Volume 191 - Issue 5
Bicycling injuries and mortality in Victoria, 2001–2006
Author: Malcolm J Wardlaw
Med J Aust 2009; 191 (5): 295-296. || doi: 10.5694/j.1326-5377.2009.tb02802.x
Published online: 7 September 2009
Published online: 7 September 2009
To the Editor: Sikic and colleagues state that the 1990 legislation making helmets compulsory for bicyclists in Victoria was associated with a decrease in non-fatal head injuries and fatalities.1 However, of the three citations given to support this statement (references 8–10 in Sikic et al),1 one is a study performed before the helmet law was introduced, another is an editorial, and the third makes the common error of attributing to helmet use the effects of economic recession and road safety campaigns. These together reduced all road deaths in Australia by about a third.2 Careful analysis takes account of such factors.
Western Australia and New Zealand offer good datasets of injuries to cyclists and control groups through the period of increasing helmet use and enforcement: neither dataset shows evidence that mass helmet use reduced the occurrence of serious head injuries to cyclists.3 With fewer serious crashes, there were fewer serious head injuries, and a general reduction in severity of injury in road accidents for all road users. These observations make it hard to accept that cycle helmets reliably confer significant protection.
Sikic et al further state that “Wearing an approved safety helmet substantially reduces the risk of serious head injury in cyclists who fall or are involved in collisions with motor vehicles”,1 citing case–control studies. Such studies are known to have serious weaknesses when applied to voluntary behaviour in a socially disparate population.4,5
Risk assessments do not justify helmet laws for cyclists alone. Analysis of Australian Government data (1988–1990) showed that cyclists faced a lower risk of death per hour than car occupants (0.41 v 0.46 fatalities per million hours of use).6 Wider risk assessment based on European data confirms that cycling risks are in the same range as for walking and driving.7
Sikic et al ask for further research to identify factors other than helmet wearing that contribute to preventing cycling injuries. One important factor is already well known: an increase in cyclists on the roads means less risk per cyclist.8 Considerable experience is now available to show that mass helmet use has not been effective in preventing serious head injuries in cycling populations.3 Enforced helmet laws in Australia may deter people from cycling9 and getting the major health benefits of moderate exercise.10
References
- Sikic M, Mikocka-Walus AA, Gabbe BJ, et al. Bicycling injuries and mortality in Victoria, 2001–2006. Med J Aust 2009; 190: 353-356.
- Australian Department of Infrastructure, Transport, Regional Development and Local Government. Road deaths Australia. 2008 Statistical summary. Canberra: The Department, May 2009. (Road safety report No. 4.) http://www.infrastructure.gov.au/roads/safety/publications/2009/pdf/rsr_04.pdf (accessed Jul 2009).
- Robinson DL. No clear evidence from countries that have enforced the wearing of helmets. BMJ 2006; 332: 722-725. CBBDCEFF
- Smith GD. Classics in epidemiology: should they get it right [editorial]? Int J Epidemiol 2004; 33: 441-442. CBBDBGIE
- Bicycle Helmet Research Foundation. Contradictory evidence about the effectiveness of cycle helmets. http://www.cyclehelmets.org/1052.html (accessed Jul 2009).
- Robinson D. Head injuries and bicycle helmet laws. Accid Anal Prev 1996; 28: 463-475. CBBCBEFJ
- Wardlaw MJ. Assessing the actual risks faced by cyclists. Traffic Eng Control 2002; 43: 420-424. CBBBCJIJ
- Jacobsen P. Safety in numbers: more walkers and bicyclists, safer walking and bicycling. Inj Prev 2003; 9: 205-209. i1091888
- Bicycle Helmet Research Foundation. Changes in cycle use in Australia. http://www.cyclehelmets.org/1194.html (accessed Jul 2009).
- Andersen LB, Schnohr P, Schroll M, Hein HO. All-cause mortality associated with physical activity during leisure time, work, sports, and cycling to work. Arch Intern Med 2000; 160: 1621-1628. i1091894
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