,254

FM

7.00 (6.00–8.00)

_

_

Usually

FM

8.00 (6.00–10.0)

_

_

Sometimes

M

_

M

8.00 (6.00–10.0)

_

_

Usually

M

9.00 (7.00–11.0)

_

_

Sometimes

F

_

F

1.00 (1.00–3.00)

_

_

Usually

F

0.40 (0.01–1.80)

_

_

Sometimes

Nabipour [48]

2014

Iran

Tehran

_

Observational

FM

10,752

FM

70.9 (70.0–71.7)

_

_

_

M

9941

M

70.8 (69.9–71.7)

_

_

_

F

811

F

71.3 (68.0–74.3)

_

_

_

Mohammadi [49]

2009

Iran

Kerman

_

Randomly, observational

FM

800

FM

56.9 (52.6–59.6)

_

_

_

Mohamed [50]

2011

Malaysia

_

Mean 30 ± 9.7

_

FM

793

FM

_

_

22.7 (19.8–25.7)

Always

FM

_

_

17.1 (14.5–19.9)

Often

FM

_

_

28.5 (25.3–31.7)

Sometimes

M

459

M

_

_

44.4 (39.4–49.4)

_

F

324

F

_

_

46.3 (40.1–52.6)

_

Reagan [51]

2013

USA

_

 ≥ 18

_

FM

134

FM

61.9 (53.1–70.1)

_

_

Consistent

FM

20.9 (14.3–28.7)

_

_

Occasional

M

73

M

60.2 (48.1–71.5)

_

_

Consistent

M

19.1 (10.9–30.0)

_

_

_

Occasional

F

61

F

63.9 (50.6–75.8)

_

_

Consistent

        

F

22.9 (13.1–35.5)

_

_

Occasional

Martínez-Sánchez [52]

2014

Spain

Barcelona

 ≥ 18

Observation

FM

2442

FM

89.5 (87.9–90.9)

95.4 (93.5–96.8)

67.6 (63.6–71.4)

_

M

 

M

97.6 (96.6–98.4)

_

_

_

F

 

F

98.6 (97.2–99.4)

_

_

_

Abu-Zidan [53]

2012

UAE

Al-Ain

_

_

FM

783

FM

25.6 (21.6–30.0)

6.50 (3.40–11.2)

1.30 (0.01–4.80)

_

Afukaar [54]

2010

Ghana

Kumasi Metropolis

_

Observational

FM

11,827

FM

17.6 (16.9–18.2)

4.90 (4.40–5.30)

_

_

M

11,334

M

16.4 (15.7–17.0)

4.70 (4.20–5.20)

_

_

F

493

F

44.8 (40.1–49.1)

5.4.0 (4.50–6.30)

_

_

Beck [55]

2009

USA

_

 ≥ 18

_

FM

347,280

FM

82.4 (82.1–82.7)

_

_

Always

Briggs [56]

2006

USA

Non-Hispanic white

 ≥ 16

_

FM

67,637

FM

40.3 (39.9–40.8)

44.8 (43.9–45.7)

_

_

Mexican American

    

FM

43.7 (42.1–45.3)

43.8 (41.3–46.4)

_

_

Central American/South American

    

FM

48.2 (44.4–52.2)

46.8 (40.7–53.0)

_

_

Puerto Rican

    

FM

43.1 (34.2–52.5)

39.3 (33.9–44.9)

_

_

Cuban

    

FM

39.6 (34.3–45.1)

41.0 (32.0–50.5)

_

_

Sadeghnejad [57]

2014

Iran

Tehran

 

Stratified multistage, randomly

FM

11,483

FM

77.9 (76.9–78.8)

43.7 (42.1–45.2)

_

_

M

9334

M

77.5 (76.5–78.4)

44.7 (42.6–46.7)

_

_

F

2150

F

81.0 (77.9–83.6)

42.1 (39.5–44.7)

_

_

Han [58]

2015

Nebraska

_

 ≥ 15

 

FM

10,479

FM

83.0 (82.3–83.8)

_

_

_

M

4439

M

77.1 (75.8–78.3)

_

_

_

F

6040

F

87.5 (86.6–88.3)

_

_

_

Kim [59]

2009

USA

_

Teenage

Observational

FM

14,026

FM

60.7 (59.9–61.4)

64.1 (61.6–66.6)

_

_

M

7620

 

_

_

_

_

F

7837

 

_

_

_

_

Kim [60]

2019

Korea

_

Mean 34.7

_

FM

419

FM

82.8 (76.7–87.9)

64.4 (54.6–73.5)

24.8 (17.5–33.3)

_

M

247

  

_

_

_

F

172

  

_

_

_

Kwak [61]

2015

Korea

_

 ≥ 19

_

FM

23,698

FM

76.6 (75.9–77.3)

45.6 (44.6–46.6)

_

_

M

12,527

  

_

_

_

F

11,171

  

_

_

_

Lardelli-Claret [62]

2009

Spain

_

 ≥ 18

_

FM

84,338

FM

90.4 (90.2–90.6)

88.8 (88.6–89.1)

_

_

Molnar [63]

2012

USA

_

_

_

FM

19,090

FM

66.1 (65.5–66.8)

_

_

_

M

13,439

M

62.3 (61.4–63.1)

_

_

_

F

5651

F

75.3 (74.2–76.5)

_

_

_

Sabzevari [64]

2016

Iran

Kashmar, Bardaskan, Khalilabad

 

Observational

FM

10,255

FM

51.8 (50.8–52.7)

_

_

_

M

9798

M

51.4 (50.4–52.3)

_

_

_

F

457

F

60.5 (55.9–65.1)

_

_

_

Zambon [65]

2008

Italy

Veneto region

_

Multistage sample stratification

FM

16,040

 

_

_

_

_

Observational 2003

M

 

M

_

_

10.6 (9.1–12.1)

_

F

 

F

_

_

11.7 (10.4–13.0)

_

   

_

_

 

_

Self-reported 2003

M

 

M

_

_

13.5 (12.0–15.1)

_

F

 

F

_

_

17.5 (15.8–19.1)

_

   

_

_

 

_

Observational 2005

M

 

M

_

_

25.0 (23.0–27.0)

_

F

 

F

_

_

27.6 (25.7–29.4)

_

   

_

_

 

_

Self-reported 2005

M

 

M

_

_

35.8 (33.2–38.4)

_

F

 

F

_

_

38.8 (36.9–40.7)

_

Dulf [66]

2020

Romania

Cluj-Napoca

_

Observational

FM

768

FM

66.8 (63.3–70.1)

_

_

_

M

469

  

_

_

_

F

299

  

_

_

_

Beck [67]

2019

USA

_

 ≥ 18

Probability-based sampling

FM

4170

FM

_

86.1 (85.0–87.1)

61.6 (60.0–63.1)

Always

M

2009

M

_

82.2 (80.5–83.9)

60.0 (57.7–62.3)

 

F

2161

F

_

89.6 (88.4–90.9)

62.9 (60.9–650)

 

Bhat [9]

2015

USA

_

 ≥ 18

_

FM

3953

FM

_

 

62.0 (60.4–63.5)

Always

M

1804

M

_

 

60.0 (56.9–63.1)

 

F

2149

F

_

 

62.9 (60.1–65.8)

 

Boakye [68]

2019

USA

East Tennessee

_

A multistage area probability, observational

FM

33,310

FM

92.0 (91.6–92.3)

85.4 (85.0–85.8)

_

_

M

22,172

M

86.0 (85.5–86.5)

79.0 (78.2–79.7)

_

_

F

11,138

F

86.0 (85.3–86.6)

89.0 (88.5–89.4)

_

_

Crandon [69]

2006

Jamaica

Kingston

_

Observational

FM

2846

FM

81.2 (79.5–82.7)

74.0 (70.7–77.1)

_

_

M

2028

M

77.3 (75.2–79.2)

66.3 (60.8–71.3)

_

_

F

1014

F

92.5 (90.0–94.4)

80.0 (75.7–83.6)

_

_

Fong [70]

2016

Australia

_

 ≥ 75

Observational

FM

367

FM

97.0 (94.7–98.4)

 

_

_

Iribhogbe [71]

2008

Nigeria

Benin

 

Observational

FM

1785

FM

52.3 (47.0–57.5)

18.4 (14.1–23.3)

6.10 (4.80–7.70)

_

Kamal [72]

2015

Malaysia

Selangor

18–39

Convenience sampling

FM

408

FM

45.1 (40.2–50.0)

_

_

Always

FM

27.9 (23.6–32.5)

_

_

Most of the time

FM

20.5 (16.7–24.8)

_

_

Sometimes

  

_

_

 

M

184

M

40.2 (33.0–47.6)

_

_

Always

M

28.2 (21.8–35.3)

_

_

Most of the time

M

26.0 (19.9–33.0)

_

_

Sometimes

  

_

_

 

F

224

F

49.1 (42.3–55.8)

_

_

Always

F

27.6 (21.9–34.0)

_

_

Most of the time

F

16.0 (11.5–21.5)

_

_

Sometimes

Febres [73]

2020

Spain

_

_

_

FM

257,851

FM

74.4 (74.2–74.5)

_

_

_

M

178,839

  

_

_

 

F

76,837

  

_

_

 

Ãœnal [74]

2020

Turkey

Semi-rural

Mean 16.0 ± 1.2

_

FM

1465

FM

77.1 (74.9–79.2)

_

_

_

M

759

M

74.3 (71.0–77.3)

_

_

_

F

706

F

80.1 (77.0–83.0)

_

_

_

Shaaban1 [75]

2018

Qatar

_

18–25

 

FM

3049

FM

61.4 (59.4–63.3)

48.8 (44.5–53.2)

_

_

M

1856

M

58.0 (55.6–60.4)

40.6 (33.6–47.8)

_

_

F

1193

F

67.9 (64.7–71.0)

53.6 (48.2–59.0)

_

_

Shaaban [76]

2020

Qatar

Doha

 ≥ 18

_

FM

7908

FM

83.6 (82.7–84.4)

_

_

_

M

7180

M

83.3 (82.4–84.2)

_

_

_

F

728

F

86.1 (83.4–88.5)

_

_

_

Siddiqui [77]

2014

Pakistan

Karachi

_

convenience

FM

212

FM

15.0 (10.5–20.6)

_

_

Regularly

M

126

FM

34.4 (28.0–41.2)

_

_

Occasionally

F

86

  

_

_

 

Li [78]

2018

China

Shanghai

_

Stratified, observational

FM

77,641

FM

88.4 (88.1–88.6)

_

_

_

M

61,561

 

_

_

_

_

F

61,088

 

_

_

_

_

Kulanthayan [79]

2004

Malaysia

_

_

_

FM

273

FM

76.6 (68.6–83.4)

56.0 (41.2–70.0)

_

_

Lerner [80]

2001

USA

_

13–93

_

FM

1656

FM

71.9 (69.7–74.1)

_

_

_