Study Finds Alarming Increase In US Bicycle Accidents

–But doesn’t consider the public health benefits of cycling

The problem: bicycle accidents in adults in the U.S. now cost more than $24 billion a year.

The solution: more, not fewer, bikes!

A new paper published in the journal Injury Prevention finds that the number and costs of bicycle accidents in the U.S. have risen dramatically in recent decades. The change is almost certainly due to both an overall increase in cycling and, more particularly, the number of older bicycle riders, who are more likely to suffer fatal or serious injuries.

But two international experts point out that the paper fails to take into account the enormous health benefits from cycling. In the end, they say, the public health benefits of cycling almost certainly outweigh the costs of cycling injuries. Further, the investment in cycling infrastructure, despite the high cost, is almost certainly cost effective because better infrastructure can dramatically reduce accidents and encourage more people to ride, thereby extending the health benefits of cycling to a far larger population.

In the new paper, Tom Gaither, MD, of the University of California San Francisco, and colleagues pulled together data from 1997 through 2013 from various sources. During the study period there were 3.8 million non-fatal accidents in adults and 9,839 deaths. The $24 billion yearly cost, which rose 140% from $9.3 billion in 1997, is now almost twice the cost of workplace injuries in the U.S., according to the authors.

Riders ages 45 and over accounted for 26% of all costs in 1997. This more than doubled to 54% in 2013. Older riders, write the authors, are riding more often, are more likely to have underlying conditions, and probably have longer recovery periods.

The total number of deaths increased from 588 in 1999 to 855 in 2013. But this was a product of a decrease in deaths among younger riders ages 18-44, from 333 to 273, and a big increase in deaths among older riders ages 45 and above, from 255 to 582. The authors cite another study showing that rider miles in the older group increased from 1,905 million in 2001 to 3,645 million in 2009.

The authors reported that street crashes, often involving a motor vehicle, account for an increasing proportion of accidents. Street accidents can be significantly reduced with better bicycle paths and other infrastructure, though this can be expensive. However, the authors estimate that the creation of a bikeway network covering one-sixth of the country would cost $300 billion, “which roughly equals the total costs of non-fatal and fatal bicycle injuries in the 10-year study period ($293 billion).”

The Injury Prevention paper focuses almost exclusively on the costs and dangers associated with cycling.

But because it fails to look at the other side of the coin — the health and associated economic benefits of cycling — the paper represents “a setback for the implementation of bicycling as a preventive measure,” said Mathias Ried-Larsen, PhD, an epidemiologist from Copenhagen.

He said that a balanced perspective requires a “proper cost-effectiveness and cost-utility analysis” that takes into account the benefits of increased physical activity, which “may level out the societal costs from the increased risk of injuries.” Without this countervailing perspective there is no “actual basis for discussing the relevance of bicycling in prevention.” But the new paper, “as it appears now, would prevent people” from starting to cycle.

An important point is that increased participation in cycling and the presence of extensive cycling infrastructure leads to a reduced risk of injury. Lars Bo Andersen, PhD, of Western Copenhagen University of Applied Sciences, has studied data from Copenhagen, where cycling increased more than 30% from the late 1990s until 2015, but the number of injuries actually decreased. “The most plausible explanation is improved infrastructure,” said Andersen.

Andersen pointed out that the new paper shows that 10,000 people were killed during 14 years in the U.S. In Denmark, however, with only 5.5 million people, “more than 6,000 deaths are avoided every year, because of people cycling.” Andersen said that the reductions in diabetes and cardiovascular disease means that cycling is cost effective. “The problem is that each injured cyclist is very visible, but that prevented disease and mortality is not seen even if it is real.”