Using head-on collisions to compare risk of driver death by frontal air bag generation: a matched-pair cohort study

US air bag regulations were changed in 1997 to allow tests of unbelted male dummies in vehicles mounted and accelerated on sleds, resulting in longer crash pulses than rigid-barrier crashes. This change facilitated depowering of frontal air bags and was intended to reduce air bag-induced deaths. Controversy ensued as to whether sled-certified air bags could increase adult fatality risk. A matched-pair cohort study of two-vehicle, head-on, fatal collisions between drivers involving first-generation versus sled-certified air bags during 1998-2005 was conducted by using Fatality Analysis Reporting System data. Sled certification was ascertained from public information and a survey of automakers. Conditional Poisson regression for matched-pair cohorts was used to estimate risk ratios adjusted for age, seat belt status, vehicle type, passenger car size, and model year for driver deaths in vehicles with sled-certified air bags versus first-generation air bags. For all passenger-vehicle pairs, the adjusted risk ratio was 0.87 (95% confidence interval: 0.77, 0.98). In head-on collisions involving only passenger cars, the adjusted risk ratio was 1.04 (95% confidence interval: 0.85, 1.29). Increased fatality risk for drivers with sled-certified air bags was not observed. A borderline significant interaction between vehicle type and air bag generation suggested that sled-certified air bags may have reduced the risk of dying in head-on collisions among drivers of pickup trucks.