Examination of some possible biases in double pair comparison estimates of safety belt effectiveness

Biases in double pair comparison estimates of safety belt effectiveness due to two effects (noncoding of some surviving passengers, and driver/passenger impact during crashes) are investigated by calculating effectiveness from fatality frequencies assumed altered by the biases. Noncoding surviving right-front passengers does not affect estimates for drivers, but does overestimate slightly passenger effectiveness. Two biasing driver/passenger contact effects occur for right-side impacts--a "cushioning" effect (risk to unbelted driver is reduced by striking passenger rather than the vehicle interior) and a "missile" effect (passenger risk is increased by being struck by unrestrained driver). Cushioning and missile effects both reduce estimates; their combined effects could cause right-side impact effectiveness to be underestimated by as much as 20% (probably much less). Correcting for all effects increases the overall estimate from 42.6% to 43.2%. Thus, to the nearest percent, the result is still that if all presently unbelted drivers and right-front-seat passengers were to become wearers, fatalities to this group would decline by (43 +/- 3)%.