Physical activity, including bicycling, is linked with multiple health benefits. However, although bicycles account for only about 1% of trips across all modes of transportation, on a per trip basis, bicyclists die on U.S. roads at a rate double that of vehicle occupants. In 2009, an estimated 392 billion trips (across all modes) were taken in the United States, including 4.1 billion bicycle trips, and 33,808 deaths occurred on U.S roadways (across all modes), including 630 bicyclist deaths. This report examines mortality trends among cyclists using national collision data from the Fatality Analysis Reporting System (FARS) for the period 1975—2012. Annual rates for cyclist mortality decreased 44%, from 0.41 to 0.23 deaths per 100,000 during this period, with the steepest decline among children aged <15 years. In recent years, reductions in cyclist deaths have slowed. However, age-specific cyclist mortality rates for adults aged 35—74 years have increased since 1975. Multifaceted approaches to bicyclist safety have been shown to be effective in increasing bicycling while decreasing traffic injuries and fatalities. With U.S. adults choosing to walk and cycle more, implementation of these approaches might help counter recent increases in adult cyclist deaths. The U.S. Department of Transportation's National Highway Traffic Safety Administration (NHTSA) maintains the FARS database. FARS catalogues an annual census of fatal traffic crashes from the years 1975—2012 collected through agreements between NHTSA and agencies in each state. To be included in FARS, an incident 1) must involve a motor vehicle traveling on a roadway open to the public, and 2) must have resulted in the death of a motorist or a non-motorist within 30 days of the crash. This analysis uses FARS variables that were consistent during the period 1975—2012. Cyclist fatalities were identified using the "person type" descriptors "non-motorist: pedalcyclist," "non-occupant bicyclist," and "bicyclist" in the FARS "person" tables. Consistent data from the entire study period were available from 48 states (data were not available from Alaska and Hawaii) and the District of Columbia. The age and sex of the injured person as well as the state and county of the crash were collected from FARS. Annual county population, stratified by age and sex, was obtained from the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER) program.* Age-adjusted mortality rates were calculated for each year using CDC's published weights for the 2000 U.S. standardized population. Data were downloaded, processed, and analysed using generalized linear models with statistical software. Over the 38-year study period, FARS captured 29,711 cyclist deaths. Annual cyclist fatalities declined from a high of 955 in 1975 to 717 in 2012. The annual age-adjusted mortality rate declined 44%, from a high of 0.41 per 100,000 in 1975 to 0.23 per 100,000 in 2012. The proportion of cyclist deaths among all annual motor vehicle—related fatalities was highest in 1975 at 2.3%, dipped to a low of 1.4% in 2003, and increased to 2.2% by 2012 (Figure 1). Trends in age-specific cyclist mortality rates varied in magnitude and direction. In bivariate linear models, mortality rates for age groups <35 years and ?75 years decreased significantly over the study period, with the largest decrease among children aged <15 years. Historically, mortality rates for children aged <15 years were substantially higher than rates for other age groups. In 1975, the mortality rate for children aged <15 years was 1.18 per 100,000, more than four times higher than the rate (0.25 per 100,000) for persons aged ?15 years. This pattern shifted over the 38-year study period, and by 2012, the rate among children aged <15 years (0.09 per 100,000) was one third that of all other age groups (0.27 per 100,000). During 1975—2012, the cyclist mortality rate among children aged <15 years declined 92%. The overall decrease in age-adjusted mortality rates can be attributed to declines among children aged <15 years because no linear decline was observed when children were excluded from models. Mortality rates for adults aged 35—74 years increased significantly during the study period. The largest increase was among adults aged 35—54 years, with the mortality rate increasing nearly threefold, from 0.11 to 0.31 per 100,000. The overall mortality rate for males was six times greater than the overall mortality rate for females. In 2012, males accounted for 87% of total bicycle deaths in the United States. This proportion increased over the 38-year study period, from 79% in 1977 to a peak of 90% in 2001. All 48 states and the District of Columbia experienced a decrease in age-adjusted cyclist mortality rates when comparing averages during the first 5 years with those during the last 5 years of the study period. Cyclist mortality rates varied more than 10-fold across jurisdictions, from a low of 0.04 per 100,000 (Vermont) to a high of 0.57 per 100,000 (Florida). Maine had the greatest decrease in cyclist mortality (78.7%) and declined from 0.47 per 100,000 to 0.10 per 100,000. Florida saw one of the smallest decreases (9.7%) in its age-adjusted cyclist mortality rate, from 0.63 to 0.57 per 100,000. (Author/publisher)
Samenvatting