Bicycling injuries in children and the role of the built environment: a case-crossover study

Bicycling has many health benefits for children but can result in injuries. The built environment is associated with the risk of bicycling injury in adults, yet less is known about risks for children. This study sought to explore associations between built environment characteristics and child bicyclist injuries in three Canadian municipalities.

A case-crossover design where injured child bicyclists provided their injury site and two control sites along their route was used. Participants were recruited from three paediatric emergency departments in Vancouver, Calgary and Toronto. We recruited 333 injured child bicyclists (ages 5-17) from May 2018 to October 2021. Participants completed interviews that captured details concerning their injury location and route. We conducted built environment audits along the child's bicycling route at the injury and two control sites. We compared the odds of injury across built environment characteristics of the injury and control sites using a mixed-effects logistic regression model.

The median route distance to the injury location was 742 m. Most participants were injured while bicycling on local streets and on sidewalks/paths next to the road. Compared with sidewalks/paths next to the road, unpaved off-road locations (adjusted OR (aOR): 2.45; 95% CI 1.33 to 4.51) were associated with higher odds of injury. Other risk factors included locations with debris (aOR: 1.52; 95% CI 1.05 to 2.21), surfaces with bumps/holes (aOR 2.14, 95% CI 1.25 to 3.66) and construction (aOR: 2.31; 95% CI 1.37, 3.91).

This study adds to evidence suggesting built environment supports are important for increasing bicycling safety for Canadian children.