Cyclists of all ages who ride on streets and highways are at risk of an encounter with a MV (eg, crash with a MV and swerve to miss a MV) resulting in non‐fatal injury or death. Consistent with other studies,12,13,14,15,16
our findings indicate that injury rates were highest for children aged 10–14 years; most of those injured were male; most occurred during the summer months; and riders injured during an encounter with a MV had more severe injuries. Internal head injuries and extremity fractures were the most common types of injuries among those who were hospitalised.
Over 90% of the 62
267 cyclists treated in US hospital EDs from an encounter with a MV were injured from being hit by or hitting a moving MV. Cyclist injuries also resulted from being side swiped by a moving MV and then hitting a stationary MV or object, swerving to miss a moving MV and hitting a stationary MV or object, and running into a car door of a parked car that was being opened. Other studies suggest that cyclists sharing the road are more likely to be injured from encounters with MVs at intersections, at bike trail crossings and on narrow roadways and bridges.13,14
Communities should develop cost‐effective strategies to improve the safety of cyclists on roads that consider all of these factors. Built environment strategies that encompass community design, land use and transportation infrastructure are available to help and guide communities to make roadways and bridges more bike friendly.17,18
Also, national estimates of cyclist non‐fatal injury rates from the NEISS‐AIP can be useful to US public health and transportation officials as baseline data for comparison with local data to assess the magnitude of the problem in their communities.
Our findings emphasize the need to integrate built environment strategies with other strategies known to reduce the severity of cyclist injuries resulting from an encounter with a MV. Other strategies such as legislation to increase helmet use among cyclists, particularly younger children, while riding on the road should be given a high priority.16,19,20
Strategies to decrease the number of alcohol‐impaired cyclists on the road could also reduce cycling‐related deaths and injuries. Data from the National Highway Traffic Safety Administration indicate that 20% of the cyclists killed in traffic crashes in 2004 had blood alcohol concentrations at or above the legal limit for driving.6
A bicycling‐injury study found that 23.5% of fatally injured and 8.9% of seriously injured cyclists had positive blood alcohol concentrations.21
Other interventions (eg, road design, bicycle lanes, outer wear and education) have been suggested to improve the safety of cyclists, but many have not stood the test of rigorous evaluation or, are in need of further testing to determine their effectiveness.12,15,16,17,18,19,20,21,22,23,24,25
For example, a systematic review of the international literature produced an estimated 10% decrease in the number of cyclist crashes with the use of cycle lanes, a 12% decrease with cycle lanes in signalized intersections and a 27% decrease for advanced stop lines for cyclists at signalized intersections. However, none of these decreases were statistically significant.22
Increasing cyclist visibility using fluorescent materials in bright colors during the day and lights and retro‐reflective materials at night have been shown to improve driver detection but have not been shown to decrease cyclist crashes or injuries.23
The findings in this study are subject to at least four limitations. First, NEISS‐AIP provides only national estimates and not state or local estimates. Second, NEISS‐AIP provides data on patients treated in hospital EDs and does not include patients treated in outpatient settings or not treated at all. Third, data on helmet use was only reported for 953 (18%) of the 5281 sample cases; therefore, national estimates were not presented. Of these 953 sample cases, 209 (21.9%) were reported as wearing a helmet at the time of injury. Finally, population‐based data were not available to calculate rates based on the number of riders, exposure time (eg, number and duration of bicycle trips) or riding experience. Efforts to collect these population‐based data would be helpful to understand the relative risks of cyclist injuries among population subgroups in the US and elsewhere.
International efforts involving high‐income, middle‐income and low‐income countries are needed to assess and implement cost‐effective, practical interventions aimed at a safer environment for cyclists on the road. The World Health Organization has recognized reducing cyclist injuries as a priority area in world road traffic injury prevention.3
Changes in the road environment (eg, separating bicycles from other forms of traffic, bicycle lanes, traffic signals and signs aimed at cyclists, and creating clear lines of sight) along with efforts to promote safe personal behavior and practices (eg, using a bicycle helmet and safe bicycling practices) could be the key to reducing cyclist injuries and deaths. Data systems like NEISS‐AIP have an important role in providing population‐based data to assess the impact of these interventions through monitoring changes in cyclist injury rates over time.
- This is the first US study to provide national estimates of non‐fatal injuries to cyclists while sharing the road with motor vehicles (MVs).
- Compared to all other types of cyclist injuries, those involving MVs on the road were 2.6 times more likely to warrant hospitalization or transfer for specialized care (12.5% vs 4.8%).
- Although most (90.5%) of these cyclist injuries involved moving MVs, almost 7% involved hitting a parked or stopped vehicle.
- Reducing cyclist injuries is an important aspect of world traffic road safety prevention efforts; prevention efforts should include improvement in the road environment along with promotion of safe personal behavior and practices.