Association of Infrastructure and Route Environment Factors with Cycling Injury Risk at Intersection and Non-Intersection Locations: A Case-Crossover Study of Britain.

OBJECTIVE: This paper examines infrastructural and route environment correlates of cycling injury risk in Britain for commuters riding in the morning peak. METHODS: The study uses a case-crossover design which controls for exposure. Control sites from modelled cyclist routes (matched on intersection status) were compared with sites where cyclists were injured. Conditional logistic regression for matched case-control groups was used to compare characteristics of control and injury sites. RESULTS: High streets (defined by clustering of retail premises) raised injury odds by 32%. Main (Class A or primary) roads were riskier than other road types, with injury odds twice that for residential roads. Wider roads, and those with lower gradients increased injury odds. Guard railing raised injury odds by 18%, and petrol stations or car parks by 43%. Bus lanes raised injury odds by 84%. As in other studies, there was a 'safety in numbers' effect from more cyclists. Contrary to other analysis, including two recent studies in London, we did not find a protective effect from cycle infrastructure and the presence of painted cycle lanes raised injury odds by 54%. At intersections, both standard and mini roundabouts were associated with injury odds several times higher than other intersections. Presence of traffic signals, with or without an Advanced Stop Line ('bike box'), had no impact on injury odds. For a cyclist on a main road, intersections with minor roads were riskier than intersections with other main roads. CONCLUSIONS: Typical cycling environments in Britain put cyclists at risk, and infrastructure must be improved, particularly on busy main roads, high streets, and bus routes.