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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...

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.”
 

Simon joined road.cc as news editor in 2009 and is now the site’s community editor, acting as a link between the team producing the content and our readers. A law and languages graduate, published translator and former retail analyst, he has reported on issues as diverse as cycling-related court cases, anti-doping investigations, the latest developments in the bike industry and the sport’s biggest races. Now back in London full-time after 15 years living in Oxford and Cambridge, he loves cycling along the Thames but misses having his former riding buddy, Elodie the miniature schnauzer, in the basket in front of him.

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85 comments

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OldRidgeback | 11 years ago
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The advantage of the paper plate protective headgear also is that it is biodegradable, unlike the shell type helmet which requires expanded polystyrene and is not nonly non-biodegrable, but also results in the release of atmosphere damaging gases.

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Stumps replied to Coleman | 11 years ago
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Coleman wrote:
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.

Totally agree there. Unfortunately we, as cyclists, offer very little to the purses of Govt. Until that changes, which i have no doubt the current govt will try, and we have to pay to use the roads we have little say, or should i say, have very little amount people willing to listen to our concerns  14

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AlexStriplight | 11 years ago
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The Canadian Medical Association Journal is currently ranked 11th amongst medical journals. I doubt any other journal would publish this because of it's flawed methodology. Maybe they should have employed a statistician to look at their findings before Dr. Nav Persaud started pontificating, what's referred to in medical terms as, bollocks.

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Paul J replied to AlexStriplight | 11 years ago
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Alex: I like their limitations section. The only limitations they consider are those they think might cause the "helmets associated with fewer head deaths" risk to be under-estimated. No consideration at all of any factors that might cause their study to over-state the association - such as their very narrow data-set, focused on the worst accidents, such as other factors that might correlate with fatalities and helmet use (people who are naturally inclined to take more risks, intoxication, etc).

Being very focused and selective with data is a classic way to introduce bias into statistical results (unwittingly or through deliberate manipulation).

Addendum: the authors of the study appear to be medical doctors, a sociologist, and one other person with a BA in something I havn't uncovered - but their professional background doesn't suggest it was in anything math or stats related. The statistical analysis in this study is extremely basic - simple stuff taught in A-levels / undergrad introductory statistics classes. That's not to say it's invalid, but I wonder if part of the reason they didn't do a more sophisticated, multi-variate analysis (e.g. pathology records they used would surely have toxicology details) is simply that none of the authors had the required skills in statistics.

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AlexStriplight | 11 years ago
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Well put Paul.
Obviously it would be better if we based our scientific knowledge on 'anecdotal evidence', then we could enjoy reading medical journals that started their studies by saying "I met a bloke down the pub and he told me that wearing a wet fish on his head saved his life..."

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Simon E replied to DNAse | 11 years ago
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DNAse wrote:

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.

I'm not sure I agree. Plenty of people wear helmets while riding inappropriately or in an unsafe manner. Even some MAMILs with all the gear ride like dicks. Have you not heard of risk compensation?
http://waronthemotorist.wordpress.com/2011/07/25/risk-compensation-and-b...

Gasman Jim wrote:

Of course I'm no expert, I'm just a consultant anaesthetist with nearly 20 years experience of dealing with trauma.

It's OK, I can tell you're no expert on cycle helmets.

How does putting patients to sleep mean you to know more than the rest of us about the effectiveness of cycle helmets? Did you interview the patients and/or police forensic teams about the incident as well? Did you then inspect a significant sample of post-impact helmets? One could argue your conclusion is an emotional one due to what you've encountered rather than it be a decision based on the science. What about all the cyclists etc that have fallen yet not required surgery and quizzed them about whether they were wearing a helmet at the time?

Yennings wrote:

Why does every study like this seem to bring all the helmet refuseniks out of the woodwork?

Because it prompts all the blindly faithful evangelists to cry "You really should wear a helmet!" as if it's some kind of magic answer.

Yennings wrote:

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.

Are you really suggesting that every bare-headed cyclist will inevitably die from a blow to the head while out riding? There are weirdo religious groups desperate for idiots like you to help them spread their message.

Most of us arguing against you are not refuseniks. I wear one most of the time now, even in bed (you can't be too careful, you know). Lots of people have cycled for many years without one so don't see it as an essential survival aid. More important is the risk of creeping compulsion. Helmet compulsion has shown to be counterproductive and damaging to the health of the population as a whole. You don't have to be a brain surgeon, anaesthetist, lawyer or rock climber to work that one out.

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Stumps | 11 years ago
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After reading some of the comments placed on the forum on this discussion and other helmet discussions i think i might change my stance towards the wearing of a helmet. I've said, even on this current discussion, it's the individuals choice.

However i now think it should be made law. Not because there is all of a sudden some magical evidence to say its right, just so that all the plonkers who come on here and belittle those who do think its a good idea without offering any other form of discussion, will have to wear one. God that would be a good sight  4

Mind you there are those on the site who give very good and well thought out arguements against wearing them and i do not mean to say you are a plonker, far from it, but i guess everyone knows who i mean  3

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Trackal | 11 years ago
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The issue here is not whether helmets make you safer but one of being compelled to wear one. I should have the right to choose to take the risk not to wear one, in the same way I can choose to take the risk of crossing a road at a non-designated crossing point. It is highly unlikely that I will damage anyone other than myself by not wearing a helmet, there is the issue of potentially costing more to fix/look after me in terms of medical costs if I suffer a head injury whilst cycling without one but that argument can be endlessly extended to include people who drink too much, eat too much, drive to fast etc. By all means lets have more studies into the risks so that we can all make more informed decisions about when we choose to wear or not wear a helmet but if the study recommends compulsory helmet wearing it should be clear who they think needs protecting or what money they are trying to save for whom.

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pauldmorgan replied to Trackal | 11 years ago
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Trackal: Do you believe that you should also have the right not to wear a helmet whilst riding a motorbike or a seatbelt whilst driving or riding in a car?

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Stumps replied to pauldmorgan | 11 years ago
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Pauldmorgan wrote:

Trackal: Do you believe that you should also have the right not to wear a helmet whilst riding a motorbike or a seatbelt whilst driving or riding in a car?

I'm all for wearing a helmet but even i have to admit its nothing compared to the wearing of a lid for a motorbike or a seat belt in a car.

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shockleader | 11 years ago
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In the UK, smoking kills literally thousands of people a year, obesity and lack of exercise again probably thousands and alcohol again thousands. Last year cycling deaths were 116. We don't know the injuries or helmet situation in these fatalities so lets pretend that none of the cyclists were wearing helmets. According to the Canadian study, about 30% would be saved by wearing a hat. So that's 30 - 35 people a year. Sorry guys, any government that fails to address smoking, drinking and obesity but concentrates on a few (albeit tragic) cycling fatalities is deliberately missing the big picture. Cyclists are an easy target for well meaning do gooders who think victim blaming is the way to promote a healthy activity.

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hairyairey | 11 years ago
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Interesting comment above "rock climbing is dangerous, cycling isn't". When you are riding uphill in the Pyrenees you will discover that they are eroding and that large chunks regularly fall onto the road. Personally I wouldn't be a pedestrian high up there without a helmet. Something to think about during your next Etape or Marmotte when you feel like taking your helmet off on the hills. It may indeed be a rare occurence for a rock to hit you, but in the words of Dirty Harry "do you feel lucky, punk?"

(the rate of erosion of the Pyrenees flies in the face of a theory of an old earth - but that's a story for another time).

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arowland replied to pauldmorgan | 11 years ago
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Pauldmorgan wrote:

Trackal: Do you believe that you should also have the right not to wear a helmet whilst riding a motorbike or a seatbelt whilst driving or riding in a car?

Yes. There is a junction on my regular commute where it is dangerous to wear a seatbelt because it prevents my leaning forward and craning to see round/over a wall and tell if someone is coming before I pull out. (The belt always locks solid as I brake before the Give Way sign.) So I take the belt off. By doing so I am endangering no-one other than myself; if I fail to, I potentially put others at greater risk too.
Being permitted to drive half a ton of potentially lethal metal around in public places carries with it an awesome responsibility, which I always take seriously. As the 'captain' of my vessel, the safety of others rests in my hands, not the government's, I and resent that I might be fined for putting others before myself. (Though in this case, mine and others' interests coincide because it is better to avoid a collision in the first place.) But I wear a belt at other times and refasten it as soon as it is safe to.

I don't ride a motorbike so am not really qualified to answer, but I would wear a helmet if I did.

  • The risks are greater because of the bike's speed compared to a cycle
  • Motorbike helmets are more effective than cycle ones
  • We do have a responsibility, all things being equal, to avoid making ourselves a burden on society unnecessarily
  • You don't get all hot and sweaty from pedalling like you do on a cycle.

Whether that lot adds up to an argument for compulsion is another matter.

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JohnS replied to hairyairey | 11 years ago
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hairyairey wrote:

Interesting comment above "rock climbing is dangerous, cycling isn't". When you are riding uphill in the Pyrenees you will discover that they are eroding and that large chunks regularly fall onto the road.

Do tell me you're joking. And by the way, the valleys into the Vercors are more prone to rockfalls than those in the Pyrenees, to the extent that my favourite routes are closed for road works every summer in alternate years; and I don't wear a helmet when riding uphill in heat.

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Titivulus | 11 years ago
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I have only banged my head once in over 200,000 miles - on a jay-walking pedestrian in Battersea High Street. I bought a helmet recently though (Giro Savant, very comfy) just because of the ignorant pronouncements of coroners. I want maximum compensation for my children when I'm killed.

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WolfieSmith | 11 years ago
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The Helmet Debate enters it's 5th year... I'm not getting involved this time.  3

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Stumps replied to WolfieSmith | 11 years ago
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MercuryOne wrote:

The Helmet Debate enters it's 5th year... I'm not getting involved this time.  3

I thought the same then bingo a dozen entries later  20

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paulfg42 | 11 years ago
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Phew, I'm glad I read this. Now I know how dangerous it is to wear my helmet. Thanks, guys.

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Mixk40 | 11 years ago
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Strange lot ! Ok my experience ? I got taken out at 30 mph (it was down a slight hill) basically they went to overtake me and then pulled in trapping me between a park car and theirs. Result straight over the bars and down the road for about 50 m or so. Helmet split in half. Got whiplash left to right as I hit the road on my side. Lost a large amount of skin from ankle, knee and hip. Jacket protected up half. After 3 days could not walk - ribs at the back had been pushed of the spine 3 months before I could cycle .

Conclusion ? I always wear a helmet ! But I firmly believe that you should be allowed to decide for your self

And before you ask the driver ? That stoped and waited for the police / ambulance etc .
BUT they did not take any further actions ! Despite over 10 witness validating my story

Maybe crying and saying sorry lots of time works!

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OldRidgeback replied to Stumps | 11 years ago
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stumps wrote:

After reading some of the comments placed on the forum on this discussion and other helmet discussions i think i might change my stance towards the wearing of a helmet. I've said, even on this current discussion, it's the individuals choice.

However i now think it should be made law. Not because there is all of a sudden some magical evidence to say its right, just so that all the plonkers who come on here and belittle those who do think its a good idea without offering any other form of discussion, will have to wear one. God that would be a good sight  4

Mind you there are those on the site who give very good and well thought out arguements against wearing them and i do not mean to say you are a plonker, far from it, but i guess everyone knows who i mean  3

Ok, here's a good reasoned argument against compulsory wearing of helmets by cyclists. The vast majority of cycle helmets offer so little impact protection as to be next to useless. They offer such low levels of protection and are tested to such laughably low standards as to be an utter waste of time. That's why I made the sarcastic comment about the paper plate. Many people seem to think they're protecting themselves with a cycle helmet when they're riding, but they're not because it doesn't.

Yes, we've seen a few stories about how people fell off their bikes, slid down the road and the cycle helmets prevented head injury. But to be really scientific, each person would have to repeat the incident exactly as before but without a helmet.

I wear a motorbike helmet when I'm riding my motorbike because it's the law. But it also makes sense as the motorbike helmet does offer impact protection and as my motorbike travels faster than a bicycle. Car seatbelts are required by law and also offer protection.

The health benefits of cycling outweight the risks by a factor of 20:1. And as another post made quite clear, the government would do a lot better if it addressed the completely preventable damage caused by smoking and obesity on which the country wastes fantastically large amounts of money every year.

And in any case, it would be far far more effective to reduce the danger at source and tackle what causes most cycle accidents, bad driving on behalf of other road users. I've cycled in London and Amsterdam a lot over the years and I know which is safer and where very few people bother with helmets.

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jasterixstrange | 11 years ago
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if you don't wear a helmet you are a moron ... fact

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Stumps replied to OldRidgeback | 11 years ago
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OldRidgeback wrote:
stumps wrote:

After reading some of the comments placed on the forum on this discussion and other helmet discussions i think i might change my stance towards the wearing of a helmet. I've said, even on this current discussion, it's the individuals choice.

However i now think it should be made law. Not because there is all of a sudden some magical evidence to say its right, just so that all the plonkers who come on here and belittle those who do think its a good idea without offering any other form of discussion, will have to wear one. God that would be a good sight  4

Mind you there are those on the site who give very good and well thought out arguements against wearing them and i do not mean to say you are a plonker, far from it, but i guess everyone knows who i mean  3

Ok, here's a good reasoned argument against compulsory wearing of helmets by cyclists. The vast majority of cycle helmets offer so little impact protection as to be next to useless. They offer such low levels of protection and are tested to such laughably low standards as to be an utter waste of time. That's why I made the sarcastic comment about the paper plate. Many people seem to think they're protecting themselves with a cycle helmet when they're riding, but they're not because it doesn't.

Yes, we've seen a few stories about how people fell off their bikes, slid down the road and the cycle helmets prevented head injury. But to be really scientific, each person would have to repeat the incident exactly as before but without a helmet.

I wear a motorbike helmet when I'm riding my motorbike because it's the law. But it also makes sense as the motorbike helmet does offer impact protection and as my motorbike travels faster than a bicycle. Car seatbelts are required by law and also offer protection.

The health benefits of cycling outweight the risks by a factor of 20:1. And as another post made quite clear, the government would do a lot better if it addressed the completely preventable damage caused by smoking and obesity on which the country wastes fantastically large amounts of money every year.

And in any case, it would be far far more effective to reduce the danger at source and tackle what causes most cycle accidents, bad driving on behalf of other road users. I've cycled in London and Amsterdam a lot over the years and I know which is safer and where very few people bother with helmets.

Mate, i wasn't having a pop at you, far from it, you always put reasoned points over whatever subject we talk about. Its the ones who make snide comments but cant offer anything in reply that annoy me  4

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Izaak30 | 11 years ago
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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....

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korblimey | 11 years ago
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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.

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Kapelmuur replied to Francois | 11 years ago
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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.

If we believe the 'Wiggo effect' then most people who have taken up cycling recently will have done so after seeing riders in the TdF and Olympics all of whom wore helmets.

People copy the leading figures in their sport, so it's unlikely that wearing a helmet will be a deterrent.

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burtthebike | 11 years ago
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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?

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burtthebike replied to jasterixstrange | 11 years ago
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jasterixstrange wrote:

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

Were you wearing a helmet when you wrote that?  39

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burtthebike replied to jasterixstrange | 11 years ago
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 39

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Stumps | 11 years ago
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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.  3

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burtthebike replied to Izaak30 | 11 years ago
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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

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