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

BMJ 2020; 368 doi: (Published 11 March 2020) Cite this as: BMJ 2020;368:m336

Linked Editorial

Designing better cycling infrastructure

  1. Claire Welsh, medical statistician1,
  2. Carlos A Celis-Morales, research fellow123,
  3. Frederick Ho, research associate1,
  4. Donald M Lyall, lecturer3,
  5. Daniel Mackay, professor4,
  6. Lyn Ferguson, student1,
  7. Naveed Sattar, professor1,
  8. Stuart R Gray, senior lecturer1,
  9. Jason M R Gill, professor1,
  10. Jill P Pell, professor3,
  11. Paul Welsh, senior lecturer1
  1. 1Institute of Cardiovascular and Medical Sciences, University of Glasgow, BHF Glasgow Cardiovascular Research Centre, Glasgow, G12 8TA, UK
  2. 2Centre for Exercise Physiology Research (CIFE), Universidad Mayor, Santiago, San Pío, Chile
  3. 3Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
  4. 4School of Medicine, Dentistry and Nursing, University of Glasgow, UK
  1. Correspondence to: P Welsh paul.welsh{at} (or @UofGICAMS on Twitter)
  • Accepted 16 January 2020


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.


  • Contributors: CW and CCM contributed equally to this work and are joint first authors. CW, CCM, FH, SG, JMRG, NS, JPP, and PW conceived and designed the study, advised on all statistical aspects, and interpreted the data. CW, CCM, FH, and PW did the statistical analysis. CW, CCM, and PW drafted the manuscript. All authors reviewed the manuscript and approved the final version to be published. All authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. CW, CCM, JPP, and PW are the guarantors. The corresponding author attests that all listed authors meet authorship criteria and that no others meeting the criteria have been omitted.

  • Funding: This study was supported by a grant from Chest, Heart, and Stroke Association Scotland (Res16/A165]) The research was designed, conducted, analysed, and interpreted by the authors entirely independently of the funding sources.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: funding by a grant from Chest, Heart, and Stroke Association Scotland; JMRG, PW, CACM, NS, SRG, and JPP have received grant funding from British Cycling and HSBC UK for the Cycle Nation Project, a workplace based intervention to increase cycling participation, outside the submitted work; no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: UK Biobank received ethical approval from the North West Multi-centre Research Ethics Committee (REC reference: 11/NW/03820). All participants gave written informed consent before enrolment in the study, which was conducted in accordance with the principles of the Declaration of Helsinki.

  • Data sharing: Researchers can apply to use the UK Biobank resource and access the data used. No additional data available.

  • The manuscript’s guarantors (CW, CCM, JPP, and PW) affirm that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned (and, if relevant, registered) have been explained.

  • Dissemination to participants and related patient and public communities: There are no plans to disseminate the results of the research to study participants directly, but results will be made publicly available by open access publication, press release, and dissemination via social media and UK Biobank resources such as its website.

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