Route infrastructure and the risk of injuries to bicyclists: a case-crossover study

• Published in: American journal of public health (1971) Vol. 102; no. 12; pp. 2336 - 2343
• Main Authors: Teschke, Kay, Harris, M Anne, Reynolds, Conor C O, Winters, Meghan, Babul, Shelina, Chipman, Mary, Cusimano, Michael D, Brubacher, Jeff R, Hunte, Garth, Friedman, Steven M, Monro, Melody, Shen, Hui, Vernich, Lee, Cripton, Peter A
• Format: Journal Article
• Language: English
• Published: United States American Public Health Association 01-12-2012
• Subjects: Adult; Aged; Bicycling; Bicycling - injuries; Bicycling - statistics & numerical data; British Columbia - epidemiology; Cities; Design; Female; Head injuries; Humans; Infrastructure; Injuries; Interviews; Male; Middle Aged; Mountain biking; Ontario - epidemiology; Population; Public health; Questionnaires; Research and Practice; Residence Characteristics; Risk Factors; Safety; Studies; Teaching hospitals; Young Adult; Ontario; British Columbia; Denmark; Canada; Netherlands; Germany
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2012.300762

We compared cycling injury risks of 14 route types and other route infrastructure features.
We recruited 690 city residents injured while cycling in Toronto or Vancouver, Canada. A case-crossover design compared route infrastructure at each injury site to that of a randomly selected control site from the same trip.
Of 14 route types, cycle tracks had the lowest risk (adjusted odds ratio [OR] = 0.11; 95% confidence interval [CI] = 0.02, 0.54), about one ninth the risk of the reference: major streets with parked cars and no bike infrastructure. Risks on major streets were lower without parked cars (adjusted OR = 0.63; 95% CI = 0.41, 0.96) and with bike lanes (adjusted OR = 0.54; 95% CI = 0.29, 1.01). Local streets also had lower risks (adjusted OR = 0.51; 95% CI = 0.31, 0.84). Other infrastructure characteristics were associated with increased risks: streetcar or train tracks (adjusted OR = 3.0; 95% CI = 1.8, 5.1), downhill grades (adjusted OR = 2.3; 95% CI = 1.7, 3.1), and construction (adjusted OR = 1.9; 95% CI = 1.3, 2.9).
The lower risks on quiet streets and with bike-specific infrastructure along busy streets support the route-design approach used in many northern European countries. Transportation infrastructure with lower bicycling injury risks merits public health support to reduce injuries and promote cycling.