TY  - JOUR
PY  - 2019//
TI  - Individual and environmental factors associated with death of cyclists involved in road crashes in Spain: a cohort study
JO  - BMJ open
A1  - Molina-Soberanes, Daniel
A1  - Martínez-Ruiz, Virginia
A1  - Lardelli-Claret, Pablo
A1  - Pulido-Manzanero, José
A1  - Martín-delosReyes, Luis Miguel
A1  - Moreno-Roldán, Elena
A1  - Jiménez-Mejías, Eladio
SP  - e028039
EP  - e028039
VL  - 9
IS  - 8
N2  - OBJECTIVE: To quantify the magnitude of associations between cyclist fatalities and both cyclist and environment related characteristics in Spain during the first 24 hours after a crash. <br><br>DESIGN: Cohort study. SETTING: Spain. PARTICIPANTS: 65 977 cyclists injured in road crashes recorded between 1993 and 2013 in the Spanish Register of Road Crashes with Victims. MAIN OUTCOME: Death within the first 24 hours after the crash. <br><br>METHODS: A multiple imputation procedure was used to mitigate the effect of missing values. Differences between regions were assumed and managed with multilevel analysis at the cyclist and province levels. Incidence density ratios (IDR) with 95% CI were calculated with a multivariate Poisson model. <br><br>RESULTS: Non-use of a helmet was directly associated with death (IDR 1.43, 95% CI 1.25 to 1.64). Among other cyclist characteristics, age after the third decade of life was also directly associated with death, especially in older cyclists ('over 74' category, IDR 4.61, 95% CI 3.49 to 6.08). The association with death did not differ between work-related cycling and other reasons for cycling.There was an inverse association with death for crashes in urban areas and on community roads. Any adverse meteorological condition also showed a direct association with death, whereas altered road surfaces showed an inverse association. Crashes during nighttime were directly associated with death, with a peak between 3:00 and 5:59 am (IDR 1.58, 95% CI 1.03 to 2.41). <br><br>CONCLUSIONS: We found strong direct and inverse associations between several cyclist and environment related variables and death. These variables should be considered in efforts to prioritise public health measures aimed at reducing the number of cycling-related fatalities.<br><br>© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.<p />  <p>Language: en</p>
LA  - en
SN  - 2044-6055
UR  - http://dx.doi.org/10.1136/bmjopen-2018-028039
ID  - ref1
ER  -