Article Text
Abstract
Objective To quantify the magnitude of associations between cyclist fatalities and both cyclist and environment related characteristics in Spain during the first 24 hours after a crash.
Design Cohort study.
Setting Spain.
Participants 65 977 cyclists injured in road crashes recorded between 1993 and 2013 in the Spanish Register of Road Crashes with Victims.
Main outcome Death within the first 24 hours after the crash.
Methods A multiple imputation procedure was used to mitigate the effect of missing values. Differences between regions were assumed and managed with multilevel analysis at the cyclist and province levels. Incidence density ratios (IDR) with 95% CI were calculated with a multivariate Poisson model.
Results Non-use of a helmet was directly associated with death (IDR 1.43, 95% CI 1.25 to 1.64). Among other cyclist characteristics, age after the third decade of life was also directly associated with death, especially in older cyclists (‘over 74’ category, IDR 4.61, 95% CI 3.49 to 6.08). The association with death did not differ between work-related cycling and other reasons for cycling.
There was an inverse association with death for crashes in urban areas and on community roads. Any adverse meteorological condition also showed a direct association with death, whereas altered road surfaces showed an inverse association. Crashes during nighttime were directly associated with death, with a peak between 3:00 and 5:59 am (IDR 1.58, 95% CI 1.03 to 2.41).
Conclusions We found strong direct and inverse associations between several cyclist and environment related variables and death. These variables should be considered in efforts to prioritise public health measures aimed at reducing the number of cycling-related fatalities.
- cyclist
- bicycling
- injuries
- fatality
- risk factor
- road crash
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Footnotes
Contributors All authors meet the conditions for authorship. PLC conceived and designed the study, helped to draft the manuscript and critically revised it. DMS and VMR carried out the literature review and prepared the first draft of the manuscript. JPM, EMR and LMMR helped with the literature review and critically reviewed the manuscript. EJM critically reviewed the first draft of the manuscript, proposed corrections and provided methodological advice. All authors approved the final version of this manuscript. The present article is part of the doctoral thesis of Daniel Molina-Soberanes in the Clinical Medicine and Public Health program at the University of Granada.
Funding This work was partially supported by the National Council of Science and Technology of Mexico [doctorate grant number 410668].
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data availability statement All data relevant to the study are included in the article or uploaded as supplementary information.