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

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.”
 

Born in Scotland, Simon moved to London aged seven and now lives in the Oxfordshire Cotswolds with his miniature schnauzer, Elodie. He fell in love with cycling one Saturday morning in 1994 while living in Italy when Milan-San Remo went past his front door. A daily cycle commuter in London back before riding to work started to boom, he's been news editor at road.cc since 2009. Handily for work, he speaks French and Italian. He doesn't get to ride his Colnago as often as he'd like, and freely admits he's much more adept at cooking than fettling with bikes.

85 comments

Avatar
Paul J [884 posts] 3 years ago
0 likes

Look at the incident types. "Collision with motor vehicle" covers 77% of the fatalities, regardless of whether or not they were wearing helmets. Surely there is a better lesson to learn here than "cyclists should wear helmets"? (Regardless of your opinion on that matter - mine is that helmets could help you in certain circumstances, in others there may be better ways to reduce injury risks).

A pet flaw of mine with helmet studies: Didn't consider alcohol intoxication. Not much excuse for this flaw, as it would be recorded in the records they were using (more reliably than helmet usage). From US and NL public accident data, alcohol intoxication is present in a significant number of fatalities (forget exactly how much, I think order 30 to 40% in US case, I remember it being more in NL). My educated guess is that alcohol intoxication correlates strongly with not wearing a helmet (in which case) - which will skew the conclusion a little if not accounted for.

Another flaw: It's not a population study (these are admittedly very expensive to do, and so they're rare). It's only looking at fatalities. Everyone who had an accident, went to hospital but didn't die: excluded. Everyone who had an accident, but didn't go to hospital: excluded. Everyone who cycled but didn't have an accident: excluded. Everyone who lived longer because cycling allowed them to make exercise a normal part of their life: excluded.

Narrow data-sets run the risk of not being representative of the full population. E.g. 86% of the cases in this study were male - why are there are so few women? Are only 14% of cyclists in Toronto female? Perhaps what this study is saying is more about males and/or those who end-up in fatal accidents being bigger risk takers, than anything about helmets?

Narrow data-sets or hypotheses can lead to conclusions that are only narrowly applicable - missing important factors. Also, as the study says "Not wearing a helmet while cycling is associated with an increased risk of sustaining a fatal head injury." - association does not, per se, mean causation.

How do the dutch manage to have such good, population wide cycling safety, while pretty much never wearing helmets? Does the extremely high-rate of cycling the Netherlands have any part to play in the Netherlands having *half* the rate of obesity as the UK?

Avatar
DNAse [27 posts] 3 years ago
0 likes

The key missing relative risk is that cyclists that tend to wear helmets also tend to cycle more, cycle more prudently, use lights & hi-viz at night, and maintain their bikes properly etc.

You can make this observation yourself quite easily; the cyclist that scuttles across the road in front of you, without looking, with no lights on a broken BSO won't be wearing a helmet. (not to say that some helmet wearing cyclists also put themselves in danger just that a lower proportion of them do).

Avatar
Gasman Jim [154 posts] 3 years ago
0 likes

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.

Avatar
JohnS [198 posts] 3 years ago
0 likes

When are we going to see research finding that not driving into cyclists is the key to reducing cyclists' head injuries?

Avatar
OldRidgeback [2620 posts] 3 years ago
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.

I am curious if you cycle wearing leg and arm protection, since as someone being involved in the medical profession I'm certain the majority of cycling injuries you'll encounter will be to the limbs. Perhaps all cyclists should adopt the protection used by downhill MTB racers and BMX racers and use body armour, knee/shin guards and a full face motocross type helmet. Those flimsy shell type helmets road cyclists wear are useless anyway.

Avatar
Paul J [884 posts] 3 years ago
0 likes

Gasman Jim: No offence, but you are professionally biased. Like a policeman who believes nearly all people are dodgy scum, because their job constantly has them in contact with those kinds of people, and rarely with good people. Your job constantly brings you into contact with victims of trauma - and likely more severe trauma, for those being wheeled into your OR.

Agree though it is also important to look at non-fatal trauma, simply for statistical reasons, if nothing else.

It is also important to include the general cycling population, including the minor and non-accident-having cyclists, for the same statistical reasons. Unfortunately, hospital-record studies (the most common) can not do this.

Avatar
Yennings [237 posts] 3 years ago
0 likes

Why does every study like this seem to bring all the helmet refuseniks out of the woodwork? What is it about the prospect of wearing a lid that they find so odious? It's not like they're even that expensive.

Surely, even if the science is not 100 per cent clear, it's worth hedging one's bets? Surely it doesn't take a rocket scientist to work out that smacking one's head against the road/car bonnet/random object is going to be more painful without a big wedge of styrofoam in between? I'm all for freedom of choice but honestly...

Before I got into cycling, I used to do a bit of rock climbing. Exactly the same fierce debate about helmets happened amongst climbers. And again, those who opposed them were generally the same people who were eventually killed or seriously injured by falling rocks. I guess ultimately you can lead the horse to water...

Avatar
ColT [289 posts] 3 years ago
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.

Just curious, like, but does this mean you also wear a helmet when travelling in a car or when you are crossing the road as a pedestrian? Have you also seen injuries which were potentially caused by helmets?

I'm not saying I doubt your expertise, but I'm not sure your reasoning stands up to scrutiny. I'm happy to be convinced otherwise.

Avatar
Tripod16 [157 posts] 3 years ago
0 likes

In all the helmet debate, I have still, yet, to come across a person who has come off their bike, landed on their spam and who says they were lucky to not have been wearing a helmet...  39

Avatar
JohnS [198 posts] 3 years ago
0 likes
Yennings wrote:

What is it about the prospect of wearing a lid that they find so odious?

Why do helmet evangelists always use jokey terms like "lid"? Don't they want adult discussion? But I digress:

Quote:

Surely, even if the science is not 100 per cent clear, it's worth hedging one's bets?

Apart from the science being considerably less than 100% clear - it is suggested by some that helmet-wearing not only discourages the healthy activity of cycling, but even makes cycling injuries worse in some cases - sure, it may be worth hedging your bets. Just don't make helmet-wearing compulsory, which is what will happen if hordes of cyclists start wearing helmets for no good reason.

Quote:

Before I got into cycling, I used to do a bit of rock climbing. Exactly the same fierce debate about helmets happened amongst climbers. And again, those who opposed them were generally the same people who were eventually killed or seriously injured by falling rocks. I guess ultimately you can lead the horse to water...

Rock climbing is obviously risky. Cycling isn't.

Avatar
OldRidgeback [2620 posts] 3 years ago
0 likes
Yennings wrote:

Why does every study like this seem to bring all the helmet refuseniks out of the woodwork? What is it about the prospect of wearing a lid that they find so odious? It's not like they're even that expensive.

Surely, even if the science is not 100 per cent clear, it's worth hedging one's bets? Surely it doesn't take a rocket scientist to work out that smacking one's head against the road/car bonnet/random object is going to be more painful without a big wedge of styrofoam in between? I'm all for freedom of choice but honestly...

Before I got into cycling, I used to do a bit of rock climbing. Exactly the same fierce debate about helmets happened amongst climbers. And again, those who opposed them were generally the same people who were eventually killed or seriously injured by falling rocks. I guess ultimately you can lead the horse to water...

Most shell type cycle helmets are useless flimsy things. You might as well wear a paper plate on your head tied on with a bit of string as the protection offered isn't as different as you might think. Unless you wear a proper competition type full face cycle helmet or at least a skate type lid, then safety is marginal. A shell type helmet is more for decoration than protection.

Avatar
Angelfishsolo [132 posts] 3 years ago
0 likes

As a medical professional I am sure you know that Cycle helmets are specified by their manufacturers as meeting one or more of the international standards for this equipment. All of the standards test the helmet's protection of only a decapitated headform, (i.e. one with no body attached); and all tests involve only low speed impacts. Impact speeds are less than 6.6 m/s (24 km/h or 15 mph), and in some cases, barely 5 m/s (18 km/h or 11 mph). Unlike seatbelt tests, helmet test standards do not realistically replicate serious crashes.

My injuries for Mountain Biking were a broken wrist, compressed spine and rotator cuff injury. I wore a helmet at all times. I was traveling a lot faster than 11mph and my helmet was not SNELL certified.

As such I can conclude the following. The helmet did not prevent the injuries I sustained.

Avatar
JohnS [198 posts] 3 years ago
0 likes
Tripod16 wrote:

In all the helmet debate, I have still, yet, to come across a person who has come off their bike, landed on their spam and who says they were lucky to not have been wearing a helmet...  39

A few years ago, I was riding along a lane in Essex quite fast (about 25mph) when I hit a tree root under the Tarmac which knocked the bars out of my hands.

I parted company from the bike and slid about 50 yards along the road on my head (without helmet) and shoulder.

The only injury was loss of skin, unlike a previous occasion when I'd come off at low speed after hitting a kerb while wearing a helmet. I slid on my helmet a few feet. This resulted in a painfully stiff neck for a week.

Avatar
stevebull-01 [63 posts] 3 years ago
0 likes
Quote:

Rock climbing is obviously risky. Cycling isn't.

Really johnS ? Maybe you should try my 10 mile daily commute. I gladly wear a helmet...

Avatar
ColT [289 posts] 3 years ago
0 likes
Yennings wrote:

Why does every study like this seem to bring all the helmet refuseniks out of the woodwork? What is it about the prospect of wearing a lid that they find so odious? It's not like they're even that expensive.

Surely, even if the science is not 100 per cent clear, it's worth hedging one's bets? Surely it doesn't take a rocket scientist to work out that smacking one's head against the road/car bonnet/random object is going to be more painful without a big wedge of styrofoam in between? I'm all for freedom of choice but honestly...

Before I got into cycling, I used to do a bit of rock climbing. Exactly the same fierce debate about helmets happened amongst climbers. And again, those who opposed them were generally the same people who were eventually killed or seriously injured by falling rocks. I guess ultimately you can lead the horse to water...

I certainly don't consider myself a refusenik. What does bother me is the lack of evidence, or the dismissal of anyone daring to question the (potential) failings of helmets. Comparison with rock climbing is spurious; clearly a lump of rock landing on your head is going to hurt/damage and it's likely that you'll not be able to react in any way. i.e. you won't know it's coming. If coming off a bike, it's likely that you'll try to compensate and having something which (effectively) makes your head larger can cause problems. If you doubt this, try wearing a hard hat (like builders have to wear) in a confined space and not banging your head.

I think the whole black and white argument is unhelpful. We need to be given the facts (pros and cons) in order to allow us to make an informed choice.

As it happens, I choose to race so I choose to wear a helmet to comply with racing requirements. I could choose not to, but I'd feel happier if proper empirical evidence were provided. This is unlikely as it's impossible to precisely compare/replicate accidents with and without helmets.

If you've not already seen it, here's my kind of reasoning:
http://fiftyyearsandcounting.wordpress.com/2012/08/09/speed-kills/

Avatar
Angelfishsolo [132 posts] 3 years ago
0 likes
stevebull-01 wrote:

Rock climbing is obviously risky. Cycling isn't.

Really johnS ? Maybe you should try my 10 mile daily commute. I gladly wear a helmet...

So I take it you fall off on a regular basis during your commute? Maybe you are the problem?

If you climb higher than the height of a person sitting on a bicycle a fall is going to do you more danger than a fall from a bike.

If you are hit by a car whilst cycling I am yet to see proof that a helmet prevents, leg, arm, spinal facial or and body injuries.

Avatar
Francois [9 posts] 3 years ago
0 likes

The core objective should remain to increase cycling as a form of transportation across the board. Helmet laws do not help towards that objective.

Avatar
Yennings [237 posts] 3 years ago
0 likes

Frankly I think people choosing not to wear a helmet is up there with smoking as a brilliant example of Darwinism. You pays your money and you makes your choice, ultimately. Who am I to argue?

Avatar
AWPeleton [3310 posts] 3 years ago
0 likes

Every time someone presents a topic about helmet use it ends up with numerous comments neither proving or disproving the benefit of helmet use, and in the end i dont think there ever will be conclusive proof either way.

Personally if a helmet stops me from hurting my head i will wear one. They dont look cool and some are not cheap if you want the lighter versions. I wear a Giro Atmos cos i do a lot of cycling and the weight is important to me after seperating 3 vertabrae in my neck through rugby

As for people stating the obvious "my helmet didnt stop me from breaking my leg" can i just say (IMHO) you sound very silly, of course it didnt, just like my helmet didnt stop me from cutting my finger when i peeled some spuds.

In the end it should remain as a PERSONAL CHOICE and if you do land on your head without a lid on (i do like the word lid) tough and i hope it bloody hurts.

Avatar
ColT [289 posts] 3 years ago
0 likes
Yennings wrote:

Frankly I think people choosing not to wear a helmet is up there with smoking as a brilliant example of Darwinism. You pays your money and you makes your choice, ultimately. Who am I to argue?

How so Darwinism? Isn't there irrefutable evidence that smoking is harmful? Where is the irrefutable evidence about wearing a helmet? Isn't this comparing the proverbial apples with pears?

I worked for the Royal Mail for a while. They told me I had to wear a helmet. When I asked about the downsides they were unable to respond. This is my point; there is a default position that helmets will 'save your life' or 'will save you from serious (head) injury'. This is patently not true.

Trust me. I'm genuinely interested and would welcome someone pointing me to the evidence while also pointing me to the evidence of the potential dangers.

Avatar
ColT [289 posts] 3 years ago
0 likes
stumps wrote:

Every time someone presents a topic about helmet use it ends up with numerous comments neither proving or disproving the benefit of helmet use, and in the end i dont think there ever will be conclusive proof either way.

Personally if a helmet stops me from hurting my head i will wear one. They dont look cool and some are not cheap if you want the lighter versions. I wear a Giro Atmos cos i do a lot of cycling and the weight is important to me after seperating 3 vertabrae in my neck through rugby

As for people stating the obvious "my helmet didnt stop me from breaking my leg" can i just say (IMHO) you sound very silly, of course it didnt, just like my helmet didnt stop me from cutting my finger when i peeled some spuds.

In the end it should remain as a PERSONAL CHOICE and if you do land on your head without a lid on (i do like the word lid) tough and i hope it bloody hurts.

And what if you are wearing a helmet and it causes you to break your neck? I wouldn't wish that on you or anyone and I wouldn't wish you to suffer any pain. i.e. it may save you from injury; it may cause you injury; it will probably make no difference at all.

Avatar
AWPeleton [3310 posts] 3 years ago
0 likes
JohnS wrote:
Tripod16 wrote:

In all the helmet debate, I have still, yet, to come across a person who has come off their bike, landed on their spam and who says they were lucky to not have been wearing a helmet...  39

A few years ago, I was riding along a lane in Essex quite fast (about 25mph) when I hit a tree root under the Tarmac which knocked the bars out of my hands.

I parted company from the bike and slid about 50 yards along the road on my head (without helmet) and shoulder.

The only injury was loss of skin, unlike a previous occasion when I'd come off at low speed after hitting a kerb while wearing a helmet. I slid on my helmet a few feet. This resulted in a painfully stiff neck for a week.

Whilst its not pleasant to hurt oneself the fact you hurt your neck whilst wearing a helmet may or may not have had anything to do with it. Your neck is very delicate and any sudden movements regardless of speed can aggravate it, hence the whiplash injuries even at low speed. This can be caused by the neck being at an unusual angle causing the muscles / tendons / ligaments to spasm causing the pain and stiffness.

Now i'm not saying the helmet was not responsible just that your injury can be easily caused with or without the wearing of a helmet.

Avatar
AWPeleton [3310 posts] 3 years ago
0 likes

deleted.

Avatar
AWPeleton [3310 posts] 3 years ago
0 likes
ColT wrote:
stumps wrote:

Every time someone presents a topic about helmet use it ends up with numerous comments neither proving or disproving the benefit of helmet use, and in the end i dont think there ever will be conclusive proof either way.

Personally if a helmet stops me from hurting my head i will wear one. They dont look cool and some are not cheap if you want the lighter versions. I wear a Giro Atmos cos i do a lot of cycling and the weight is important to me after seperating 3 vertabrae in my neck through rugby

As for people stating the obvious "my helmet didnt stop me from breaking my leg" can i just say (IMHO) you sound very silly, of course it didnt, just like my helmet didnt stop me from cutting my finger when i peeled some spuds.

In the end it should remain as a PERSONAL CHOICE and if you do land on your head without a lid on (i do like the word lid) tough and i hope it bloody hurts.

And what if you are wearing a helmet and it causes you to break your neck? I wouldn't wish that on you or anyone and I wouldn't wish you to suffer any pain. i.e. it may save you from injury; it may cause you injury; it will probably make no difference at all.

You see this is what i mean. The "what if" terminollogy should not come into a reasoned discussion. We cant live our lives with the "what if" question.

It should remain as personal choice and not forced onto us without extensive and thorough independant examination of all the facts. I will continue to wear one regardless as i personally believe it will prevent certain injuries.

Avatar
Chris James [388 posts] 3 years ago
0 likes

stevebull-01 wrote:
Rock climbing is obviously risky. Cycling isn't.

Really johnS ? Maybe you should try my 10 mile daily commute. I gladly wear a helmet...

So I take it you fall off on a regular basis during your commute? Maybe you are the problem?

If you climb higher than the height of a person sitting on a bicycle a fall is going to do you more danger than a fall from a bike.

You do realise that rock climbers use ropes and protection (nuts, cams, slings) to limit their chance of falling far? In fact, if seconding you probbaly wouldn;t even fall as far as falling off a bike.

Whereas coming off a bike onto the road at 20 odd mph hurts like hell. I have been more badly injured cycling than climbing.

Having said all that, how much help is an inch of polystyren going to be in a 20 mph crash?

Avatar
JohnS [198 posts] 3 years ago
0 likes
stumps wrote:

Now i'm not saying the helmet was not responsible just that your injury can be easily caused with or without the wearing of a helmet.

If I hadn't been wearing a helmet, my head would have slid rather than being yanked round. Wearing a helmet made the crash worse.

Avatar
JohnS [198 posts] 3 years ago
0 likes
Angelfishsolo wrote:
stevebull-01 wrote:

Rock climbing is obviously risky. Cycling isn't.

Really johnS ? Maybe you should try my 10 mile daily commute. I gladly wear a helmet...

So I take it you fall off on a regular basis during your commute? Maybe you are the problem?

If you climb higher than the height of a person sitting on a bicycle a fall is going to do you more danger than a fall from a bike.

If you are hit by a car whilst cycling I am yet to see proof that a helmet prevents, leg, arm, spinal facial or and body injuries.

I think we're at cross-purposes. I crashed about four times during 30 years of commuting 35km a day (that's more than 200,000km), never with serious injury, never wearing a helmet. As I said, cycling isn't obviously risky. And is a lot less risky than rock-climbing.

Avatar
mingmong [258 posts] 3 years ago
0 likes

My grey matter, matters! I agree with Gasman Jim - Your brain floats inside a bone skull at the end of the day. Head trauma or Fatality should be enough to make you protect.

I've slung my bike down the road a few times and each time my lid has taken the road rash and [thankfully] what little impact my bonce received.

Ultimately though, you pay your money and take your choice I suppose.

Avatar
Coleman [335 posts] 3 years ago
0 likes
Francois wrote:

The core objective should remain to increase cycling as a form of transportation across the board. Helmet laws do not help towards that objective.

Spot on. This is just the latest distraction from what really should be being debated/ funded/ implemented.

Avatar
AWPeleton [3310 posts] 3 years ago
0 likes
JohnS wrote:
stumps wrote:

Now i'm not saying the helmet was not responsible just that your injury can be easily caused with or without the wearing of a helmet.

If I hadn't been wearing a helmet, my head would have slid rather than being yanked round. Wearing a helmet made the crash worse.

No probs mate i accept what you say. Having bust my neck i know how sore they get  20

Pages