Route Infrastructure and the Risk of Injuries to Bicyclists: A Case-Crossover Study

TLDR

Transportation infrastructure with lower bicycling injury risks merits public health support to reduce injuries and promote cycling. The study compared cycling injury risks across 14 route types and other infrastructure features among 690 injured cyclists in Toronto and Vancouver. A case‑crossover design compared route infrastructure at each injury site to a randomly selected control site from the same trip. Cycle tracks reduced injury risk to one‑ninth of major streets with parked cars, while major streets without parked cars or with bike lanes lowered risk by 37 % and 46 %, respectively; local streets also lowered risk by 49 %, whereas streetcar tracks, downhill grades, and construction increased risk by 200 %, 130 %, and 90 %, respectively, supporting the use of quiet streets and bike‑specific infrastructure.

Abstract

We compared cycling injury risks of 14 route types and other route infrastructure features.We recruited 690 city residents injured while cycling in Toronto or Vancouver, Canada. A case-crossover design compared route infrastructure at each injury site to that of a randomly selected control site from the same trip.Of 14 route types, cycle tracks had the lowest risk (adjusted odds ratio [OR] = 0.11; 95% confidence interval [CI] = 0.02, 0.54), about one ninth the risk of the reference: major streets with parked cars and no bike infrastructure. Risks on major streets were lower without parked cars (adjusted OR = 0.63; 95% CI = 0.41, 0.96) and with bike lanes (adjusted OR = 0.54; 95% CI = 0.29, 1.01). Local streets also had lower risks (adjusted OR = 0.51; 95% CI = 0.31, 0.84). Other infrastructure characteristics were associated with increased risks: streetcar or train tracks (adjusted OR = 3.0; 95% CI = 1.8, 5.1), downhill grades (adjusted OR = 2.3; 95% CI = 1.7, 3.1), and construction (adjusted OR = 1.9; 95% CI = 1.3, 2.9).The lower risks on quiet streets and with bike-specific infrastructure along busy streets support the route-design approach used in many northern European countries. Transportation infrastructure with lower bicycling injury risks merits public health support to reduce injuries and promote cycling.