Nonuse of bicycle helmets and risk of fatal head injury: a proportional mortality, case-control study.
BACKGROUND
The effectiveness of helmets at preventing cycling fatalities, a leading cause of death among young adults worldwide, is controversial, and safety regulations for cycling vary by jurisdiction. We sought to determine whether nonuse of helmets is associated with an increased risk of fatal head injury.


METHODS
We used a case-control design involving 129 fatalities using data from a coroner's review of cycling deaths in Ontario, Canada, between 2006 and 2010. We defined cases as cyclists who died as a result of head injuries; we defined controls as cyclists who died as a result of other injuries. The exposure variable was nonuse of a bicycle helmet.


RESULTS
Not wearing a helmet while cycling was associated with an increased risk of dying as a result of sustaining a head injury (adjusted odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3-7.3). We saw the same relationship when we excluded people younger than 18 years from the analysis (adjusted OR 3.5, 95% CI 1.4-8.5) and when we used a more stringent case definition (i.e., only a head injury with no other substantial injuries; adjusted OR 3.6, 95% CI 1.2-10.2).


CONCLUSIONS
Not wearing a helmet while cycling is associated with an increased risk of sustaining a fatal head injury. Policy changes and educational programs that increase the use of helmets while cycling may prevent deaths.
Office of the Chief Coroner for Ontario, Toronto, Ont. nav.persaud@utoronto.ca
Navindra
N
Persaud
Emily
E
Coleman
Dorothy
D
Zwolakowski
Bert
B
Lauwers
Dan
D
Cass
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001642:Bicycling / Q000293:injuries*; D002648:Child; D006259:Craniocerebral Trauma / Q000209:etiology / Q000401:mortality* / Q000517:prevention & control; D005260:Female; D006260:Head Protective Devices / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D018570:Risk Assessment; D055815:Young Adult