Passenger air bags are saving lives in automobile crashes, but more children are being killed than saved by air bags, according to a recent article in The Journal of the American Medical Association (JAMA).

Elisa R. Braver, Ph.D., and colleagues from the Insurance Institute for Highway Safety in Arlington, Va., studied fatalities among right front passengers riding in 1992 to 1995 model year cars and passenger vans using data from the Fatality Analysis Reporting System.

They found that passenger air bags were associated with a substantial reduction in crash deaths: “... right front passenger fatalities were 18 percent fewer than expected in frontal crashes of cars with dual air bags. For all fatal crashes (frontal and non-frontal), deaths were 11 percent lower among right front passengers in cars with dual air bags.”

But among children under the age of ten, fatalities were 34 percent higher than expected in frontal crashes. The deaths of three infants and 11 children were attributed to air bags during the study.

The researchers write: It is unacceptable for children to lose their lives in low-severity crashes that they would have otherwise survived.

Counter-measures to reduce the number of infants and children killed or seriously injured by air bags are needed immediately.

Crash investigations show child deaths have involved mostly unbelted or improperly belted children. The authors urge stronger restraint-use laws and active enforcement of those laws. They also suggest that making air bag inflators deploy with less force could reduce risks to children and be readily developed by car makers.

Among other findings of the study:

• The risk of frontal crash death for right front passengers in cars with dual air bags was reduced by 14 percent among those using seat belts, and 23 percent among unbelted passengers.
• Women in cars with dual air bags had a 12 percent reduction in frontal crash deaths; men had a 23 percent reduction.
• There was a six percent reduction in deaths among passengers aged 65 and older.

The Cost Effectiveness of Air Bags

In an accompanying article in the same issue of JAMA, John D. Graham, Ph.D., and colleagues from the Center for Risk Analysis of the Harvard School of Public Health in Boston evaluated the costs, benefits and cost-effectiveness of U.S. air bag systems, compared with manual safety belt systems.

The researchers used a computer model to track a hypothetical fleet of ten million new vehicles for a period of 20 years. They projected changes in costs and health outcomes for three types of systems: manual lap and shoulder belts alone; driver’s side air bags with safety belts; and safety belts with dual air bags.

They write: Cost-effectiveness ratios for air bags are comparable to other well-accepted measures in preventive medicine. Immediate steps can be taken to enhance the cost-effectiveness of front passenger air bags, such as moving children to the rear seat and increasing the rate at which children are properly restrained in crashes.

During the 1989 through 1996 model years, more than 56 million new vehicles with driver’s side air bags were sold in the United States; 27 million of those were also equipped with front passenger air bags. Dual air bags became required standard equipment in all new passenger cars sold in the United States in 1997.