Published online September 1, 2008
PEDIATRICS Vol. 122 No. 3 September 2008, pp. 605-610 (doi:10.1542/peds.2007-1776)
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ARTICLE

Trends in Pediatric and Adult Bicycling Deaths Before and After Passage of a Bicycle Helmet Law

David E. Wesson, MD, FRCSCa, Derek Stephens, MScb, Kelvin Lam, MScc, Daria Parsons, MScd, Laura Spence, BScNe and Patricia C. Parkin, MD, FRCPCb,f,g

a Baylor Division of Pediatric Surgery, Texas Children's Hospital, Houston, Texas
b Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, Ontario, Canada
c Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
d Daria Parsons Consulting, Toronto, Ontario, Canada
e Okanagan Health Surgical Centre, Kelowna, Canada
f Division of Pediatric Medicine
g Pediatric Outcomes Research Team, Hospital for Sick Children and University of Toronto Faculty of Medicine, Toronto, Ontario, Canada

OBJECTIVES. The goals were to examine bicycle-related mortality rates in Ontario, Canada, from 1991 to 2002 among bicyclists 1 to 15 years of age and 16 years of age through adulthood and to determine the effect of legislation (introduced in October 1995 for bicyclists <18 years of age) on mortality rates.

METHODS. The average numbers of deaths per year and mortality rates per 100000 person-years for the prelegislation and postlegislation periods, and the percentage changes, were calculated for each of the 2 age groups (1–15 years and ≥16 years). Differences before and after legislation in the 2 age groups were modeled in a time series analysis.

RESULTS. There were 362 bicycle-related deaths in the 12-year period (1–15 years: 107 deaths; ≥16 years: 255 deaths). For bicyclists 1 to 15 years of age, the average number of deaths per year decreased 52%, the mortality rate per 100000 person-years decreased 55%, and the time series analysis demonstrated a significant reduction in deaths after legislation. The estimated change in the number of deaths per month was –0.59 deaths per month. For bicyclists ≥16 years of age, there were only slight changes in the average number of deaths per year and the mortality rate per 100000 person-years, and the time series analysis demonstrated no significant change in deaths after legislation.

CONCLUSIONS. The bicycle-related mortality rate in children 1 to 15 years of age has decreased significantly, which may be attributable in part to helmet legislation. A similar reduction for bicyclists 16 years of age through adulthood was not identified. These findings support promotion of helmet use, enforcement of the existing law, and extension of the law to adult bicyclists.

Key Words: bicycle helmet • death • legislation

Abbreviations: CI—confidence interval

Accepted Dec 12, 2007.


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