A STEADY rise in the number of cyclists seriously injured in road accidents is the dark side to the growing popularity of cycling in cities that weren’t built for bicycles, experts say.

New research published in the MJA found that cyclists were the only category of road user for whom the incidence of hospitalised major trauma increased between 2007 and 2015.

The Victorian study used trauma registry data and coronial information to identify 8066 hospitalised road traffic major trauma cases (Injury Severity Score > 12) and 2588 road traffic fatalities over the 9-year period; 55% involving motor vehicle occupants, 19% motorcyclists, 11% cyclists and 14% pedestrians.

While the incidence of all road traffic deaths declined by 4% per year for all road users, there was no significant decline in mortality for pedal cyclists or pedestrians. Moreover, for cyclists, the incidence of hospitalised major trauma increased by 8% per year, whereas there was no change in hospitalisations for major trauma for other road user types.

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Similarly, disability-adjusted life-years (DALYs) – a measure combining years of life lost and years lived with disability – increased by 56% over the period for cyclists, whereas it declined for the other road user types.

The study found that the majority of people seriously injured in cycling accidents were male (87%), with an average age of 46 years (interquartile range, 35–56).

The study authors, led by Monash University’s Dr Ben Beck, wrote that the increasing incidence of cycling injuries may be partly explained by increased cycling participation rates.

“Further investment in [cyclists’] safety, such as providing dedicated and separated cycle paths, is needed to reduce their burden of injury, particularly as cycling bodies and public health activists continue to advocate increased cycling participation,” they wrote.

Professor Gordian Fulde, director of Emergency Medicine at St Vincent’s Hospital in Sydney, said that there was no doubt about it: “Cycling injuries have significantly increased in the city of Sydney”.

Speed was typically a factor in major trauma cases involving cyclists, he said.

“Not only are bicycles now very, very popular, they can go very fast, very quickly; 50–60 km per hour with no problems,” he said.

“We get some of the worse cycling accidents on Saturday mornings when people do their pelotons,” he added.

Professor Fulde believed that road rage could also be contributing to the increasing injury rate. “As the roads are getting so much more congested and there are more cyclists, both riders and drivers are becoming more aggressive and taking risks because they’re frustrated at having to wait,” he said.

Professor Narelle Haworth, director of the Centre for Accident Research and Road Safety – Queensland (CARRS-Q) said that the study’s findings were likely to be consistent with trends in other Australian states and reflected the growing popularity of cycling.

Research from CARRS-Q has shown that the number of cyclists in the Brisbane CBD increased by 50% between 2010 and 2015, she said.

“Lower speed limits in areas where there are cyclists and pedestrians are really important and will make a difference in safety, and will also increase active travel and therefore contribute to reductions in chronic disease,” she said.

The push to build dedicated cycleways has been a source of tension between procyclists and promotorists in cities around the world.

Professor Haworth said that while cycle paths had been shown to improve safety, “we can’t afford separated infrastructure everywhere, and it probably won’t be needed in those locations where speeds are low enough”.

However, Associate Professor Yusuf Nagree, chair of the Australasian College of Emergency Medicine’s Council of Advocacy, Practice and Partnerships, said that cycle paths should be a priority.

“Roads currently are not designed for co-sharing with cyclists as our cycle lanes are rarely physically separated from motorists,” Associate Professor Nagree told MJA InSIght.

“There is ample evidence from Europe and Australia that helmets and dedicated bicycle paths reduce the incidence and severity of injury,” he said. “The priorities should be enforcing helmet laws, ensuring that bicycle lanes are physically separated from the road and encouraging motorists and cyclists to obey road rules and share the road.”

Some Australian states have introduced a rule that motorists must give cyclists 1 m of space when passing them on the roads.

Professor Haworth said that there was not yet clear evidence on whether the 1 m rule had reduced injuries to cyclists. However, a CARSS-Q evaluation in Queensland found that 75% of cyclists and 60% of drivers believed it had changed drivers’ behaviours. The group’s observations showed that 88% of drivers left 1 m or more in 60 km/hour or less speed zones and 79% left 1.5 m or more in higher speed zones.

The authors of the MJA study said that their findings showed the importance of measuring not only the road toll – deaths – but also traffic injuries.

“Australia is internationally recognised for its success in improving road safety; interventions such as legislation for compulsory seat belt use and restricting drink-driving, targeted public safety campaigns, and lower speed limits have reduced road traffic mortality,” they wrote.

“However, our finding of no change in the incidence of hospitalisation for major trauma indicates that the impact of such interventions is not translating into reduced rates of serious injury.

“Given the substantial burden of serious road traffic injury and the associated economic costs, efforts to improve road safety should clearly shift in emphasis to averting serious injuries,” they wrote.

The total cost of health loss related to road traffic injuries in Victoria over the 9-year period of the study exceeded $14 billion, they wrote.


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More money should be spent on infrastructure such as bike lanes to keep cyclists safe
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11 thoughts on “Cyclists copping brunt of bad city design

  1. Jim Ferry Manly says:


  2. Cate Swannell says:

    EDITOR’S NOTE: Dear Dr Doolan, MJA InSight isn’t a medical journal, it’s just affiliated with one (the MJA). We are an open forum website which means not all our commenters are doctors, as our articles are available to everyone. Thank you for your feedback. Cate

  3. Marcus says:

    So, just to be clear: cycling to work – every day – at speed, on a major arterial road, beside cars and trucks… Is that ‘everyday cycling’? i.e. “not at all dangerous”?
    PS. Risk is usually a rate, not a number: there are more head-injured drivers because there are more drivers. To say that the risk of head injury in motorists is “orders of magnitude” (i.e. a log scale, and plural) higher than for cyclists is nonsense.
    Being an anti-bike-helmet zealot – even if apparently more intelligent – is no licence to make up false facts.

  4. Dr Gavin Doolan says:

    Gosh, I would have thought the comments in a medical journal would be a lot more intelligent than most of those above. How depressing!

    I follow this area with interest as I like riding my bike, and I have lived in Australia and Europe/Scandinavia.

    I’ll keep my comments brief:

    1. A distinction needs to be made between recreational cycling/racing and ‘everyday cycling’. Everyday cycling is not at all dangerous and this is the area that needs investment and encouragement to flourish.

    2. Two interventions are needed to improve safety for every day cyclists.
    A- World class bicycle infrastructure, like you see in Denmark, the Netherlands, and other foreword thinking countries.
    B- Reduction in the speed limit to 30km/h where bikes and cars must share the road.

    3. Helmet laws lead to a huge reduction in everyday cycling. This is multifactorial and has little to do with helmet hair. Cycling is the way of the future for our cities as there is just no more room or tolerance for cars. Until the helmet laws are repealed, the level of cycling will never reach its potential.

    4. If you really want to reduce the burden of head injuries in the community, helmet laws should be introduced for those in cars. People driving around in cars are at the greatest risk of head injury by orders o magnitude.

    5. Australia is literally 45 years behind Europe in the area of cycling for transport. Unless the discussion becomes more intelligent, it will continue to fall behind.

  5. Anonymous says:

    @#2: ”It’s far cheaper to build dedicated cycle lanes than roads”….
    …and it could be cost-effective too if cyclists would be prepared to use them, but they won’t ‘cos they want to go fast.
    Cyclists’ insistence that they have as much right to use the roads as anybody else has resulted in lanes being stolen from car-users and dedicated to cyclists: increases traffic congestion, for a volume of cyclists that is still less than the number of cars disadvantaged. That goes some of the way to explaining why drivers don’t like cyclists.
    A speed limit for cyclists based on safety parameters outlined above and commensurate with similar safety considerations as they apply to cars would have cyclists travelling at a maximum 10-15km/h, which is about the speed they travel in those much-admired European cities (usually upright and with a wicker basket on the front).

  6. Anonymous says:

    no one has commented on bike riders traveling at considerable speed on footpaths colliding with pedestrians or runners. They usually cycle away so avoid any civil or criminal charge. They usually cannot be identified, don’t have any third party insurance and have little chance of being convicted of a serious traffic violation as would a car driver. All bike riders over the age of 16 should be registered as should the bike and third party insurance included.

  7. Sydney Sacks says:

    As a long-time recreational cyclist and previously a bicycle commuter (having had 2 fractured hips from falls, one requiring emergency replacement at the time) I feel I can comment. I still ride and still love it but the reality is that bicycle advocates underplay the danger and the morbidity and mortality are significant. I think this is less so in more cycle friendly countries (European). Safe cycling depends on skills and attitudes of cyclists and motorists, not airbags and seatbelts. There is no requirement for Australian motorists to learn anything about cyclists’ rights when they obtain a drivers license. Is there any wonder that mortality and injuries are rising?

  8. Ian Hargreaves says:

    The comment in the article about compulsory seat belts says it all. Bicycles lack the modern safety provisions of seat belts, airbags, and side impact protection. They have no traffic indicators, no radar to sense adjacent vehicles, and rudimentary lights and brakes.

    Furthermore, every professional cyclist has fallen off, without an actual collision. World champions such as Cadel Evans, Anna Meares, and most recently Richie Porte, have fallen off and sustained significant injuries. There is a simple medical explanation for this, because the human cerebellum was evolved to balance on a foot base of about half a metre, not a wheel base of 2 cm. Our top speed in the wild is approximately 20 kmh, the speed of an Ethiopian marathon runner – Usain Bolt can manage 36 kmh for a few dozen metres. Modern bicycles travel fast enough to exceed the design parameters of the riders’ brains and bones.

    The road environment has also changed, with far more vehicles per hour on all commuter roads, and poorly manoeuvrable vehicles like semi trailers and articulated buses. Because bicycles had been around for centuries, they have been allowed on this 21st century road environment, unregulated – an unlicensed rider with an unregistered vehicle, not ANCAP rated, which undergoes no annual safety check, and is frequently the subject of home maintenance. The vehicle’s air intake is usually unfiltered, and slip streaming behind a bus inhaling all the volatiles and particulates of its emission, probably negates any cardiovascular benefit of the aerobic exercise.

    The AMA advocates banning boxing, but cycling is far more lethal. The AMA supports marriage equality on the grounds of decreasing psychological stress, but the harrowing stories like the comments by the doctors above show intense family trauma from cycling. I am a hand surgeon specialising in wrist injuries, so the increase in cycling has been a great boon to my business, but as an ethical doctor, I feel that our profession should be active in preventive medicine, not just reactive (and making a good living) in patching up the wounded.

    Like the semiautomatic rifle or the sabre, there may be a limited place for the bicycle in modern sporting competition, but not in general public use. I look forward to seeing Senator Hanson wheeling into the chamber with a cry of “Ban the biker”.

  9. Anonymous says:

    Cycling has benefits both medical and financial.
    It’s far cheaper to build dedicated cycle lanes than roads.
    Cycling can reduce the incidence of illness related to our sedentary lifestyle.
    We need to encourage safe cycling by separating cars and bicycles and ensuring appropriate behaviour by cyclists,ie not excessive speed peletons on main roads

  10. (Frederick) John Blackford says:

    I have a daughter, 48 years old and very fit at the time, severely injured – avulsed kidney (nephrectomy), Monteggia #,(plated 10 days after), #’s lumbar transverse processes, cartilaginous #’s both acetabular rims – hi-tech bicycle, lost control at excessive speed – no head injury or concussion.
    She has recovered well but it is my view (as a retired clinician/surgeon) that the severity of the injury with the associated period of relative hypovolaemia (approximately 2 and 1/2 hours between accident and definitive surgical treatment – which included renal artery embolization, laparotomy and nephrectomy) that she has probably compromised her prognosis in respect of longevity. We will never know with any degree of certainty! i

  11. Randal Williams says:

    In my home town a fair number of doctors in the over forty age group have taken up cycling, joining the MAMIL group ( middle aged men in lycra). I suspect this has been reflected elsewhere. Many have suffered broken bones and soft tissue injuries resulting in weeks off work. There has been one devastating and irreversible head injury, and a number of cases of serious multi-trauma. These have mostly been due to collisions with motor vehicles or falls at high speed. With the popularity of cycling enhanced by events like the Tour Down Under and international competitions, and the heavy promotions of cycling as a healthy activity, I believe the risks have been downplayed.
    Even with dedicated lanes cycling on main roads in peak hour traffic is inherently unsafe, not to mention inhalation of diesel fumes, and I believe any roads with a speed limit greater than 60kph should be closed to cyclists. “Born again” doctor cyclists are putting their lives and livelihoods at risk.

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