| If you have been injured, you may find this useful: the Cyclist's Collision Checklist by the Environmental Law Centre at the University of Victoria. |
| We have just completed a review of the scientific literature about bicyclists' injuries or crashes and the transportation infrastructure. A summary and the full review are now available. |
Our study of "Bicyclists' Injuries and the Cycling
Environment" ("the BICE
Study") will examine the types of cycling routes that are associated
with higher or lower rates of injury to cyclists. It is funded by
the Heart and Stroke Foundation of Canada and the Canadian Institutes
of Health Research, and will take place in Vancouver and Toronto.
The study's design was initially developed by a team of doctoral
students and faculty mentors of the
Bridge Program. It is described in more detail at the bottom
of this page. First we provide a description of the issues.
importance of cycling safety
Injury risk is a deterrent: Cycling safety is important, first because of the harms resulting from the injuries themselves. In addition, the risks of cycling discourage people from choosing this mode of transportation, despite its many individual and population health benefits:
- increases in physical fitness, declines in body weight;
- lower risks of associated diseases, e.g., diabetes, stroke, heart disease, cancer, and osteoporosis;
- reductions in air, noise, and water pollution.
In surveys asking about factors that affect the choice of cycling,
safety is one of the most frequently cited deterrents. For example,
in the Opinion Survey, the following 4 factors
were among the top 6 deterrents: the risk of injury from car-bike
collisions; the risk from motorists who don't know how to drive safely
near bicycles; vehicles driving faster than 50 km/hr; and streets
with a lot of car, bus, & truck traffic.
cycling injuries in Canada
Numbers of injuries: Data compiled by Transport Canada [2005] provide estimates that the number of cyclists seriously injured in Canada each year is about 7,500 and the number of fatalities ranges from 40 to 70. The severity of the injuries is highlighted by the following data from 2002: 1,361 cyclists were hospitalized in Ontario [unpublished data from the Ontario Trauma Registry]; 1,268 cyclists were hospitalized in British Columbia [unpublished data from the British Columbia Injury Database]; and ~950 injured cyclists were attended by ambulance in Montreal [personal communication, Dr. Patrick Morency, Direction de santé publique de Montréal, December 15, 2006]. Data from the Emergency Department Injury Surveillance System and the BC Injury Reporting System suggests that there are 7 to 9 times as many people treated in emergency rooms for cycling injuries as are admitted to hospital. Thus, in Ontario and British Columbia alone, we estimate that each year there are about 20,000 people who attend emergency departments for injuries incurred while bicycling.
Cycling could be safer than it is: Data suggest that cycling in North America is more dangerous than it should be. The risk of traumatic injury is greater than for motor vehicle occupants, and also greater than for cyclists in European countries. Cyclists are 7 to 70 times more likely to be injured, per trip or per kilometer traveled, than car occupants [Aultman-Hall and Kaltenecker 1999, Pucher and Dykstra 2003, and Transport Canada 2005]. In addition, cyclists in North America are 2 times more likely to be killed and 8 times more likely to have serious injuries than cyclists in Germany, and 3 times more likely to be killed and 30 times more likely to have serious injuries than cyclists in the Netherlands [Pucher and Dykstra 2003].
The good news is that cycling injury rates have been declining over time [Pucher and Dykstra 2003], cycling in Canada is safer than in the US [Pucher and Buehler 2006], and if cycling is safer in Europe than in Canada, it can be made safer here. In addition, the risk of injury needs to be balanced against the individual and public health benefits of cycling, outlined above.
To reduce the risk of cycling injuries, the first step is to understand the determinants of risk, the purpose of our study.
cycling injury risk factors
One of the factors that differs between European countries
with low cycling injury rates and North America where injury rates
are higher, and that could be postulated to explain the differences
in injury risk, is the transportation infrastructure for cycling.
Cycling infrastructure in Canada and the United States varies between and within cities, but commuter cycling generally follows a strong pattern of being on road, beside both moving and parked motor vehicles. In contrast, northern European cities offer more dedicated cycling infrastructure alongside roads, but separated from motorized traffic (e.g, with medians, curbs, or other barriers). The relative merits of these two styles of infrastructure from a safety perspective are the subject of a great deal of debate. As an example, a California transportation engineer, John Forester, has advocated cycling on roads in vehicle lanes with cars as the safest mode of travel (“vehicular cycling”). His thinking has been integrated in part into North American transportation planning.
It is very difficult to study differences in injury risk between different types of infrastructure. It may be straightforward to count the injuries that occur on different route types (numerator data), but it is more difficult to gather data on the number of cyclists who use various route types (the denominator data needed to calculate the risk).
We have just completed a review of the scientific literature about bicyclists' injuries or crashes and the transportation infrastructure. The evidence to date suggests that purpose-built bicycle-only facilities (e.g. bike routes, bike lanes, bike paths, cycle tracks at roundabouts) reduce the risk of crashes and injuries compared to cycling on-road with traffic or off-road with pedestrians. Street lighting, paved surfaces, and low-angled grades are additional factors that appear to improve cyclist safety.
Still, these studies do not provide detailed guidance about which cycling route designs would be safest, in part because the infrastructure was characterized in broad categories, grouping route types that might have different risks (e.g., paved and unpaved off-street paths), and did not take into account multiple infrastructure features.
Cycling modal share: The proportion of trips is another factor that differs between European countries and North America and may explain differences in injury risk. In Canada, cycling represents about 2% of urban transportation trips [Pucher and Dijkstra 2003] and about 8% of the urban population report cycling in a typical week [Winters et al. 2007]. In Austria, Switzerland, Sweden and Germany, about 10% of urban trips are made by bicycle. In Denmark and the Netherlands, cycling represents 20% and 28% of urban trips, respectively, and the large majority of the population cycles on a regular basis [Pucher and Dijkstra 2003].
Studies of patterns of injuries and ridership in California, Australia, and Europe, between cities, within cities, and over time consistently support the principle of safety in numbers: both traumatic death rates and injury rates are lower where cycling modal shares are higher [e.g., Leden et al. 2000 and Jacobsen 2003]. For example, using North America-wide data, Pucher and Buehler [2006] found that lower cycling fatality rates were associated with higher cycling modal share in comparisons across 59 Canadian provinces and American states.
the BICE study
Our study will examine the association between bicyclists' injuries and the cycling environment (primarily the types of route, including integration or separation of the cyclist from motorized or pedestrian traffic; types of intersection; and presence of car parking and junctions).
The study is taking place in Toronto and Vancouver. The participants are adults who were injured while bicycling and who attended hospital emergency departments for treatment. Five hospitals are recruiting participants, over 600 in total. The participants are interviewed to map the routes they rode on the injury trip. They are also asked about weather and other conditions on the trip, the bicycle they used, the clothing they wore, and some personal data.
A research assistant then goes to the injury location to gather data. Two other locations along the trip routes are also visited. The information recorded includes the type of route, the type of intersection, car parking, junctions, traffic, route grade, route surface, lighting, and land use. The features of the injury site will be compared to those of the other locations. This will allow us to determine what features have elevated and reduced risks of injury.
The "case-crossover design" allows the focus to be on infrastructure features; the comparisons are within a person-trip, thus controlling for personal characteristics and trip-specific weather and bicycle characteristics.
The results of this study will provide sound evidence for transportation planners, allowing them to select cycling infrastructure that will improve the safety of cycling in Canadian cities. This should not only reduce the risk of traumatic injuries to cyclists, but, as a result, promote cycling as an urban transportation option, with attendant personal and public health benefits.
presentations, posters, reports
Article in Momentum Magazine and media release about the launch of this study.
Outline of the BICE study presented at the 7th International Conference on Urban Health in Vancouver, October 29-31, 2008: Methods for studying bicyclists' injuries and the cycling environment .
Data on cycling injuries on the Burrard Street Bridge from the BICE Study reported on CBC News, Metro News and The Georgia Straight.
The BICE Study featured in the Vancouver Sun and UBC Reports.
