This is the first report of cycling fatalities in Alberta, a province with two large urban areas, five mid-sized regional centers, and a large number of small towns across sparsely populated rural areas. Fatally injured cyclists were most often adult males and commonly sustained their injuries following a collision with a motor vehicle. Reported helmet use was infrequent, and 76 % of fatally injured cyclists suffered a head or brain injury. Fatal cycling collisions most often occurred in urban locations, on roads, and during times of good light and fair weather (i.e., when cycling is most frequent).
Notable differences were observed in deceased cyclists and crash circumstances between urban and rural areas. Although most fatal cycling crashes in Alberta occurred in urban areas, the rates of cycling deaths per 1,000,000 inhabitants per year were noticeably higher in rural regions where cyclists may ride more often on highways due to lack of other available routes. Additionally, health resources are typically more limited in rural regions which may result in a longer delay between crash occurrence and receiving advanced trauma care than in urban areas [20]. The fatality rate was especially high in the Alberta Rockies, which has a very small population and is popular with cycle-tourists. Future research should examine the burden on local health systems due to injuries occurring in non-residents, as this could have implications for where to target injury prevention strategies. Cyclists killed in urban areas more frequently had evidence of alcohol use than cyclists killed in rural areas. Cycling may be viewed by urban cyclists as a safe transportation alternative to driving after planned drinking; on the other hand, cycling after drinking is not as feasible in rural areas due to the often long travel distances.
Canadian cycling fatalities have been previously examined in British Columbia and Ontario. In British Columbia, cyclists were at higher risk of being struck by a motor vehicle and fatal injury than in-line skaters and skateboarders [13]. In Ontario, young (<10 years old) and older (≥45 years old) cyclists who died after a cycling crash more frequently made cycling errors that contributed to the crash than adolescents and younger adults, while 19–44 year olds were more frequently killed while cycling at night [16]. The most recent Ontario inquiry, which had similar findings to the current study, resulted in a Coroner’s Report and recommendations for safer cycling [7, 21].
Despite the provincial differences, these results from Alberta mainly agree with previous studies of Canadian cycling fatalities in that the majority of cyclist deaths involved males and were the result of collisions with motor vehicles [7, 16]. However, while previous reports from Ontario and the United States indicated that one-third of cycling fatalities occurred in children, [16, 22] only 19 % of deceased cyclists in the current report were under the age of 20. In our study, all children and most of adolescents died after a collision with a motor vehicle, which is consistent with other reports of pediatric cycling fatalities [15, 16]. It is possible that recently implemented interventions aimed to reduce distracted driving may also help to reduce cycling fatalities.
Cycling fatalities among children and adolescents have been decreasing nationally, which may result from improvements in the built environment and/or mandatory helmet legislation (MHL), which was introduced first in Canada in Ontario in 1998, in 2002 in Alberta (for cyclists <18 years only), and has since been introduced in other provinces. Although reported helmet use was low in this study, a larger proportion of fatally injured cyclists were wearing a helmet compared with older reports [4, 15, 16]. This increase is likely due to the influence of MHL, which (although targeted at under-age cyclists) has been shown to increase helmet use among all ages [18].
It is interesting to note that the population-based rate of fatal cycling events increased with age, but this observation must be interpreted with caution. Older cyclists may be less coordinated and frailer than younger cyclists and therefore more likely to be involved in a cycling crash and sustain more serious injuries; [23] however, data on cycling exposure including distance traveled, number of trips, and number of cyclists, are not readily available for Alberta, and it is possible (although unlikely) that older cyclists have a higher level of exposure to cycling which may bias the population-based rate upwards.
Alcohol use prior to fatal cycling events was particularly concerning. The correlation of alcohol consumption with non-use of protective devices such as helmets and seatbelts has been previously documented and is also indicated by our data, as deceased cyclists with evident alcohol use were less frequently reported to have been wearing a helmet than deceased cyclists without evident alcohol use [24]. The legal BAC limit for motorists in Alberta during the study period was 0.08 g/dL (17 mmol/L). Twenty-three of the 26 deceased cyclists with evident alcohol consumption, and all of those between 20 and 44 years old, were over the legal limit. Similar to a previous report, [25] in this study a larger proportion of deceased cyclists involved in non-MVCC collisions were intoxicated. Compared with the widespread knowledge of the effects and penalties of consuming alcohol before driving a motor vehicle, [26] cyclists may not recognize the danger of impairment while cycling and may use cycling as an alternative mode of transportation after social drinking, which is suggested by the high proportion of younger adult (20–44 years old) cyclists with evident alcohol use who were over the legal limit for operation of a motor vehicle. Additionally, drivers who lose their license due to impaired driving convictions are likely to turn to cycling as an alternative mode of transportation [27]. Drinking and biking has been identified as a potential issue elsewhere; [28] further study on the attitudes around drinking and cycling is needed to develop successful strategies to reduce injuries resulting from drinking and biking.
Cycling fatalities account for a disproportionate 3.2 % of Canadian road fatalities, though cyclists only make up 1.2 % of regular road users [12, 29]. Reports of cyclist crashes contribute to a lack of safety perceived by both cyclists and non-cyclists [12]. While the results presented here represent only one province, there are few other studies of cycling fatalities in regions with similar demographic and climactic characteristics, and the results presented here may be of interest to policy- and decision-makers in other regions with a low population densities and cold climates in Canada, such as Saskatchewan, Manitoba, and the Territories, and around the world (e.g., Northern mid-west US states, eastern Russia, etc.)
Future efforts to reduce cycling fatalities will require attention to interactions between motorists and cyclists. Prevention strategies that target risk-taking behaviors among cyclists, including education for cyclists on the potential dangers of drinking and cycling and encouraging all cyclists to wear a helmet should be explored. In addition, educational initiatives to instruct safe interactions between all types of road users should be implemented in Alberta, and other similar regions, to inform all road users on how to safely interact with each other [30]. These safety initiatives could help to reduce the public’s perception of cycling as a dangerous activity, and therefore help to decrease injuries, increase physical activity, and promote the uptake of active transportation.
Limitations
The results of this exploratory study should be interpreted with caution, due to the lack of a control group. The retrospective methods employed in this study present several limitations. Relevant cases may have been missed due to miscoding, and OCME files are not available for cases in which an investigation, litigation or criminal proceedings are ongoing; however, given the small number of fatalities that occurred in the late fall and winter in other years, it is unlikely that a significant number of cases from 2011 were missed. The level of detail and missing data in the OCME files varied; thus the proportions listed here should be interpreted conservatively, as they may be underestimates. The rates calculated for the whole study period may over-estimate the annual cycling fatality rates prior to 2006 and under-estimate the annual rates after 2006 due to variation in the annual number of events and the change in Alberta’s population over the study period. Finally, the use of population as the denominator for the fatality rates here does not reflect the risk of death due to exposure to cycling.