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Factors Associated with Severe and Fatal Cycling Injuries in North America Open Access


Other title
North America
Type of item
Degree grantor
University of Alberta
Author or creator
Gaudet, Lindsay A
Supervisor and department
Rowe, Brian (Emergency Medicine)
Examining committee member and department
Voaklander, Donald (School of Public Health)
Sevcik, William (Alberta Health Services)
Jhangri, Gian (School of Public Health)
Rowe, Brian (Emergency Medicine)
Hagel, Brent (Department of Pediatrics, University of Calgary)
School of Public Health
Date accepted
Graduation date
Master of Science
Degree level
Background: Cycling is an increasingly popular recreational activity and mode of transportation, and many North American municipalities are implementing policies and infrastructure to encourage cycling participation for all ages. Crashes while cycling, however, can have devastating consequences including debilitating injury and death. The factors relating to the occurrence of severe injury events are not well studied, making it difficult to refine and implement successful injury prevention strategies. This thesis aims to compile the current evidence on cycling fatalities, examine the role of age in their occurrence compared to severe injury, and describe their occurrence in a sparsely populated area with a northern climate. Methods: Three studies were completed to investigate severe and fatal cycling injuries in North America. First, a scoping review was conducted to explore the current literature on fatal cycling injuries in North America. Second, a systematic review was conducted to examine the burden of injury due to cycling fatalities in adults compared with children. Finally, a descriptive observational study was conducted using chart review methods to extract data from fatality case files of the Office of the Chief Medical Examiner of Alberta, and population-based fatality rates by age category and by region were calculated using census data. Results: The scoping review identified 25 studies documenting cycling fatalities in North America, of which 21 used data from US populations, four used data from Canadian populations, 19 included both child and adult cyclists, four included only children, and two reported only on adults. Studies most commonly reported on: sex (n=16), motor vehicle involvement (n=12), lighting condition (n=12), alcohol use (n=10), and occurrence of head injury (n=9). Of the 46 eligible studies of severe and fatal cycling injuries in North America identified in the systematic review, data were available from 27. Overall, children had a lower weighted proportion of fatalities (3.0%; 95% CI: 2.3-3.8%) than adults (7.2%; 95% CI: 5.6 - 8.7%). Heterogeneity was very high, except for pediatric studies conducted in Canada (I2=27) and pediatric studies in regions where mandatory helmet legislation existed (I2=0). One-hundred and one cycling-related deaths over 14 years in Alberta were identified. Most (87%) deceased cyclists were male, median age was 47 years (inter-quartile range: 25, 58), and 25% wore helmets. Collisions with motor vehicles and cyclist-only crashes accounted for 67% and 22% of fatalities, respectively; 12 (12%) crashes had “other” mechanisms, such as a collision with a train, light rail transit, pedestrian, or other cyclist. The population-based fatality rate was highest for the ≥65 age group. Conclusions: There are few high-quality studies examining the factors associated with cycling fatalities, especially compared with nonfatal injuries. Overall, studies of severe and fatal cycling injury events provide only weak evidence, have inconsistent reporting of results and efforts to standardize them are warranted. In cases of severe injury, adults appear to have a higher burden of fatality than children, and older adults (≥60 years old) had the highest fatality burden. Injury prevention strategies should target male cyclists, helmet use and avoidance of substance use while cycling. Future studies should focus on improved methods, including use of comparison groups and prospective study designs, and more detailed reporting of known or suspected risk factors.
This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for the purpose of private, scholarly or scientific research. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.
Citation for previous publication
L. Gaudet, N. T. R. Romanow, A. Nettel-Aguirre, D. Voaklander, B. E. Hagel, B. H. Rowe, “The epidemiology of fatal cyclist crashes over a 14-year period in Alberta, Canada,” BMC Public Health. 2015;15(1):1142.

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