Canadian research claims cyclists with helmets three times less likely to die from head injury

Researchers analysed coroner's records for fatalities of cyclists in Ontario

by Simon_MacMichael   October 16, 2012  

White cycle helmet

New research published in the Canadian Medical Association Journal claims that cyclists wearing a helmet are three times less likely to die from head injuries than those who are not.

The researchers say that their study supports calls for the introduction of compulsory helmet laws across Canada for all age groups.

However, concerns have been raised locally regarding the validity of the methodology employed, based on an adjusted odds ratio, which does not take account of relative risk, and which it is said may significantly exaggerate the effect of the claimed findings.

The team studied Ontario Chief Coroner’s records relating to 129 people who died in bicycle-related incidents in the province from 2006 to 2010, three in four of whom had been involved in a collision with a motor vehicle.

The other fatalities resulted from an incident involving another cyclist, a pedestrian or other object and, in 10 per cent of cases, a fall. Males accounted for 86 per cent of the victims, with ages ranging from 10 to 83.

“Helmets save lives,” insists Dr. Nav Persaud of St. Michael’s Hospital in Toronto, who led the research.

“There are about 70 cycling deaths in Canada every year, and based on our study, we estimate we could prevent about 20 of them with helmets.

“We found that 88 per cent of people who died were 18 years of age or older, which is important because the helmet legislation in Ontario currently only applies to those younger than 18 years,” he added.

While Alberta also requires only under-18s to wear a helmet, in the provinces of British Columbia, New Brunswick, Nova Scotia and Prince Edward Island, all cyclists must wear one, irrespective of age.

He acknowledged, however, that making road conditions safer for cyclists in the first place would also lead help reduce casualties.

“Helmets only prevent injuries after a collision takes place,” he explained. “It would be better to prevent the collision from taking place at all. And infrastructure changes like building separated cycle lanes prevent collisions from taking place.

“That being said, even if we had a perfect cycle infrastructure, cyclists would still interact with cars at intersections, for example, so helmets would still be important.”

Opponents of compulsory helmet legislation, including organisations in the UK such as Sustrans and the CTC, believe it should be left to the individual to choose, pointing out that in places where they have been made mandatory, the number of cyclists has reduced, and that the general health benefits of regular cycling mean it is preferable to encourage more people to ride bikes rather than enacting laws that may deter them.

The CTC also cites several research papers published that found no link between the proportion of cyclists wearing helmets and any the safety of cyclists.

In a description of the background to the research in the Canadian article’s abstract, it was claimed: “Cycling fatalities [are] a leading cause of death among young adults worldwide.”

According to a report published earlier this year in partnership with The Lancet, Unicef said that “in middle- and high-income countries, cars are the biggest killers” among young people aged 10-19.

In Great Britain, an average of 10 children under 16 years have been killed while cycling during each of the past five years.

There’s no way of knowing how many of those fatalities involved head injuries, nor how many of the children were wearing a helmet and if they weren't, whether one may have possibly helped prevent the fatality.

During the same period, four times as many child pedestrians – 42 in an average year – were killed in Britain in road traffic collisions, according to Department for Transport figures.

While Unicef cites injury as the leading cause of death for adolescents worldwide, it’s a broad category that includes “road traffic injuries; injuries such as falls, burns, poisoning and drowning; and injuries from violence, including armed violence.”
 

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“That being said, even if we had a perfect cycle infrastructure, cyclists would still interact with cars at intersections, for example, so helmets would still be important.” Dr. Nav Persaud, one of the authors of this report.

This quote demonstrates quite clearly that the researchers know absolutely nothing about cycle helmets, road safety or anything really. Cycle helmets are pretty ineffective even in single vehicle accidents, where the cyclist just falls off, but they are utterly, utterly useless in collisions with motor vehicles, and the manufacturers always warn that they are not effective in those circumstances. Anyone who says that they are useful in collisions with motor vehicles is clearly misinformed to the point of ignorance, and demonstrates a very considerable degree of bias. Given that this is exactly what the good doctor did, I wouldn't trust his research farther than I could see in a pitch black cellar.

As others have pointed out, the methods used to produce this result are suspect, and any conclusions drawn are not robust. All long term, large scale, reliable research shows at best no benefit from helmet wearing, and at worst an increase in risk. Check out cyclehelmets.org for research a little more reliable than this hashed up nonsense. Who trained these researchers? Thompson, Rivara and Thompson?

burtthebike

posted by burtthebike [80 posts]
17th October 2012 - 21:01

2 Likes

jasterixstrange wrote:
if you don't wear a helmet you are a moron ... fact

Were you wearing a helmet when you wrote that? Thinking

burtthebike

posted by burtthebike [80 posts]
17th October 2012 - 21:08

0 Likes

Thinking

burtthebike

posted by burtthebike [80 posts]
17th October 2012 - 21:08

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burtthebike - you are asking for trouble mate when you make a sweeping statement like "they are utterly utterly useless in collisions with motor vehicles".

There will be numerous people on the site who can recount instances when it has helped them in a collision. I for one attended an RTC when the helmet did prevent quite a nasty injury to a colleague but thats irrelevant at the mo. Wink

There are no stupid questions, just stupid people.

stumps's picture

posted by stumps [2845 posts]
17th October 2012 - 21:14

2 Likes

Izaak30 wrote:
One of our club members was squeezed/hit by a car in the last fortnight. Apart from being "officially" critically injured including badly broken ribs and punctured lungs, his helmet saved his life. When paramedics undid the straps it split into 2. He and his wife are most grateful he had it on. The other injuries will heal eventually. If it wasn't for helmet then they probably wouldn't have mattered....

And:

"I crashed on the Ballbuster Duathlon in March hitting my head on the road so hard my helmet cracked and was caved in when I examined it at the end of the race. I'd never ride without a helmet ever again."

This is not proof that helmets are effective, it is opinion, unverified and unverifiable. It is anecdote and is as scientifically valid as claiming that smoking doesn't harm anyone because your grandad lived to 98 and he smoked twenty fags a day. All reliable evidence shows that cycle helmets are not effective at improving the safety of cyclists, and that smoking kills people. There are thousands of "helmet saved my life" stories and if even ten percent of them were true, there would be a marked effect at a population level, but there is no such effect. So either the stories are not correct, or just as many people are killed by their helmets as are saved by them, but the people killed by them don't tell the rest of us that that was what killed them, unlike the people who think they were saved.

It is a very common misconception that a helmet has been effective at preventing death or injury when actually it has failed catastrophically and has provided little if any protection. This is especially true if they have split or cracked, which takes little energy and demonstrates complete failure to work as intended.

http://www.cyclehelmets.org/1209.html

burtthebike

posted by burtthebike [80 posts]
17th October 2012 - 21:27

4 Likes

JohnS wrote:
I don't wear a helmet when riding uphill in heat.

YOU WILL SURELY DIE!!!

@hairyairey - do people driving open-top cars in the Pyrenees wear a helmet? And what about the vast majority of us who aren't in the Pyrenees? Should we fear rockfalls too?

Simon E's picture

posted by Simon E [2054 posts]
17th October 2012 - 21:27

1 Like

jasterixstrange wrote:
if you don't wear a helmet you are a moron ... fact

So the Dutch Prime Minister is a moron then? http://www.telegraph.co.uk/finance/debt-crisis-live/9220235/Debt-crisis-...

giff77's picture

posted by giff77 [1068 posts]
17th October 2012 - 22:04

1 Like

All politicians are morons, even the ones I vote for.

posted by paulfg42 [379 posts]
17th October 2012 - 22:59

0 Likes

Simon E wrote:
JohnS wrote:
I don't wear a helmet when riding uphill in heat.

YOU WILL SURELY DIE!!!

Big Grin

posted by JohnS [198 posts]
18th October 2012 - 7:38

2 Likes

jasterixstrange wrote:
if you don't wear a helmet you are a moron ... fact

Since the main purpose of a cycle helmet is to assuage the guilt of the motorist who runs you down, I think you may be wrong.

posted by JohnS [198 posts]
18th October 2012 - 7:40

1 Like

I always wear a helmet since coming off without one and gashing my head open. I think it was Chris Boardman though who suggested the best way to improve road safety was to ban seatbelts and have a large sharp spike protruding from the steering wheel of all cars to within a couple of inches of the drivers heart, would focus the mind on driving carefully I suppose !

High vis is more important than helmets (maybe). I don't think some people realise just how much difference it can make, I was out early in the car on Sunday and didn't see the guy dressed all in black (really ?) on a slightly foggy morning with low winter sun casting long shadows. Fortunately I drive slowly and look out for such things, but the fact is this guy was asking for a SMIDSY episode

Scott Spark 910 - Boardman Team Carbon - Planet X XLS

posted by colinth [188 posts]
18th October 2012 - 8:05

0 Likes

burtthebike wrote:

This is not proof that helmets are effective, it is opinion, unverified and unverifiable. It is anecdote and is as scientifically valid as claiming that smoking doesn't harm anyone because your grandad lived to 98 and he smoked twenty fags a day. All reliable evidence shows that cycle helmets are not effective at improving the safety of cyclists, and that smoking kills people. There are thousands of "helmet saved my life" stories and if even ten percent of them were true, there would be a marked effect at a population level, but there is no such effect. So either the stories are not correct, or just as many people are killed by their helmets as are saved by them, but the people killed by them don't tell the rest of us that that was what killed them, unlike the people who think they were saved.

It is a very common misconception that a helmet has been effective at preventing death or injury when actually it has failed catastrophically and has provided little if any protection. This is especially true if they have split or cracked, which takes little energy and demonstrates complete failure to work as intended.

http://www.cyclehelmets.org/1209.html

Precisely the point I have been trying to make. Why is it so difficult for people to grasp this aspect of the debate?

Anyway, my concern is primarily road safety and the (re)education of drivers. If just 10% of the energy spent on the helmet debate amongst cyclists was directed towards getting drivers to give us all more room and respect, maybe we'd start to see some progress.

ColT's picture

posted by ColT [225 posts]
18th October 2012 - 9:08

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Actually, angelfishsolo, I've never fell off my bike. The point I was making is that cycling is risky. Of course wearing a helmet isn't going to necessarily stop serious or fatal injury, but as part of being safe on the bike surely it helps

posted by stevebull-01 [62 posts]
18th October 2012 - 10:04

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jasterixstrange wrote:
if you don't wear a helmet you are a moron ... fact

I am a great admirer of brevity. A concisely, clearly made argument is something to aspire to.

However, you have simply exposed yourself as an ignorant jerk. You'll be telling me next that Armstrong raced clean, is a lovely guy and it's all a conspiracy.

Simon E's picture

posted by Simon E [2054 posts]
18th October 2012 - 10:10

0 Likes

Expert opinion, anecdotal evidence and common sense all suggest I'm safer with a helmet. But if some of you want to put your heads on the line to prove me wrong, I'm grateful.

Maybe a few martyrs will persuade Governments to invest in better cycling infrastructure rather than spoiling our fun. And those lard-asses for whom a helmet is the only barrier to a healthy life style will thank you too.

posted by ontheroad [9 posts]
18th October 2012 - 10:30

0 Likes

Please stop this nonsense and look at the Netherlands and Denmark
Thank you

Wesselwookie's picture

posted by Wesselwookie [154 posts]
18th October 2012 - 11:06

0 Likes

@ontheroad - what a gloriously self-righteously smug person you are. Martyrdom, whatever the cause, would be too exalted an end for you.

Simon E's picture

posted by Simon E [2054 posts]
18th October 2012 - 11:59

0 Likes

My Dad cycled for 30 years or so to and from work not wearing a helmet and never once suffered a serious head injury. I, on the other hand never ride without my helmet on. I guess I'm trying to say it's personal choice, there seem to be arguments both for and against helmets. We're all cyclists here though and all on the same side, I hope, so maybe the it's time to stop with the insults....

posted by stevebull-01 [62 posts]
18th October 2012 - 13:47

1 Like

I'm neutral in this debate, but I'm struggling to understand what harm can be caused by wearing a helmet.

I'm old enough to remember the fuss when wearing seat belts was made compulsory, lots of stories about people being trapped in burning cars and unable to unfasten their belts etc. Some of the arguments on here seem similar.

I also don't understand why anecdotes from people who have fallen on their heads and report serious damage to their helmets are dismissed. Is it that the helmetless head would not have been damaged and a bare head absorbs shock better than a helmet?

Crosshouses's picture

posted by Crosshouses [216 posts]
18th October 2012 - 14:18

1 Like

Wear helmet => less sexy => less sex => fewer children => less DNA passed on => Darwinian loser

posted by SpamSpamSpam [20 posts]
18th October 2012 - 14:44

0 Likes

Sadly this study has not put the issue to bed. The point still stands that wearing a helmet may result in more relative risk (likelihood of being involved in an accident in the first place) [1].

There are a few forms of study which would (potentially) put the issue to rest:

1 - A population study: take a large population, of those who cycle compare the mortality rates and collision rates of the group which mostly wears helmets with the group which mostly does not wear helmets. Problems: age and sex matching are difficult, ignores effects of helmet wearing on cycling uptake.

2 - A randomised controlled trial: take a group of cyclists, divide into three groups: 1 group do not wear helmets (control), 1 group wear "placebo" helmets (placebo), 1 group wears real helmets (treatment). Compare the mortality rates and collision rates.
Problems: at least 1 group (placebo + 1 other group) have been placed in (relative increased) danger, randomising where individuals have very strong personal opinions is nigh impossible (dropouts).

3 - Intervention study: take a group of cyclists. Require all to wear helmets. Compare mortality rates and collision rates to overall cycling population normalising for distances travelled.
Problems: ignores effects of helmet wearing on cycling uptake, group will be self selecting for those who normally wear helmets (dropouts), the act of intervention may change the behaviour of the group (e.g. reduce risk taking).

Anyone else have any ideas / proposals?

[1] http://drianwalker.com/overtaking/

posted by Henz [41 posts]
18th October 2012 - 15:00

0 Likes

Cool Sorry guys accept it as the motorcyclists had to. One day helmets will be compulsory nuff said Crying

posted by sodit [75 posts]
18th October 2012 - 15:20

1 Like

Just get everyone in the whole country to wear helmets at all times. Surely it's only common sense that this will decrease the chance of death and injury?

posted by SpamSpamSpam [20 posts]
18th October 2012 - 17:00

0 Likes

How ridiculous you steadfast refusniks are! It's just plain obvious that if you hit your head & it's not protected you risk injury - the same goes for many professions where a helmet is expected to be worn. How many builders refuse to go on site or leave the trade because a helmet is mandatory?

Make it law - if some people stop cycling then fine, they can sulk for a bit then go buy a damn helmet once they've got over it & put weight on.

posted by beelzebomb [8 posts]
18th October 2012 - 17:58

1 Like

beelzebomb wrote:
How ridiculous you steadfast refusniks are! It's just plain obvious that if you hit your head & it's not protected you risk injury - the same goes for many professions where a helmet is expected to be worn. How many builders refuse to go on site or leave the trade because a helmet is mandatory?

Make it law - if some people stop cycling then fine, they can sulk for a bit then go buy a damn helmet once they've got over it & put weight on.

Since the helmet standards are so incredibly low, the level of protection offered by a cycle helmet is so minimal as to make wearing one commpletely and utterly pointless.

Try this test. Pick up a motorcycle helmet. Now pick up a cycle helmet in the other hand. Feel the difference in the weight. Examine the structure of the motorcycle helmet. Now do the same with the cycle helmet. You will notice that the motorcycle helmet is rather more substantial. It works. The cycle helmet on the other hand, is insubstantial and the protecion it offers is almost non-existent.

Denmark and Holland have the highest percentages of people cycling in Europe, and also the best safety record for cyclists. Go there and see how many wear helmets while riding. If you wait long enough, you might see one.

OldRidgeback

posted by OldRidgeback [2308 posts]
19th October 2012 - 7:41

0 Likes

OldRidgeback wrote:
beelzebomb wrote:
How ridiculous you steadfast refusniks are! It's just plain obvious that if you hit your head & it's not protected you risk injury - the same goes for many professions where a helmet is expected to be worn. How many builders refuse to go on site or leave the trade because a helmet is mandatory?

Make it law - if some people stop cycling then fine, they can sulk for a bit then go buy a damn helmet once they've got over it & put weight on.

Since the helmet standards are so incredibly low, the level of protection offered by a cycle helmet is so minimal as to make wearing one commpletely and utterly pointless.

Try this test. Pick up a motorcycle helmet. Now pick up a cycle helmet in the other hand. Feel the difference in the weight. Examine the structure of the motorcycle helmet. Now do the same with the cycle helmet. You will notice that the motorcycle helmet is rather more substantial. It works. The cycle helmet on the other hand, is insubstantial and the protecion it offers is almost non-existent.

Denmark and Holland have the highest percentages of people cycling in Europe, and also the best safety record for cyclists. Go there and see how many wear helmets while riding. If you wait long enough, you might see one.


Way to go Ridgeback, couldn't agree more.

antonio

antonio's picture

posted by antonio [1016 posts]
19th October 2012 - 8:00

0 Likes

Yep, I second that one. Should also add that builders wear safety hats to prevent their noggin being penetrated by falling masonry etc. Those forces are totally different to the sudden acceleration and deceleration that occurs in a collision with a vehicle.

By all means make helmets and hiviz compulsory BUT make the sentence for 'death by driving' a minimum of 5 years with a life long driving ban. Make all motorists and passengers wear full face helmets and neck braces after all more drivers suffer head and neck trauma than cyclists.

I've been cycling for near enough 40 years and the worst injuries I've had are a twisted shoulder and road rash. I've learnt to hold a good road position, give clear signals and read the road. The issue that needs to be addressed is the aggressive driving that exists and the fact that the majority of our towns and cities are not designed for motorised traffic

giff77's picture

posted by giff77 [1068 posts]
19th October 2012 - 9:32

0 Likes

Yep, anyone who really believes in wearing a helmet whilst riding for protection should wear a motorcycle helmet, or at the very least a full-face race helmet for downhill MTB racing or BMX racing. Downhill MTB racing/BMX racing body armour incorporating arm protection and knee/shin guards are of course even more important as anyone should be aware limb injuries are prevalent amongst cyclists. A kneck brace is of course necessary for protection too.

Those shell type things some people call cycle helmets are a waste of space, other than for decoration if you ask me.

And no, I haven't plucked those beliefs from opinion derived from reading comments online. I've a bit of paper at home somewhere that reminds me I qualified as a mechanical engineer, with expertise in materials technology and structural design.

Ride safe, claim the road.

Smile

OldRidgeback

posted by OldRidgeback [2308 posts]
19th October 2012 - 11:51

0 Likes

beelzebomb wrote:
How ridiculous you steadfast refusniks are! It's just plain obvious that if you hit your head & it's not protected you risk injury - the same goes for many professions where a helmet is expected to be worn. How many builders refuse to go on site or leave the trade because a helmet is mandatory?

Make it law - if some people stop cycling then fine, they can sulk for a bit then go buy a damn helmet once they've got over it & put weight on.

so people dying of obesity is okay but people dying from hitting their heads is not? not sure i follow. and you should check how much the NHS spends on those two things.

the health benefits of cycling outweigh the risks by an order of magnitude and more. since cycling actively decreases your chance of dying overall, why put obstacles in people's way? what we should be doing is making it easier and cheaper, not harder and more expensive. to take head injuries and look at them in isolation completely misses the point.

Dave Atkinson's picture

posted by Dave Atkinson [7501 posts]
19th October 2012 - 11:55

0 Likes

Gasman Jim wrote:
Death isn't the only end point which should be considered when discussing the merits of wearing helmets. I would say non-fatal traumatic brain injury occurs more frequently than death and is more likely to be reduced in severity or even prevented by wearing a helmet.

Of course I'm no expert, I'm just a consultant anaesthetist with nearly 20 years experience of dealing with trauma. I've seen enough to make sure I NEVER cycle without a helmet.

Of course on the roads better separation of cars and bikes would be ideal, but wearing a helmet is one of the few things we can do something about ourselves.

You're right - you are no expert. You can cite your personal experience but it is just that - personal. It is not scientifically compiled or statistically validated. You have no control group. You are apparently looking at head injury without considering limb and torso injuries, which are more prevalent in incidents with vehicles, especially HGVs, in urban situations.

You are not taken account of what non-trauma doctors such as cardiovascular, obesity, diabetes and other specialists might have to say.

It is better than the old " a helmet saved my life" canard, but only just.

posted by Paul M [325 posts]
20th October 2012 - 18:41

1 Like