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Social inequality in motorcycle helmet use: when a reduction in inequality is not necessarily good news
  1. Shu-Ti Chiou1,2,
  2. Tsung-Hsueh Lu3,
  3. Ching-Huei Lai4,
  4. Tung-liang Chiang5,
  5. Ichiro Kawachi6
  1. 1Health Promotion Administration, Ministry of Health and Welfare, Taipei, Taiwan
  2. 2Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
  3. 3Department of Public Health, National Cheng Kung University, Tainan, Taiwan
  4. 4Safety Division, Institute of Transportation, Ministry of Transportation and Communications, Taipei, Taiwan
  5. 5Institute of Health Policy and Management, College of Public Health, National Taiwan University, Taipei, Taiwan
  6. 6Department of Social & Behavioral Sciences, Harvard School of Public Health, Harvard University, Boston, USA
  1. Correspondence to Professor Tsung-Hsueh Lu, Department of Public Health, National Cheng Kung University, No.1 Dah Hsueh Road, Tainan City 701, Taiwan; robertlu{at}


Background We sought to examine changes in the magnitude of social inequality in motorcycle helmet use in Taiwan between 2001 and 2009.

Methods Using data from the 2001 and 2009 Taiwan National Health Interview Surveys, we calculated absolute (the slope index of inequality, SII) and relative (relative index of inequality, RII) measures of inequality in helmet use by three indicators of socioeconomic position.

Results The rate of motorcycle helmet use was 92% (14 801/16 100) in 2001 and decreased to 89% (15 748/17 948) in 2009. We noted a significant decrease in social inequality in helmet use in RII according to urbanisation level, a significant decrease in SII and RII according to income level, and a significant increase in SII according to education level. The reduction in RII according to urbanisation level was more prominent than that based on income level, from 1.73 (95% CI 1.63 to 1.84) in 2001 to 1.33 (95% CI 1.27 to 1.39) in 2009. The decline in helmet use was most prominent for motorcycle users who live in suburban areas, from 94% in 2001 to 88% in 2009.

Conclusions The significant reduction of social inequality in helmet use according to urbanisation level and income is not a public health success story. Rather, it is a warning sign of slackening law enforcement in Taiwan.

  • Social Inequalities
  • Health Behaviour
  • Injury

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