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Trends in cyclist casualties in Britain  with increasing cycle helmet use

This analysis is to the year 2000
Later information may be found elsewhere on this site

Introduction

Cycle  helmet  use  in  Britain  has  increased  significantly  since  the  mid  1980s.  This  has  come  about largely due to the vigorous promotion of cycle helmets by Government, the medical profession and others as an effective and unequivocal means of reducing the severity of head injuries to cyclists.

This paper looks at trends in cyclist casualties in Britain over the period when helmet use has risen from virtually zero to as much as 40 per cent or more in some parts of the country. It then looks at similar research that has been carried out in other countries to establish any similarities.

Pedal cycle casualties in Great Britain

The total number of deaths to cyclists in Great Britain has been falling almost continually since 1934 (Figure 1), when there were a total of 1,536 cyclist fatalities. In 1997 the total was 183.

A  breakdown  of  other  severities  of  cyclist  injury  is  only  available  to  the  author  since  1974,  when there were 282 fatalities, 4,166 serious injuries and 18,900 slight injuries. From 1974 the number of serious  injuries  rose  until  1984  and  has  fallen  steadily  since  (Figure  2).  In  1997  there  were  3,371 serious injuries. The number of slight injuries also rose until 1984, but since that time has remained steady at around 20,000 a year.

The above statistics take no account of the number of   people   cycling.   This   number   has   fallen dramatically  since  the  trend  of  declining  fatalities started  in  1934.  A  fairer  way  to  assess  trends  in casualties  irrespective  of  the  number  of  people cycling   is   to   look   at   the   severity   ratio:   the proportion of cyclist casualties that involve fatal or serious injuries.

Since  1974  (the  first  year  for  which  full  statistics are  available)  the  severity  ratio  has  fallen  almost consistently   (Figure   3),   although   the   fall   was arrested between 1993 and 1996.

Helmet trends, Great Britain

Until the mid 1980s helmet use was rare amongst British cyclists. Helmet use started to grow from about  1986  but  take-up  was  slow  for  some  years.  By  1996,  however,  helmet  use  had  risen  to  an average of 16% throughout Britain, and was about 18% in 1998.

A growth of around 16% in helmet use over a decade is significant, and might be expected to result in a  noticeable  impact  on  recorded  casualties  to  cyclists.  However,  for  Great  Britain  as  a  whole,  the trends in fatalities, serious injuries and severity ratio show no evidence at all of a 'helmet effect', in all cases trends continuing as they had prior to helmet use becoming more popular. Indeed, what change there has been in severity ratio would suggest that the proportion of serious injuries actually increased during the time of greatest helmet take-up.

Greater London

Greater London has probably the largest incidence of helmet use by cyclists in Great Britain. Over the decade to 1996, wearing rates rose from close to zero to about 40 per cent.

The number of cyclist fatalities in Greater London  has fallen in most years since 1981 (Figure 4), the continuation of a trend from previous years. Serious injuries, on the other hand, show no clear trend, but have increased in total number since 1994. (NB: All Greater London statistics exclude the City of London)

As  for  Great  Britain,  the  severity  ratio  provides  a  fairer  way  to  assess  trends  independently  of  the number of people cycling. For cyclists (Figure 5) there has been no improvement on the severity ratio of the early 1980s and, indeed, the seriousness of casualties has increased since 1994.

The  trends  in  fatalities,  serious  injuries  and  severity  ratio  for  Greater  London  show  no  evidence  of influence  by  the  increased  wearing  of  cycle  helmets.  Indeed,  serious  injuries  (both  in  total  and  as reflected by the severity ratio) increased noticeably during the period of greatest helmet take-up. 

It may, of course, be that some mitigating factor is cancelling out benefits achieved through helmet use. In this context it is instructive to consider the severity ratio in Greater London for pedestrian road casualties (Figure  5). This  shows a trend  very similar  to that for  cyclists. However, since  1985 the average seriousness of pedestrian casualties has decreased more than that for cyclists, and the severity ratio has not increased since 1994. Clearly, pedestrian trends have not been influenced by the wearing of helmets.


Cambridge

Cambridge is the British city with the greatest amount of cycling. Helmet use by Cambridge cyclists had reached 33 per cent by 1998 – lower than in London, but still twice the national average.

Fatalities in Cambridge have held steady since 1981, although numbers are very small at just 1 or 2 a year. Serious injuries fell by half from 1981 to 1998 and  the  severity  ratio  (Figure  6)  has  declined steadily for many years. Once more it is difficult to see any improvement in casualties  or  the  severity  ratio  in  later  years  that might be attributable to the large increase in the use of cycle helmets.

International experience

The  largest  sample  ever  used  in  an  assessment  of the  effectiveness  of  cycle  helmets  was  made  by Rodgers, 1988  when  he  studied  over  8  million cases  of  injury  and  death  to  cyclists  in  the  USA over 15 years. He concluded that there was no evidence that hard shell helmets had reduced the head injury and fatality rates. Indeed, he suggested that helmeted riders are more likely to be killed.

A study by Kunich, 2002  analysed cyclist and pedestrian fatalities for the USA from 1986 to 1996, during which  period  cycle  helmet  use  rose  from  close  to  zero  to  30  per  cent  or  more.  Although  cyclist fatalities  fell  during  this  period,  the  decline  was  proportionately  less  than  for  pedestrians,  and  the continuation  of  a  long-term  trend  most  probably  associated  with  decreased  exposure.  Kunich concluded that there is no evidence that cycle helmets are effective in reducing deaths.

Burdett, Can carried out a similar analysis for Canada from 1975 to 1997. Fatality trends were similar for cyclists and pedestrians throughout the period, and both fell. Although cycle helmet use had risen to 50 per cent by 1997, there is no detectable impact on the fatalities recorded.

In  Australia,  mandatory  helmet  laws  from  1990  -  1992  provided  a  whole-population  sample  with which  to  assess  the  effectiveness  of  a  large  increase  in  helmet  use.  Early  official  studies  claimed  a success  as  head  injuries  declined  significantly,  but  the  studies  failed  to  take  account  of  the  large decrease  in  cycle  use  brought  about  by  the  helmet  laws  or  the  concurrent  trends  in  declining  head injury  across  all  road  users.  However,  the  Australian  Road  Accident  Prevention  Research  Unit  has subsequently reported (Hendrie, Legge, Rosman and Kirov, 1999) that head injuries since helmet use became compulsory may only have fallen by 11 per cent *  – less than the decrease in cycle use. Despite a large increase in helmet use, the risk of head  injury  amongst  people  who  continue  to  cycle  has  risen,  and  in  some  parts  of  Australia  injury rates are at an all-time high.

[*: An alternative, and less likely, scenario predicted a maximum fall in injuries of 20 per cent, still no more than the decrease in cycle use.]

In New Zealand, too, large increases in helmet use seem not to have brought about any reduction in the proportion of serious head injuries, and legislation caused cycle use to fall. Scuffham and Langley, 1997  noted that although  there  had  been  a  reduction  in  mild  concussions  and  lacerations,  this  was  balanced  by  an increase in neck injuries which could be more serious.

Conclusions

Examination  of  cyclist  casualty  data  for  Great  Britain,  Greater  London  and  Cambridge  shows  no evidence  of  any  reduction  in  serious  injuries  despite  a  large  increase  in  helmet  wearing  by  cyclists since the mid 1980s.

If cycle helmets are effective in reducing head injury, it seems reasonable to expect that the reductions in injuries would be reflected in the general casualty statistics, particularly in places where helmet use has become significant. There is no indication that this is the case. 

With more than 2 out of 5 cyclists now wearing helmets in London, it is difficult to see what greater use of helmets would be necessary to achieve noticeable casualty reductions, particularly if the more optimistic predictions for the effectiveness of helmets are correct.

The  results  nonetheless  are  consistent  with  other  research  in  the  USA,  Canada,  Australia  and  New Zealand,  none  of  which  has  found  real-world  evidence  of  any  significant  reduction  in  cyclist  head injuries in large population samples.

It would seem prudent to re-assess the claims being made for the role of cycle helmets in road injury reduction, to ensure that the information being given to the general public is not misleading.

Sources

Casualty data from:

References

Burdett, Can

Burdett A, . Cyclist fatalities in Canada. OCBC .

Hendrie, Legge, Rosman and Kirov, 1999

Hendrie D, Legge M, Rosman D, Kirov C, 1999. An Economic Evaluation of the Mandatory Bicycle Helmet Legislation in Western Australia. Road Accident Prevention Research Unit .

Kunich, 2002

Kunich TH, 2002. Latest CPSC helmet standard and US fatality trends. OCBC .

Rodgers, 1988

Rodgers GB, 1988. Reducing bicycle accidents: a re-evaluation of the impacts of the CPSC bicycle standard and helmet use. Journal of Products Liability 1988 ,11:307-317.

Scuffham and Langley, 1997

Scuffham PA, Langley JD, 1997. Trends in cycle injury in New Zealand under voluntary helmet use. Accident Analysis and Prevention 1997 Jan;29(1):1-9.