Date Published: July 13, 2017
Publisher: Public Library of Science
Author(s): Youn-Jung Kim, Dong-Woo Seo, Jae-Ho Lee, Yoon-Seon Lee, Bum-Jin Oh, Kyoung-Soo Lim, Won Young Kim, Jake Olivier.
This study aimed to examine trends in the incidence and outcomes of bicycle-related injuries in emergency departments (ED) in South Korea.
We analysed data from the National Emergency Department Information System database for adult patients (≥20 years) with bicycle-related injuries presenting to EDs in South Korea between January 2012 and December 2014. Riders and bicycle passengers whose injuries were associated with bicycle use were included. Serious outcomes were defined as death at the ED, need for emergency operation, or intensive care unit admission.
The number of people who commute to work by bicycle increased by 36% from 205,100 in 2005 to 279,544 in 2015. Of 529,278 traffic-related trauma cases, 58,352 (11.0%) were bicycle-related, which increased from 7,894 (10.2%) in the first half of 2012 to 12,882 (12.2%) in the second half of 2014 (p < 0.001). However, the proportion of serious outcomes decreased from 5.0% to 4.2% during the study period (p < 0.001). Serious outcomes were most frequent in the elderly (65–74 years) and older elderly (≥75 years) groups and decreased for all but the elderly age group from 10.3% to 9.8% (p = 0.204). The helmet use rate increased from 14.2% to 20.3% (p < 0.001) but was the lowest in the older elderly group (3.6%) without change during the study period (from 4.7% to 3.7%, p = 0.656). A lack of helmet use was significantly associated with serious outcomes (odds ratio, 1.811; 95% confidence interval, 1.576–2.082). Although the incidence of bicycle-related injuries increased, the proportion of serious outcomes decreased, possibly due to increased helmet use. Public education on safety equipment use is required, especially in elderly populations.
Bicycle riding is a popular leisure activity worldwide. In South Korea, the government has promoted a bicycle-friendly infrastructure since 2010 to benefit the environment and ease urban traffic congestion. The number and length of bike lanes in South Korea have increased from 5,392 lanes and 13,037 km in 2010 to 9,374 lanes and 19,717 km in 2014 [1, 2]. Although detailed demographic data of the typical cycling population in South Korea is not available, according to a population census conducted by the National Statistical Office (NSO), Statistics Korea, the number of people who commute to work by bicycle increased by 36% from 205,100 in 2005 to 279,544 in 2015 [3, 4]. Annual bicycle sales also increased by 40% between 2008 and 2012. As bicycle riding increased in Korea, the incidence of bicycle-related injuries has also increased rapidly.
Among 529,278 traffic-related trauma cases over a 3-year period, 58,352 (11.0%) were identified as bicycle-related injuries (Table 1). The majority of patients (80.6%) were less than 65 years of age, either 30 to 64 years old (59.0%) or 20 to 29 years (21.6%). The 100,000 population-based rate of bicycle injury by age group was highest in the 65 to 74 year olds group between 2012 and 2013, while highest in the 20 to 29 year olds group in 2014. Approximately three-quarters of the patients were male (75.2%), and the ratio of rural to urban injury locations was approximately 1:1.
This population-based study evaluated temporal epidemiologic changes in bicycle-related injuries presenting to EDs in South Korea between 2012 and 2014. We found that the incidence of bicycle-related injuries increased gradually in all groups but that the proportion of serious outcome decreased during the study period in all but the elderly group (65–74 years). The rate of helmet use also increased continuously, but it remained low. Notably, the rate of helmet use was lowest (3.6%) among older elderly patients (≥75 years) and did not increase during the study period, and older elderly patients showed the highest frequency of serious outcomes.