Mandatory bicycle helmet laws in the United States
The National Transport Safety Bureau has recommended all-age mandatory bicycle helmet laws be introduced across the United States. Read about the injury and participation data ignored by the NTSB.
Bicycle Helmet Influence in the New Millennium on United States Head, Traumatic Brain Injury, Upper and Lower Body Injury Rates is an unpublished but comprehensive analysis of US cycling participation, injuries and helmet wearing from 2001 to 2020, providing up-to-date data which should be considered by American media, academics, politicians and the general public.
Below is an expanded and modified study which elaborates on peer-reviewed findings published by World Transport Policy and Practice in January 2015. The data is accurate and can be used by any researcher investigating the efficacy of bicycle helmet laws in the United States.
Abstract 2022: Studies of child and teenage cyclist injury rates in the United States consistently report a downturn since mandatory bicycle helmet laws were introduced in various states and municipalities during the 1990s and progressively since. The downturn is generally attributed to improved safety through mandatory and voluntary wearing of helmets by children and teenagers. To test these conclusions against confounding factors, primarily child cycling participation, this study considers rates of cycling sourced to public and private agencies since 1995 and compares these with injury numbers sourced to the US Consumer Product Safety Commission National Electronic Injury Surveillance System and fatality numbers sourced to the National Highway Traffic Safety Administration’s Fatality Analysis Reporting System. Participation is also compared with cyclist traumatic brain injury and concussion data each year since 1995, and with 2010/2011 cyclist fatalities in all US states with and without child helmet legislation. The study finds that 6-17yo cycling participation in the United States declined 33.7% from a 1995-2008 average of 17,607,429 to a 2009-2021 average of 11,678,077. From 2002-2011 to 2012-2021, 6-17yo total injuries fell 38.4%, head injuries fell 38.8% and concussion injuries fell 26.3%. In all ages above 6yo, the data suggests a 0.8% decrease in the number of people cycling since 1998 but a 24.0% increase in head injuries, a 16.3% increase in concussions, a 1.6% increase in upper body injuries and a 7.8% decrease in lower body injuries. Multiple sources confirm these results as indicative of US child cycling participation and injury trends, suggesting a failure of bicycle helmet laws to improve public health and cycling safety.
Materials and methods
Cycling participation data
Cycling injury data
Cycling fatality data
Cycling fatality data in different states
Appendix charts and tables
Note: Cycling participation and injury data to 2015 can be viewed here.
Previous studies of child cyclist injury rates in the United States have identified a significant decline since the 1990s and have generally attributed this to the introduction of mandatory bicycle helmet laws 1.
Published surveys suggest helmet wearing among 5-15yo cyclists increased from 25% in 1994 to 48% in 2001/2002 2, 27. A 1998 survey published in the Injury Prevention journal 3, 6 put average probability of riders aged less than 16 always or almost always wearing a helmet at 72.3% in helmet law states and 49.6% in states without a helmet law.
Different state and local jurisdictions mandate helmet wearing among <12, <14, <15, <16, <17 and <18 age groups, a small number of municipalities also requiring helmet use by cyclists of all-ages.
Among other sources, this study extracts <17yo cycling data 1995 to 2020 from the US Census Bureau 4, the Outdoor Industry Association 7 and from the US Consumer Product Safety Commission National Electronic Injury Surveillance System 5.
Some analysis results are categorized by states wherein child helmet laws are applied and the study assumes there is more helmet wearing among youth than adults across the United States, either by law, parental coercion or choice.
Child cycling participation, population, cyclist number, all-body injury, head injury and fatality data from public and private agencies are compared in different age groups and American states to determine whether helmet laws and increased voluntary helmet wearing have achieved better health and injury outcomes.
Material and methods
Data for this study are sourced from:
- The Centers for Disease Control and Prevention 6
- The Outdoor Industry Association 7
- The National Sporting Goods Administration 8
- The US Consumer Product Safety Commission’s National Electronic Injury Surveillance System 5
- The National Highway Traffic Safety Administration Fatality Analysis Reporting System 9
- The US Census Bureau 4
- U.S. Department of Transportation, Federal Highway Administration, 2009 National Household Travel Survey 10
- The US Walking and Bicycling Alliance Benchmarking Project 11
- US single year cyclist injuries and population data from 1995-2012 12
A majority of the source agencies are government and their calculations of relevant data are considered accurate.
All calculations and charts in this study were performed and created within the Apple Numbers spreadsheet application. All data used is publicly accessible from the internet and all calculations are arithmetic, requiring no skills beyond knowledge of basic spreadsheet functions to verify data.
Cycling participation data
According to An Overview of the Bicycle Study 31, a survey by the US Consumer Product Safety Commission estimated that in 1991 there were 66.9 million Americans of all ages who had cycled at least once during the previous year (39.5% in 1-14yo age bracket). An estimated 17.6% of all cyclists wore a helmet all or most of the time in 1991, with another 6% wearing a helmet sometimes (11-14yo age group 11.4%; 1-11yo age group 17.0%).
Georgia was the first American state to introduce mandatory bicycle helmet laws for children aged less than 16 years old in 1993, although child and youth helmet wearing had been mandated by various local municipalities and/or enforced by many parents and schools across the USA in previous years.
According to the National Sporting Goods Administration 8 (NSGA), an estimated 56,308,000 Americans rode bicycles in 1995 at least six times a year. However, Outdoor Industry Association (OIA) data for 6yo+ cyclists shows participation dropped 13,533,000 or 24.0% by 2021 to 42,775,000. This is despite US 6yo+ population growth of 29.2% from 1995 to 2021.
OIA 7 data below indicate the 6-17yo proportion of all cyclists on roads and paved surfaces in the US was 45.2% in 2006 (17,401,000 / 38,457,000) and 28.3% in 2021 (12,116,000 / 42,775,000).
Youth Participation in Cycling, Ages 6 to 17
Adult Participation in Cycling, Ages 18+
Participation in Cycling, All Americans Ages 6+
All the reduction from 2006 to 2021 was among 6-17yo cyclists who are subject to mandatory helmet laws in half the American states (in all states if parent, school and local government coercion is taken into account). There was a strong participation boost among 6-17yo cyclists in 2020 and 2021 due to COVID-19 lockdowns, although the COVID boost among 18yo+ cyclists was only in 2020 with a decline of 3,257,000 in 2021.
NSGA data below suggest the 7-17yo cycling proportion was 27.4% in 2012 (10,800,000 / 39,400,000).
Data from the US National Household Travel Survey 10 below confirm a significant downturn in <30yo and particularly <18yo cycling from 1995 to 2009, with 5-15yo and 16-17yo bicycle trips falling 20.1% and 40.8% respectively.
Census Bureau data show a 29.1% reduction in 7-17yo cycling from 1986 to 2009 (18,621,415 / 13,196,000) and a 42.5% reduction from 1995 to 2009 (22,948,000 / 13,196,000).
Most of the reduction has occurred in the <18yo age group although it is apparent that, as these people age, cycling participation declines in older demographics as the years roll by, with much of America's cycling participation maintained by baby boomers who grew up without helmet laws and continue to ride bikes :
Click here to view all US Census Bureau estimates of bike riding each year from 1986 to 2009
America's 7-17yo population increased 9.0% from 1995 to 2009 (41,221,000 > 44,924,000).
Demographics changes from 1986 to 2009
7-11yo : 21.2% decrease
12-17yo : 36.0% decrease
18-24yo : 54.1% decrease
25-34yo : 48.7% decrease
35-54yo : 21.3% increase
55yo+ : 11.0% increase
Demographics changes from 1995 to 2009
7-11yo : 46.9% decrease
12-17yo : 37.0% decrease
18-24yo : 38.9% decrease
25-34yo : 44.9% decrease
35-44yo : 18.9% decrease
45-54yo : 8.5% increase
55-64yo : 5.3% increase
65yo+ : 35.0% decrease
If Census Bureau data is compared with Outdoor Industry Association survey results (see above), demographic changes to 2021 are :
1986 7yo+ : 49,723,329 / 2021 6yo+ : 42,775,000 / 14.0% decrease
1986 7-17yo : 18,621,415 / 2021 6-17yo : 12,166,000 / 34.7% decrease
1986 18yo+ : 31,101,914 / 2021 18yo+ : 30,609,000 / 1.6% decrease
1995 7yo+ : 56,308,000 / 2021 6yo+ : 42,775,000 / 24.0% decrease
1995 7-17yo : 22,948,000 / 2021 6-17yo : 12,166,000 / 47.0% decrease
1995 18yo+ : 33,360,000 / 2021 18yo+ : 30,609,000 / 8.2% decrease
America's total population increased 29.9% from 1986 to 2009 (237,512,782 > 308,512,035) and 16.1% from 1995 to 2009 (265,660,555 > 308,512,035).
The Census Bureau data also show how female cycling participation has declined at a greater rate than male participation since 1986, most likely because helmets mess the hair of women :
Further, the Census Bureau data show how cycling has become the domain of the rich since the 1980s :
Inflation and wage increases may have changed the number of US households earning less than $15,000, so below compares households earning less than $25,000 :
A 50/50 split of households earning less or more than $50,000 confirms that cycling in America has become the domain of the rich :
These results validate findings by Pucher et al 27 of a 33% decline in youth participation per population 2001-2009:
Physical activity from walking and cycling for daily travel in the United States, 2001–2017: Demographic, socioeconomic, and geographic variation by Buehler, Pucher and Bauman confirms this website's estimate that youth cycling in the US declined by more than 50% from 2001 to 2017. The paper notes:
One notable change was the significant decline in walking and cycling rates of children aged 5–15. The decline in cycling by children indicated by the 2001 and 2017 NHTS is corroborated by the 48% decline in recreational cycling from 1997 to 2017 in the age group 7–17 reported by the National Sporting Goods Association (2018). The falling rates of walking and cycling by children are a continuation of a trend over previous decades, as documented by the earlier 1973–1995 NPTS surveys, which the NHTS superseded in 2001 (McDonald, 2007; Kontou et al., 2019). The long-term decline in children’s walking and cycling from 1973 to 2017 has reduced an important source of children’s regular physical activity and might be a contributor to rising child obesity rates in the United States (Ogden et al., 2016).
The modified demographic table below is based on the 2020 paper and confirms a huge decline in 5-15yo cycling:
Based on total US population in 2001 and 2017, the figures above for the 5yo to 15yo demographic translate as:
2001 : 4.5% of 285,000,000 = 12,825,000
2017 : 1.9% of 325,100,000 = 6,176,900
2001 : 3.2% of 285,000,000 = 9,120,000
2017 : 1.3% of 325,100,000 = 4,226,300
2001 : 2.4% of 285,000,000 = 6,840,000
2017 : 0.9% of 325,100,000 = 2,925,900
Averaged, these figures equate to a 53.7% reduction in US 5-15yo cycling participation from 2001 to 2017.
Alternatively, 5-15yo cycling participation can be compared with 5-15yo walking participation data contained within the paper:
2001 : 10 minutes 4.5% + 20 minutes 3.2% + 30 minutes 2.4% = 10.1%
2017 : 10 minutes 1.9% + 20 minutes 1.3% + 30 minutes 0.9% = 4.1%
2001 : 10 minutes 17.5% + 20 minutes 11.5% + 30 minutes 7.7% = 36.7%
2017 : 10 minutes 12.8% + 20 minutes 8.5% + 30 minutes 5.9% = 27.2%
The relative reduction in 5-15yo walking was 25.9% from 2001 to 2017 and for cycling it was 59.4%, more than double the proportionate decline in walking and suggesting a greater disincentive because of bike helmet promotion and mandatory helmet laws for youth.
Cycling injury data
The tables below compare US cycling participation with different injury types among 6-17yo cyclists, 6yo+ cyclists and 18yo+ cyclists from 2002 to 2021, with data sourced from the US Product Safety Commission's National Electronic Injury Surveillance System (NEISS) 5, the Outdoor Industry Association and the US Census Bureau.
6-17yo participation and total injuries, 2002-2021
18yo+ participation and total injuries, 2002-2021
6yo+ participation and total injuries, 2002-2021
The tables below compare US cycling participation with different hospitalised injury types among 6-17yo cyclists, 6yo+ cyclists and 18yo+ cyclists from 2002 to 2021, with data sourced from the US Product Safety Commission's National Electronic Injury Surveillance System (NEISS) 5, the Outdoor Industry Association and the US Census Bureau.
6-17yo participation and hospitalised injuries, 2002-2021
18yo+ participation and hospitalised injuries, 2002-2021
6yo+ participation and hospitalised injuries, 2002-2021
The tables below compare US cycling participation with different injury types among 6-17yo cyclists, 6yo+ cyclists and 18yo+ cyclists from 1998 to 2021, with data sourced from the US Product Safety Commission's National Electronic Injury Surveillance System (NEISS) 5, the Outdoor Industry Association and the US Census Bureau.
6-17yo participation and injuries, 1998-2021
18yo+ participation and injuries, 1998-2021
6yo+ participation and injuries, 1998-2021
The table below shows that US all-age cyclist head injuries as a proportion of total injuries increased by 0.7% from 2002-2011 to 2012-2021.
Cycling fatality data
Census Bureau data 15 show 18,089,000 cyclists aged 7-17yo in 1999 and 13,196,000 in 2009. CDC data 6 show 172 fatalities for 7-17yo cyclists in 2001 and 69 in 2009. Participation fell 27% and fatalities fell 59.9%.
NSGA data show 7-17yo participation at 10,800,000 in 2012, down 40.3% from the Census Bureau’s 1999 estimate. Fatality records for 2012 are unavailable but CDC data show 67 fatalities for 7-17yo in 2010, down 61% from 2001.
Census Bureau data show 24,316,000 cyclists aged 18yo+ in 1999 and 24,942,000 in 2009. CDC data show 425 fatalities for 18yo+ cyclists in 1999 and 451 in 2009. Participation increased 2.6% and fatalities increased 6.1%.
NSGA data show 18yo+ participation at 24,640,000 in 2012, up 1.3% on 1999 participation data from the Census Bureau. Fatality data for 2012 are not available but CDC data show 478 for 18yo+ in 2010, up 12.5% from 1999.
NHTSA Traffic Safety Facts 21 shows that pedal cyclist fatalities worsened as a proportion of all traffic deaths in the US from 2002 to 2011:
Out of 51 jurisdiction in the NHTSA dataset for 2011, 23 or 45.1% had some form of helmet law for child cyclists, some up to 17yo.
NHTSA Traffic Safety Facts 2011 allows comparison of cyclist and other road user death and injury rates from 2002 to 2011:
Police reported injuries are always less than hospitalised injuries but the NHTSA data suggest US cyclist death and injury trends are worse than for most other road users with the exception of motorcyclists.
Cycling fatality data in different states
The table below compares US cyclist fatalities for 2018 in different states:
Multiple data sources have been used to compare child, teenage and adult cyclist participation, injuries and fatalities from 1995 to 2021, during which time various American states introduced child helmet laws for different age groups less than 18 and concluding with 22 states and districts enacting such legislation.
Various surveys suggest that about 63% of children and 46% of adults in the US regularly wore bike helmets in 2019.
Census Bureau data show 7-17yo cycling across the US was 22,948,000 in 1995 and reliable OIA survey data show 6-17yo cyclist numbers had dropped to 12,166,000 in 2021. This is a 47.0% reduction or 10,782,000 fewer child and teenage cyclists, impacting regular recreational exercise among American youth with future public health implications.
Participation surveys by the Outdoor Industry Association show 6-17yo cyclist numbers fell 30.1% from 2006 to 2021.
In response to such significant falls in child and teenage cycling participation, and with more than 60% of 5-15yo cyclists wearing helmets that are claimed to reduce head injury risk by up to 85% 23, a corresponding reduction in accidents and injured cyclists should be expected at hospital emergency departments.
Analysis of all 1,740 bicyclists aged 0-16 years in FARS 9 who died or suffered an incapacitating injury from a motor vehicle collision between January 1999 and December 2011 allows a per million population comparison between states with child helmet laws and those without:
There is no significant difference in child cyclist fatality rates per million population in states that enforce mandatory child helmet legislation. Various US local municipalities have enforced helmet laws for different ages, primarily children, regardless of state legislation and it is likely that voluntary helmet wearing also increased in states without helmet laws through parental or school coercion.
US Government data suggest that among 5-15yo cyclists the average annual total injury count fell by 38.1% from 1998-2008 to 2009-2019, while the all head injury average fell by 41.3% and the head only injury average fell by 28.2%, despite the significant increase in child and teenage mandatory/voluntary helmet wearing since 1995. These reductions were mostly due to a substantial decline in recreational cycling exercise and participation among American youth.
Although most adults in the US are not subject to mandatory bicycle helmet laws, there has been a substantial increase in voluntary wearing.
NEISS injury data show that although there was an 18.3% increase in 18yo+ cycling participation from 1998-2009 to 2010-2021, head only injuries increased 92.9%, concussion injuries increased 76.6%, upper body injuries increased 41.5% and lower body injuries increased 43.6%.
6yo+ cycling participation actually declined 0.8% from 1998-2009 to 2010-2021, yet head only injuries increased 24.0%, concussion injuries increased 16.3%, and upper body injuries increased 1.6%.
6yo+ lower body injuries (lower leg, upper leg, foot, toes) decreased 7.8% from 1998-2009 to 2010-2021, suggesting America's huge increase in mandatory and voluntary bike helmet wearing has resulted in more protection for cyclists' feet than for their heads.
Click here for a pop-up window with Figures 17-44 showing total US cyclist participation and head, concussion, face, upper arm, lower arm, neck, upper trunk, hand, elbow, shoulder, lower leg, upper leg, toe and foot injury trends among child and adult cyclists from 1995 to 2012.
This study is limited in scope by different age group parameters defined in the source datasets published by public and private agencies, at times requiring comparison between slightly different age groups (e.g. 6-17yo, 7-17yo and 5-15yo).
No attempt has been made to adjust state data according to different variables such as speed limits, drink driving laws and driver age limitations in the 51 state jurisdictions. These confounding factors are numerous and all have a debatable influence on child cyclist injury and fatality rates.
Raw participation and fatality data are compared between 29 states without helmet laws and 22 states/districts with helmet laws, each with unique and countervailing variables such as population, demographics, wealth, infrastructure and geography that create an unbiased average.
US Census Bureau data on cycling participation since 1995 is only available to 2009. This study uses survey findings from the Outdoor Industry Association for 2006 to 2021, and from the National Sporting Goods Association for 2012.
Census Bureau/NSGA data from 1995 to 2009 and NSGA data for 2012 are for cyclist ages 7-17 but the OIA data from 2006 to 2021 are for cyclist ages 6-17.
A comparison of participation surveys from the three sources in overlapping years from 2003 to 2009 shows similar annual numbers with lower NSGA figures that more accurately reflect the 7-17yo age criteria.
Albeit using different survey methods, NSGA and OIA all-age cycling participation results are similar (2006 - 38,457,000 / 35,600,000; 2007 - 38,940,000 / 37,400,000 / 2008 - 38,114,000 / 38,700,000; 2009 - 40,140,000 / 38,100,000 / 2010 - 39,320,000 / 39,800,000; 2011 - 40,348,000 / 39,300,000; 2012 - 39,232,000 / 39,300,000).
The NSGA annual numbers are generally lower than OIA surveys because they estimate 7-17yo rather than 6-17yo participation. This is also true of Census Bureau data prior to 2006.
Some timescale calculations include data for states that were voluntary at first but have since enacted child helmet laws, with no adjustment for their early absence of law so as to maintain a consistent baseline. Due to different and at times large state populations, adjustments distort trends and normally exaggerate fatality and injury rates in states that now have child helmet laws.
Census Bureau participation data for 2008 is significantly above trend. Assuming the bureau is consistent and accurate in its survey methodology, the 2008 spike may be related to cycling interest generated by the Beijing Olympics, consecutive Tour de France victories by Lance Armstrong, above average summer temperatures across the US 24 and/or record high gasoline prices above US$4 per gallon 29.
All public and private data sources confirm that child and teenage cycling participation in the United States has fallen by at least a third since the 1990s with latest surveys suggesting the decline continued to 2020 but with a substantial increase in 2021 most likely due to the COVID-19 pandemic - although numbers remain below 2013 and all preceding years.
A reduction of approximately 11,000,000 cyclists aged <17yo from 1995 to 2021, ignoring population growth over that period, signals a substantial decline in recreational exercise among American youth.
Concussion and head injury data show the significant increase in child and teenage mandatory/voluntary helmet wearing since 1995 has had little impact on these injury types per cyclist when the participation decline is factored in.
Although youth cycling participation rates in each state are unknown, childhood disdain for helmet wearing is a likely cause of the decline in cycling participation, coupled with increased parental safety fears.
Child cycling participation rates in all American states warrant further study to determine if the reduction is related to helmet laws. A breakdown of child cyclist fatalities per million population in states with and without laws shows little difference, which conflicts with expectations that rates should be lower in jurisdictions where more children wear helmets.
It should be noted that according to An Overview of the Bicycle Study 31, there were an estimated 66.9 million Americans of all ages cycling (at least once per year) in 1991, with about 531,000 hospital emergency department injuries (excluding bike passengers). This represents 0.79% of all cyclists in 1991 being injured (531,000/66,900,000). According to annual surveys by the Outdoor Foundation 32, in 2018 there were an estimated 47,877,000 cyclists aged 6+ who had cycled at least once in the previous year, with 401,901 emergency department injuries (0.84% of cyclists injured).
If the 1991 participation/injury percentage (0.79%) is applied instead of 0.84%, there should have been 378,228 cyclist injuries in 2018 instead of 401,901. Such data consistently suggests an increase in the ratio of overall injuries to cyclists participating over the 27 years, despite child helmet laws in half the American states, similar parental or school enforcement in other states, and about half the adult population voluntarily wearing helmets.
Consistent data from public and private agencies suggest reduced recreational cycling among children and teenagers with current and potential future health implications for the US, which has the highest obesity and overweight ratio in the world. Increased per cyclist injury rates and similar state fatality rates point to a failure in public policy for cycling safety in the United States.
1) Bicycle Helmet Laws Are Associated with a Lower Fatality Rate from Bicycle–Motor Vehicle Collisions - William P. Meehan, Lois K. Lee, Christopher M. Fischer, Rebekah C. Mannix
2) Bicycle helmet use among children in the United States: the effects of legislation, personal and household factors, Dellinger, Kresnow
3) Injury Prevention
4) US Census Bureau
5) US Consumer Product Safety Commission National Electronic Injury Surveillance System
6) Centers for Disease Control and Prevention web-based Injury Statistics Query and Reporting System (WISQARS) 13/7/4
7) The Outdoor Industry Association
8) National Sporting Goods Administration
9) National Highway Traffic Safety Administration’s Fatality Analysis Reporting System
10) U.S. Department of Transportation, Federal Highway Administration, National Household Travel Survey
11) Alliance Bicycling and Walking Benchmarking Project
12) US single year cyclist injuries and population 2001-2011 (Excel)
13) Bicycle Retailer and Industry News: Light at the end of the tunnel? Maybe.
14) Bicycle Retailer and Industry News: More women, fewer kids riding bikes
15) US Census Bureau bike riding participation data
16) Centers for Disease Control and Prevention tabulated age and injury data (Excel)
17) The Centers for Disease Control and Prevention Surveillance for Traumatic Brain Injury Related Death - United States, 1997-2007
18) Traumatic Brain Injury
19) US Consumer Product Safety Commission National Electronic Injury Surveillance System concussion data
20) US Department of Transportation National Highway Traffic Safety Administration
21) US Department of Transportation National Highway Traffic Safety Administration Traffic Safety Facts 2011
22) FARS and US Census data tables (Excel)
23) A case-control study of the effectiveness of bicycle safety helmets, Thompson, Rivara
24) National Oceanic and Atmospheric Administration
25) The Risk Compensation Theory and Bicycle Helmets; J Adams, M Hillman
26) Safety in numbers? A new dimension to the bicycle helmet controversy
27) Walking and Cycling in the United States, 2001-2009: Evidence from the National Household Travel Surveys, Pucher et al
28) NHTSA FARS cyclist fatalities 0-16yo and all-ages in different states (Excel)
29) US Energy Information Administration: Gasoline and Diesel Fuel Update
30) Safety in numbers: more walkers and bicyclists, safer walking and cycling; PL Jacobsen
31) An Overview of the Bicycle Study; Gregory B Rodgers
32) An Overview of the Bicycle Study; Gregory B Rodgers
33) Overcoming obstacles to bicycle riding
Appendix charts and tables
Note: In January 2015, Health Economics published Effects of Bicycle Helmet Laws on Children's Injuries (PDF download 217K) by Sara Markowitz and Pinka Chatterji who found similar evidence to this paper that the laws discourage cycling with unintended injury consequences.
Note: In August 2015, the Centers for Disease Control and Prevention published Bicyclist Deaths Associated with Motor Vehicle Traffic — United States, 1975–2012 by Vargo et al who again found similar evidence to this paper.
Note: In September 2015, the Journal of the American Medical Association published Bicycle Trauma Injuries and Hospital Admissions in the United States, 1998-2013 by Sanford et al who again found similar evidence to this paper, with injuries among cyclists aged 18+ increasing 28%, hospital admissions increasing 120% and head injuries increasing 60%.
Note: In December 2016, Research and Practice published Trends in Walking and Cycling Safety: Recent Evidence From High-Income Countries, With a Focus on the United States and Germany by Buehler and Pucher, its cyclist injury conclusions similar to the study on this page.
The rate of serious cyclist injuries per 100 million kilometres in the United States fell from 230.5 in 2001-02 to 207.1 in 2008-09. However, the rate of severe cyclist injuries was 4.7 times higher in the US than in Germany.
The severe injury rate for cyclists in 2008–2009 in the US was much higher for children (415.7) than the national average (207.1), despite most children wearing helmets due to state laws, local regulations or school and parent demand. The severe injury rate for children rose significantly between 2001-02 and 2008-09, from 392.9 to 415.7.
Between 2001-02 and 2008-09, the severe injury rate per 100 million kilometres for 15-24yo fell from 305.2 to 176.0, increased for 25-64yo from 141.5 to 156.5, and fell for 65yo+ from 351.3 to 337.3.
Note: In 2019, Sanford et al published Trends in bicycle-related injuries, hospital admissions, and deaths in the USA 1997–2013, finding that the crude incidence of injury per cycling participant increased from 701 per 100,000 in 1997 to 1,164 per 100,000 in 2013, with hospital admissions increasing from 41 per 100,000 in 1997 to 109 per 100,000 in 2013.
Note: Published in 2019, Trends in school-age pedestrian and pedalcyclist crashes in the USA: 26 states, 2000–2014 analysed police-reported motor vehicle crash data for pedestrians and cyclists in 26 US states for the 5-19yo demographic from 2000 to 2014, finding they represented 29.0% of all age pedestrians and 44.3% of all age cyclists involved in such crashes.
These school aged children and teenagers represented 44.5% of all age cyclist injuries and 30.0% of all age pedestrian injuries; 25.4% of all age cyclist deaths and 11.3% of all age pedestrian deaths; and with 5-19yo cyclists having an average crash rate of 35.4 per 100,000 population compared to 5-19yo pedestrians with an average crash rate of 42.9 per 100,000 population.
The average cyclist crash rate per 100,000 population from 2000 to 2014 was 37.50 in the 10 states with helmet laws and 34.07 in the 16 states without helmet laws.
The authors found an overall 40% decline in 5-19yo pedestrian crashes and 53% decline in 5-19yo bicyclist crashes between 2000 and 2014. It is worth noting published research findings that from 2001 to 2017 in the US, the relative reduction in 5-15yo walking duration was 25.9% from 2001 to 2017 and for cycling duration it was 59.4%.
Note: A 2020 study based in California and titled Helmet Usage Reduces Serious Head Injury Without Decreasing Concussion After Bicycle Riders Crash.