Association of injury related hospital admissions with commuting by bicycle in the UK: prospective population based study

Welsh, C. et al. (2020) Association of injury related hospital admissions with commuting by bicycle in the UK: prospective population based study. British Medical Journal, 368, m336. (doi: 10.1136/bmj.m336) (PMID:32161038) (PMCID:PMC7190046)

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Objective: To determine whether bicycle commuting is associated with risk of injury. Design: Prospective population based study. Setting: UK Biobank. Participants: 230 390 commuters (52.1% women; mean age 52.4 years) recruited from 22 sites across the UK compared by mode of transport used (walking, cycling, mixed mode versus non-active (car or public transport)) to commute to and from work on a typical day. Main outcome measure: First incident admission to hospital for injury. Results: 5704 (2.5%) participants reported cycling as their main form of commuter transport. Median follow-up was 8.9 years (interquartile range 8.2-9.5 years), and overall 10 241 (4.4%) participants experienced an injury. Injuries occurred in 397 (7.0%) of the commuters who cycled and 7698 (4.3%) of the commuters who used a non-active mode of transport. After adjustment for major confounding sociodemographic, health, and lifestyle factors, cycling to work was associated with a higher risk of injury compared with commuting by a non-active mode (hazard ratio 1.45, 95% confidence interval 1.30 to 1.61). Similar trends were observed for commuters who used mixed mode cycling. Walking to work was not associated with a higher risk of injury. Longer cycling distances during commuting were associated with a higher risk of injury, but commute distance was not associated with injury in non-active commuters. Cycle commuting was also associated with a higher number of injuries when the external cause was a transport related incident (incident rate ratio 3.42, 95% confidence interval 3.00 to 3.90). Commuters who cycled to work had a lower risk of cardiovascular disease, cancer, and death than those who did not. If the associations are causal, an estimated 1000 participants changing their mode of commuting to include cycling for 10 years would result in 26 additional admissions to hospital for a first injury (of which three would require a hospital stay of a week or longer), 15 fewer first cancer diagnoses, four fewer cardiovascular disease events, and three fewer deaths. Conclusion: Compared with non-active commuting to work, commuting by cycling was associated with a higher risk of hospital admission for a first injury and higher risk of transport related incidents specifically. These risks should be viewed in context of the health benefits of active commuting and underscore the need for a safer infrastructure for cycling in the UK.

Item Type:Articles
Additional Information:Funding: This study was supported by a grant from Chest, Heart, and Stroke Association Scotland (Res16/A165]).
Glasgow Author(s) Enlighten ID:Gill, Professor Jason and Ho, Dr Frederick and Mackay, Professor Daniel and Welsh, Dr Claire and Ferguson, Dr Lyn and Welsh, Professor Paul and Celis, Dr Carlos and Gray, Professor Stuart and Pell, Professor Jill and Sattar, Professor Naveed and Lyall, Dr Donald
Authors: Welsh, C., Celis-Morales, C. A., Ho, F., Lyall, D. M., Mackay, D., Ferguson, L., Sattar, N., Gray, S. R., Gill, J. M.R., Pell, J. P., and Welsh, P.
College/School:College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
College of Medical Veterinary and Life Sciences > School of Health & Wellbeing > Public Health
Journal Name:British Medical Journal
Publisher:BMJ Publishing Group
ISSN (Online):1756-1833
Copyright Holders:Copyright © 2020 BMJ Publishing Group Ltd
First Published:First published in BMJ 368:m336
Publisher Policy:Reproduced under a Creative Commons license
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