Cyclist injury data before and after helmet law in Western Australia
Western Australia's compulsory bike helmet law was enforced from July 1992.
As outlined in the March 2005 issue of the Health Promotion Journal of Australia (PDF 88kb), the number of regular cyclists in Western Australia almost doubled between 1982 and 1989 from 220,000 to 400,000.
During this time, the numbers of cyclists admitted to West Australian hospitals and reported deaths and serious injuries per 10,000 regular cyclists fell by 48% and 33% respectively.
Since 1992 helmet law enforcement in Western Australia, cyclist hospital admissions have risen by 20-30% in proportion to surveyed cyclist numbers on the road, and reached consecutive records in 1997, 1998, 1999 and 2000 - by which time cyclist road numbers had recovered to pre-law levels.
Total cyclist head injury figures were higher in 1995 and 1996 than during any year before the law was introduced, an exception being 1988, and the proportion of cyclist upper body injuries almost doubled between 1988 and 2000.
Females represented 30% of the 630 cyclists admitted to West Australian hospitals in 1987. In 2000, females represented 20% of the 913 cyclist hospital admissions.
The proportional drop in female hospital admissions began in 1992, the year of law enforcement, adding to anecdotal evidence that women in particular are dissuaded from cycling because of helmets. The Health Promotion Journal of Australia reported in 2003 that Australia has a disproportionately low number of female cyclists (PDF 228kb). Read more about female cycling numbers.
Police statistics also show a marginally higher proportion of helmet wearing crash victims required hospital treatment, compared to those not wearing a helmet.
A health benefit model developed at Macquarie University in Sydney and published in March 2009 suggests Australia's national mandatory bicycle helmet laws incur a health cost to the country of approximately half a billion dollars every year.
Click here for the Austroads Review of Australia's National Road Safety Strategy, published in February 2015, showing the ratio of overall and life-threatening injury to Australian cyclists has soared since 2001 and is by far the worst among all road users.
Read a public submission to the NSW parliament's Inquiry into Vulnerable Road Users in 2010 calculating that "the risk of death and serious injury increased by 50% after the helmet law".
The chart above researched by statistician Dorothy Robinson shows head injury percentages among road users admitted to hospitals in Western Australia, showing that head injury percentages followed a similar trend for all road users with little or no obvious benefit of a law that increased helmet wearing from 37% to about 82% of all cyclists.
West Australian hospital cyclist admissions: 1985-2016
1985 - 623
1986 - 660
1987 - 630
1988 - 698
1989 - 596
1990 - 638
1991 - 730
1992 - 574
1993 - 633
1994 - 644
1995 - 660
1996 - 715
1997 - 754
1998 - 850
1999 - 862
2000 - 913
2013 - 1297
2014 - 1200
2015 - 1167
2016 - 1173
The veracity of these hospital admission figures can be checked in An Overview of Bicycle Crashes and Injuries in Western Australia published in July 2005 by the Journal of the Australasian College of Road Safety. The 2013-2016 cyclist injuries are sourced to this newspaper story.
Annual cyclist hospital admission data for Western Australia since 2000 is not available. However, it is known that an average 884 cyclists were hospitalised in Western Australia each year from 2004 to 2008. This average of 884 is 37.6% higher than the pre-law average of 642. Although it is difficult to gauge cyclist numbers after 14 years of infrastructure changes, bicycle survey figures suggest that by 2006 there were about 10% more cyclists on West Australian roads than the pre-law average.
The graph below is extracted from the WA Road Safety Council's Reported Road Crashes in Western Australia 2006. The data shows traffic crash hospitalisations involving cyclists rather than total cyclist hospital admissions as quoted above. The traffic data below indicates cyclist hospital admissions have continued their disproportionate increase in the new millennium.
The graph below is extracted from the WA Road Safety Council's Reported Road Crashes in Western Australia 2010, showing the continued upward trend in cyclist injuries.
The Road Safety Council (PDF 117kb) has published admissions figures from 1996 to 2006 showing a significant ongoing increase in cyclist hospitalisations from cyclist traffic accidents on public highways.
For a national perspective, the table below is extracted from Trends in serious injury due to road vehicle traffic crashes, Australia 2001 to 2010 (Flinders University), showing how cyclists have fared by comparison with other road users in the mandatory bike helmet jurisdictions of Australia.
In March 2014, WA's peak cycling industry representative body WestCycle published Our Bike Path 2104-2020 (PDF 6.3mb) outlining a strategic framework aimed at lifting the state's cycling participation from 405,000 people cycling per week in 2013 to one million per week in 2020.
The strategy makes no mention at all of mandatory helmets and is doomed to failure. However, the strategy document does note that in WA there were 1,244 cycling related hospitalisations in 2011/12, based on data from the WA Health Department's Hospital Morbidity Data System, and laments that 84% of children cycled, walked or used public transport to get to and from school in 1970 compared to just 5.9% cycling to school in 2011.
CensusAtSchool data shows that 4.7% of WA schoolchildren cycled in 2011, not 5.9%. The 1,244 hospital injuries in 2011/12 can be compared with Hospital Morbidity Database figures showing about 300 WA hospital injuries in 1970 and an average 654 per year in pre law 1985-1991.
The child school cycling ratio of 4.7% in 2011 can be compared with Bicyclist Helmet Wearing in Western Australia: A 1993 Review (Heathcote, B. (1993), WA Police Department, Perth) showing rates of children riding to school of:
Perth metro 1986 - 18.2%
Perth metro 1987 - 20.9%
WA 1988 - 17.51%
WA 1989 - 14.71%
WA 1990 - 14.4%
WA 1991 - 11.87%
WA 1992 - 11.07%
WA 1993 - 10.63%
In terms of participation framed as population aged 5-19yo (based on available Census age categories for 1986), these percentages translate to:
Perth metro 5-19yo population 1986 = 238,297 x 18.2% = 43,370 riding to school
Perth metro 5-19yo population 1986 = 238,297 x 20.9% = 49,804 riding to school
WA 5-19yo population 1986 = 358,883 x 18.2% = 65,317 riding to school
WA 5-19yo population 1987 = 364,241 x 20.9% = 76,126 riding to school
WA 5-19yo population 1988 = 370,062 x 17.51% = 64,798 riding to school
WA 5-19yo population 1989 = 376,830 x 14.71% = 55,432 riding to school
WA 5-19yo population 1990 = 381,488 x 14.4% = 54,934 riding to school
WA 5-19yo population 1991 = 381,821 x 11.87% = 45,322 riding to school
WA 5-19yo population 1992 = 381,229 x 11.07% = 42,202 riding to school
WA 5-19yo population 1993 = 382,023 x 10.63% = 40,609 riding to school
CensusAtSchool data provide percentages for the following years:
WA 5-19yo population 2010 = 444,658 x 5.2% = 23,122 riding to school
WA 5-19yo population 2011 = 451,053 x 4.7% = 21,199 riding to school
WA 5-19yo population 2012 = 461,655 x 4.9% = 22,621 riding to school
The story above was published in The Sunday Times newspaper on 2 March 2014.
The 2013 Australian Cycling Participation survey showed WA participation dropped 3.9% from 22.1% in the 2011 survey to 18.2% in the 2013 survey, yet it is claimed WA cycling is rising at 10% per year.
Any increase in cyclist numbers has been because of the surge in bare head riders who've emerged in Perth over the past decade. Police would need to target all regions of Perth for riders who may be without helmets, not just Fremantle, North Perth and Vincent.
In pre-law 1988-91, there were an average 177 cyclist head injuries hospitalised each year (source). In 2012/13 it was 286, a 61.6% increase.
The 2013 participation survey suggests 123,697 daily bike trips aged 9+ in WA, compared to 182,900 in 1985/86, according to CR69. WA's total population increased 63.2% over this time.
If you prefer the more accurate 2011 survey results, there were 257,024 daily bike trips in WA, up 40.5% vs population 9+ increase of 87.1%.
In pre-law 1988-91, there were an average 665 cyclist all body injuries hospitalised each year in WA (source). In 2012/13 it was 1029, a 54.7% increase.
Head injuries averaged 26.6% of all WA cyclist hospital admissions in the four years pre law, and in 2012/13 it was 27.8%.
The under-estimation of cyclist injuries by Australian authorities was reported six years earlier in Pedal cycle injuries in NSW: A comparison of data sources, published in the Dec 2003 issue of Road & Transport Research.
Similar findings can be found in Emergency presentations by vulnerable road users: implications for injury prevention, published by the Injury Research Centre at the University of Western Australia.
West Australian cyclist fatalities 1951-2016 *
1951 - 13|
1951 - 9
1952 - 10
1953 - 19
1954 - 12
1955 - 15
1956 - 7
1957 - 8
1958 - 13
1959 - 12
1960 - 6
1961 - 15
1962 - 6
1963 - 8
1964 - 8
1965 - 13
1966 - 10|
1967 - 4
1968 - 8
1969 - 9
1970 - 4
1971 - 2
1972 - 4
1973 - 7
1974 - 1
1975 - 7
1976 - 7
1977 - 10
1978 - 8
1979 - 4
1980 - 6
1981 - 4
1982 - n/a|
1983 - n/a
1984 - n/a
1985 - 5
1986 - 15
1987 - 4
1988 - 7
1989 - 7
1990 - 9
1991 - 8
1992 - 1
1993 - 4
1994 - 4
1995 - 4
1996 - 10
1997 - 6
1998 - 6|
1999 - 3
2000 - 2
2001 - 5
2002 - 6
2003 - 1
2004 - 3
2005 - 5
2006 - 3
2007 - 4
2008 - 3
2009 - 0
2010 - 4
2011 - 3
2012 - 3
2013 - 6
2014 - 9|
2015 - 4
2016 - 3
The data above can be compared with Australia's overall annual road toll from 1965 to 2007:
Road Safety in Australia (PDF 122kb) shows the average annual cyclist road fatality rate in Australia from 1980 to 1990 was 88 and from 1992 to 2002 it was 45 - a reduction of 49%. Over the same timeframes, annual average motorcyclist road fatalities fell from 382 to 195, also down 49%. The annual average road fatality rate for pedestrians fell by 40% (541 to 324). Vehicle passenger fatalities fell by an average 39% (768 to 470) and vehicle driver fatalities fell by an average 28% (1127 to 816).
Note: In the United Kingdom, cyclist deaths fell from 256 in 1990 to 114 in 2003 - a drop of 56%. The UK does not have mandatory bicycle helmet laws and people were not discouraged from cycling during the 1990s.
Recent trends in cyclist fatalities in Australia published July 2015 by Boufous and Olivier from the University of New South Wales found that multi-vehicle cyclist fatalities decreased 2.9% per annum from 1991 (helmet law enforcement 1990-92) to 2013 but cyclist-only fatalities increased 5.8% per annum, resulting in an overall 1.9% per annum reduction.
In this context it should be noted that from 1991-2002 to 2003-2014, average annual cyclist fatalities dropped 19.1% (46.2 > 37.4), pedestrian fatalities dropped 40.4% (325.9 > 194.2) and road user fatalities dropped 23.5% (1,875.8 > 1,435.8). As a percentage of all road fatalities, cyclist deaths averaged 2.5% in 1991-2002 and 2.7% in 2003-2014, while the average pedestrian proportion dropped from 17.4% to 13.5%. Comparing the pre-law decade of 1980-89 with 2005-14, average annual cyclist fatalities dropped 59.7% (94.3 > 38.0), pedestrian fatalities dropped 65.4% (543.1 > 187.8) and all road fatalities dropped 52.8% (2,971.0 > 1,402.6). In light of the significant downturn in Australian cycling participation after helmet law enforcement, this data suggests the reduction in cyclist deaths was due to fewer cyclists and safer vehicle traffic with slower speeds, rather than mandatory helmet wearing. The significant increase in cyclist-only fatalities raises questions about whether additional cycle path infrastructure has contributed to the reduction.
Recent trends in cyclist fatalities in Australia provides a charted comparison of different road user fatalities since 1991, modified by this site in red ...
It might also be worth noting that in 2006/07, preventable errors in West Australian hospitals killed 30 patients (West Australian Health Department Sentinel Event Report 2006-07). According to a report tabled in parliament by the West Australian Auditor-General in October 2007, an estimated 45,000 mishaps are harming patients and jeopardising treatments in hospitals every year, with 820 adverse events in 2006 rated as critical, causing serious harm or death. These include medication errors and patients falling. Should helmets be mandatory in West Australian hospitals?
The data above from Australian Helmet Experience: Is There Any Reliable Evidence That Australian Helmet Legislation Works? (researcher Bruce Robinson from the Bicycle Federation of Australia) shows the decline and immediate increase in Western Australia hospital cyclist admissions after law enforcement on July 1, 1992. Narrows and Causeway river bridge data suggests that in 1995 there were 36% less weekday cyclists than in the 12 months prior to law enforcement. The cyclist number vs hospital admission statistics suggest that in 1995 there was a 26% increase in injury risk to cyclists compared to the year before law enforcement.
In its April 1995 issue of Cycling in the West, the Bicycle Transportation Alliance of Western Australia writes: "Comparisons with data from previous years suggest that compulsory helmet legislation has not been nearly as successful as predicted in reducing the cyclist injury rate.". The data cited by the Bicycle Transportation Alliance mirrors the findings on this website.
Pre and post law comparisons of WA serious head injuries and fatalities of cyclists (PDF 32kb) can be made based on the following data from the WA Morbidity Data Base given to the Legislative Assembly of the West Australian parliament on June 27 2000 by then WA Transport Minister Murray Criddle:
WA adult cyclist serious head injuries - 5 year comparison pre law / with law
Pre law - Average annual number of serious head injuries to WA adult cyclists aged 16 and over 1987/88 to 1991/92 = 18.4
With law - Average annual number of serious head injuries to WA adult cyclists aged 16 and over 1992/93 to 1995/96 = 14.8
This is a reduction of 19.5% (Bridge surveys show cyclist decline of 25-30%)
WA juvenile cyclist serious head injuries - 5 year comparison pre law / with law
Pre law - Average annual number of serious head injuries to WA juvenile cyclists aged 15 or under 1987/88 to 1991/92 = 13.8
With law - Average annual number of serious head injuries to WA juvenile cyclists aged 15 or under 1992/93 to 1995/96 = 9.6
This is a reduction of 30.5% (more than 50% decline in schoolchildren cycling from 91 to 96 according to Bikewest)
WA adult cyclist fatalities - 7 year comparison pre law / with law
Pre law - Average annual number of fatalities to WA adult cyclists aged 16 and over 1985/86 to 1991/92 = 4.2
With law - Average annual number of fatalities to WA adult cyclists aged 16 and over 1992/93 to 1998/99 = 4.7
This is an increase of 12% (Bridge surveys show cyclist decline of 25-30%)
WA juvenile cyclist fatalities - 7 year comparison pre law / with law
Pre law - Average annual number of fatalities to WA juvenile cyclists aged 15 or under 1985/86 to 1991/92 = 3.2
With law - Average annual number of fatalities to WA juvenile cyclists aged 15 or under 1992/93 to 1998/99 = 1.4
This is a reduction of 55% (more than 50% decline in schoolchildren cycling from 91 to 96 according to Bikewest / figures skewed by 9 deaths in 85/86)
The serious head injury data provided by the minister to the WA parliament in 2000 can be tabulated thus:
Table: number of serious head injuries to cyclists in Western Australia by financial year and age of cyclist, compared to average weekly counts of cyclists using the Causway and Narrows bridge paths from October-December of that year. The data used for this graph is crude but nevertheless shows the law does not appear to have produced any obvious benefit in terms of reducing serious head injuries relative to the amount of cycling.
Below is a West Australian Health Department table showing the number and age-standardised rates of hospital admissions for injuries sustained in bicycle crashes from 1981 to 1995. Note an increase in cyclist admissions during the three years after 1992 helmet law enforcement, despite an estimated 30% reduction in overall cyclist numbers on West Australian roads, a 50% reduction in cycling to school and about 80% of cyclists mandatorily wearing helmets that are supposed to reduce head injuries.
Below is a West Australian Health Department table showing the percentage of cyclist injury types sustained in Western Australia hospital admissions between 1981 and 1995.
Percentage of hospitalisations for injuries sustained in cycling crashes by site and nature of injury
Western Australia, 1981-1995
|Lower limb fractures||11.1||10.1||11.2||11.0||10.4||10.8|
|Upper limb fractures||15.7||14.7||16.4||22.9||28.6||19.8|
The table above shows the proportion of head injuries had been falling before the mandatory bike helmet law was introduced in 1992. The actual number of skull fractures was 64 in 1990-1992 and 44 in 1993-1995 (-31.25%). Surveys indicate the number of cyclists on the Narrows dropped by 28% between 1991/92 and 1995/96. On the Causeway bridge, cyclist numbers dropped by 36% between 1991/92 and 1995/96.
The actual number of intracranial injuries was 423 in 1990-1992 and 403 in 1993-1995 (-4.8%). The estimated percentage of West Australian cyclists wearing helmets increased from 39% in 1991 to 77% in 1995.
Skull fractures usually don't inflict long-term disability and intracranial injuries mostly require less than one day of hospital treatment. Nevertheless, both injury types can be serious.
The decline in skull fractures in the three years after helmet law enforcement amounts to an average seven per year. The decline in intracranial injuries in the three years after helmet law enforcement also amounts to an average seven per year.
That's an average 14 less head injuries per year from a total bike ownership of more than 750,000 West Australians, and with tens of thousands of people giving up cycling after the law was enforced.
The actual number of head injuries fell marginally after helmet law enforcement. However, upper limb fractures rose sharply. Cyclist upper extremity injuries in Western Australia increased from 118 (16.9% of all injury locations) in 1988 to 274 (32.2%) in 1998.
Research by McDermott et al. (Trauma, 1993, p834-841) found a significant increase in neck injuries for helmet wearers. 3.3% of unhelmeted riders sustained neck injuries while 5.7% of helmeted riders sustained neck injuries - a 75% greater risk among helmet wearers. The study compared 366 helmeted riders and 1344 non helmeted riders admitted to hospital in the Australian state of Victoria before helmets were mandatory.
Distribution of Cyclists Admitted to Hospital by Body Region of Injury, WA, 1988-1998
Western Australia, 1988-1998
* No neck injuries because cyclists with a neck injury also sustained injury of the same severity to a higher ranking body region.
Table B9 / Bicycle Crashes and Injuries in Western Australia, 1987-2000 - Road Safety report RR131 (PDF 840kb) commissioned by Road Safety Council, dated November 2003 and authored by Lynn B. Meuleners, Arem L. Gavin, L. Rina Cercarelli and Delia Hendrie
Although head injuries represent a smaller percentage (or proportion) of overall cycling injuries, this is mostly because of a much greater number of upper body injuries within the smaller pool of cyclists on the roads.
In other words, upper body injuries replaced head injuries as the dominant injury following helmet law enforcement but mostly because the actual number of upper limb fractures rose so sharply.
Various factors explain the overall (all body) increase in injuries, which add to the public health / pollution / transport infrastructure consequences of having fewer cyclists.
These include greater risk-taking when wearing a helmet, an increase in head surface area likely to contact or graze a solid object, and greater brain injury through the added rotational force of the helmet - particularly soft tops which grip the road surface (see eMedicine for more detail).
A further reason for the failure to reduce overall injury numbers is that tens of thousands of citizens who have abandoned cycling are instead driving their cars, increasing traffic density and further endangering all road users including pedestrians, other motorists and the remaining cyclists.
Below is extracted from Serious injury to land transport accidents, Australia, 2005-06 by the Australian Institute of Health and Welfare.
The proportion of head injuries to cyclists is better than pedestrians but worse than car occupants who don't wear helmets, and much worse than motorcyclists - suggesting that hard shell rather than soft-top bicycle helmets are more effective. The data also shows a very high proportion of upper body injuries, consistent with a significant increase in upper body injury numbers following helmet law enforcement, and it appears helmets were most effective in preventing injury to the lower limb.
Cartoon thanks to Yehuda Moon and the Kickstand Cyclery
Following is a summary of WA Health Department data showing actual and averaged numbers of hospitalised cyclist injury types in Western Australia on an annual basis:
Skull fractures 89/90/91 - 75 ( = average 25 per year)
Skull fractures 93/94/95 - 44 ( = average 15 per year)
Facial 89/90/91 - 198 ( = average 66 per year)
Facial 93/94/95 - 201 ( = average 67 per year)
Intracranial 89/90/91 - 458 ( = average 152 per year)
Intracranial 93/94/95 - 403 ( = average 134 per year)
Other head 89/90/91 - 36 ( = average 12 per year)
Other head 93/94/95 - 17 ( = average 6 per year)
Spinal 89/90/91 - 23 ( = average 8 per year)
Spinal 93/94/95 - 19 ( = average 6 per year)
Lower limb fractures 89/90/91 - 220 ( = average 73 per year)
Lower limb fractures 93/94/95 - 197 ( = average 66 per year)
Upper limb fractures 89/90/91 - 388 ( = average 129 per year)
Upper limb fractures 93/94/95 - 542 ( = average 180 per year)
All other fractures 89/90/91 - 29 ( = average 10 per year)
All other fractures 93/94/95 - 29 ( = average 10 per year)
Dislocations/sprains 89/90/91 - 30 ( = average 10 per year)
Dislocations/sprains 93/94/95 - 37 ( = average 13 per year)
Superficial 89/90/91 - 307 ( = average 102 per year)
Superficial 93/94/95 - 249 ( = average 83 per year)
Internal 89/90/91 - 44 ( = average 15 per year)
Internal 93/94/95 - 43 ( = average 14 per year)
Other 89/90/91 - 116 ( = average 39 per year)
Other 93/94/95 - 117 ( = average 39 per year)
Total 89/90/91 - 1924 ( = average 641 per year)
Total 93/94/95 - 1898 ( = average 633 per year)
Surveys consistently show that cyclist numbers fell by approximately 30% from 1992 to 1995 (three years of helmet law enforcement).
When this 30% reduction in public cycling numbers is considered, the above results suggest a slight improvement in skull fractures and a worsening in intracranial injuries (which should have averaged close to 100 per year following law enforcement).
Despite far fewer cyclists, the numbers of non-head injuries either remained fairly static or, in the case of upper limb fractures, worsened markedly.
Age-standardised rates of hospital admissions for injuries sustained in bicycle and vehicle crashes
Above is a West Australian Health Department graph comparing hospital admissions for injuries sustained in bicycle and vehicle crashes from 1981 to 1995. There is no reduction in cyclist admissions after helmet law enforcement in 1992. It can be argued that the increase in vehicle crashes from 1992 coincided with July 1992 enforcement of the bicycle helmet law that caused tens of thousands of people to abandon cycling and instead drive their cars, increasing the injury risk for all road users. The increase in vehicle crashes linked to reduced cycling is explored by The Australian newspaper in 2008.
According to the Australian Commonwealth Department of Transport, one third of all car journeys are estimated to be three kilometres or less and the average length of each bike trip is 2.5 km. Every day, Perth residents make 240,000 car trips that are less than one kilometre long.
Read the views of an Accident and Emergency doctor: "Forcing people to wear helmets demonstrably reduces the number willing to ride a bicycle. Less cycle use means more obesity, heart attacks, and use of other, less environmentally-friendly means of transport. Making helmet use compulsory gives cycling an undeservedly dangerous profile, and may discourage bicycle use even further."
America's Injury Prevention magazine published an article in 2003 titled Safety in Numbers: more walkers and bicyclists, safer walking and bicycling (PDF 140kb) which concludes that policies increasing walking and bicycling can improve the safety of other road users.