Research Papers

Comparison of cycling injury hospitalization rates in Canadian provinces with different helmet legislation and cycle commuting

Version 1
Date added June 18, 2019
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Category 2019 CARSP XXIX Calgary
Tags Research and Evaluation, Session 4A
Author/Auteur Teschke, Koehoorn, Shen, Dennis
Stream/Volet Research and Evaluation

Slidedeck Presentation Only:



Background/Context: Cycling fatality rates are lower in northern European countries (where bikeways and cycling are common and helmet use is rare) than in North America (where bikeways and cycling are rare and helmet use is common). Other between-country transport policy differences make conclusions difficult. In Canada, cycling conditions, mode shares, and helmet laws differ across provinces, but there are broad similarities in most transport policies, e.g., default speed limits, intersection control, and drunk driving laws.

Aims/Objectives: This study compared cycling injury hospitalisation rates across Canadian provinces with different helmet legislation and levels of cycle commuting. Methods/Targets: The study used Canadian Institute for Health Information data on cycling hospitalisations and Canadian Community Health Survey data on cycling trips for the 6-year period from 2006 to 2011. Hospitalization rates per 100 million cycling trips were calculated for 44 strata: 11 jurisdictions x 2 age groups x 2 sexes. Analyses examined associations between hospitalization rates and sex, age group, helmet laws, and cycle commuting.

Results/Activities: On average there were 3,690 cycling injury hospitalizations and 593 million cycle trips per year among Canadians aged 12 and over. The nationwide hospitalization rate was 633 per 100 million trips, but rates varied a great deal across strata. Females had lower hospitalization rates than males: odds ratio (OR) = 0.45, 95% CI: 0.37-0.53. Age group was not related to hospitalization rates. Helmet laws resulted in consistently higher helmet use (67% on average vs. 39%), but there was no relationship with hospitalization rates for injuries to the brain, head, scalp, skull or face: OR = 1.06, 95% CI: 0.78-1.43. Hospitalization rates were lower with higher cycle commuting: OR = 0.69, 95% CI: 0.49-0.97.

Discussion/Deliverables: Lower female cycling injury risk is likely because of their lower propensity for risk taking: women have been shown to cycle more slowly on average and to ride on safer route types. A potential explanation for the lack of a helmet law effect is that our study examined head injury risk, which includes both the chance of being in a crash and the chance that the crash caused a head injury. Helmet use has been consistently shown to reduce the latter. It is possible that helmet laws and helmet use may increase the chance of being in a crash via risk compensation (e.g., faster cycling, mountain biking). The lower injury risk with increased cycling, often called "safety in numbers", has been observed consistently in other studies, and may be related to greater awareness on the part of drivers where cycling is more common, or more cycling where safer route infrastructure is provided.

Conclusions: These results suggest that policymakers interested in reducing injury rates would be wise to focus on factors related to higher cycling mode shares and female cycling choices. Bike routes physically separated from traffic or along quiet streets are a promising fit for both and are associated with a lower risk of injury.