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Surge in Bicycle Injuries to Riders Over 45

Cycling renaissance causing more hospitalizations in older adults

( The incidence of bicycle accidents has increased significantly in the U.S. in recent years, with many serious injuries occurring among riders older than 45, according to a new study led by UC San Francisco.

The researchers used a national injury surveillance database to study trends in bicycle injuries from 1998 to 2013. They found that the rate of hospital admissions associated with bicycle injuries more than doubled during that timeframe, especially with head and torso injuries.

Altogether, the proportion of injuries occurring to riders above age 45 rose 81 percent, from 23 percent to 42 percent, the authors said, and similarly the proportion of hospital admissions to older riders increased 66 percent, from 39 percent to 65 percent.

The results are published in the September 1, 2015 edition of JAMA, the Journal of the American Medical Association.

"These injuries were not only bad enough to bring riders to the emergency room, but the patients had to be admitted for further care," said senior author Benjamin Breyer, MD, MAS, associate professor of urology at UCSF and chief of urology at UCSF partner hospital San Francisco General Hospital and Trauma Center. "If you take typical 25-year-olds and 60-year-olds, if they have a similar crash, it's more likely the older person will have more severe injuries."

Urban cycling has become increasingly popular in recent years for both recreation and work, and this trend has occurred while the U.S. shifts to an older demographic.

In the new study, the researchers found that the percentage of injured cyclists with head injuries rose from 10 percent to 16 percent. Approximately two thirds of the total injuries occurred among men, the authors said, and there was "no significant change in sex ratio over time."

"These injury trends likely reflect the trends in overall bicycle ridership in the United States in which multiple sources show an increase in ridership in adults older than 45 years," the authors said. "Other possible factors ... include an increase in street accidents and an increase in sport cycling associated with faster speeds."

The authors say their findings highlight the need for more safe riding practices and better infrastructure to prevent cycling-related injuries.

"Bicycle riding provides a fantastic way to get exercise and it has a low impact on joints," said Breyer. "Previous research has shown it has broad health benefits with reduced mortality. But on a national level, we need expanded support for improving the general infrastructure for cycling, especially bike lanes. And all cyclists should be aware of the risks and take appropriate precautions such as using appropriate safety gear, including helmets, and they should follow the rules of the road."


Data were derived from the National Electronic Injury Surveillance System.

Co-authors are Thomas Sanford, MD, a resident physician in urology; Charles McCulloch, PhD, a UCSF professor and vice chair of the department of epidemiology and biostatstics; Rachael Callcut, a UCSF assistant professor of surgery; and Peter R. Carroll, MD, MPH, chair of the UCSF Department of Urology and leader of the prostate cancer program at the UCSF Helen Diller Family Comprehensive Cancer Center.

Breyer is supported by grant K12DK083021 from the National Institute of Diabetes and Digestive and Kidney Diseases. Callcut is supported by grant 8KL2TR000143-09 from the National Institutes of Health.

About UCSF: UCSF is a leading university dedicated to transforming health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. Founded in 1864 as a medical college, UCSF now includes top-ranked graduate schools of dentistry, medicine, nursing and pharmacy; a graduate division with world-renowned programs in the biological sciences, a preeminent biomedical research enterprise and top-tier hospitals, UCSF Medical Center and UCSF Benioff Children's Hospitals. Please visit


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