Brief report

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Risk of injury for bicycling on cycle tracks versus in
the street
Anne C Lusk,1 Peter G Furth,2 Patrick Morency,3,4 Luis F Miranda-Moreno,5
Walter C Willett,1,6 Jack T Dennerlein7,8
1
Department of Nutrition, ABSTRACT safety concerns and permitting their use only in
Harvard School of Public Health, Most individuals prefer bicycling separated from motor special situations. Cycle tracks, which can be one or
Boston, MA USA two-way and resemble shared-use paths, are not
2
Department of Civil and
traffic. However, cycle tracks (physically separated
Environmental Engineering, bicycle-exclusive paths along roads, as found in The mentioned in the AASHTO bike guide. A long-
Northeastern University, Boston, Netherlands) are discouraged in the USA by engineering standing, and yet not rigorously proved, philosophy
MA USA
3
guidance that suggests that facilities such as cycle in the USA has suggested instead that ‘bicyclists
Direction de santé publique de fare best when they behave as, and are treated as,
tracks are more dangerous than the street. The objective
Montréal, Montréal, Québec,
Canada of this study conducted in Montreal (with a longstanding operators of vehicles.’13 The details about cycle
4
Département de Médecine network of cycle tracks) was to compare bicyclist injury tracks in the Dutch bicycle design manual CROW3
Sociale et Préventive, Université rates on cycle tracks versus in the street. For six cycle and crash rate comparisons between the USA and
de Montréal, Montréal, Québec, tracks and comparable reference streets, vehicle/bicycle The Netherlands 5 have been dismissed by vehicular
Canada
5 crashes and health record injury counts were obtained cycling proponents,14 with arguments of non-
Department of Civil Engineering
and Applied Mechanics, McGill and use counts conducted. The relative risk (RR) of injury transferability to the American environment. Cycle
University, Montréal, Québec, on cycle tracks, compared with reference streets, was tracks have been controversial, especially due to
Canada determined. Overall, 2.5 times as many cyclists rode on conflicting studies with warnings of increased crash
6
Department of Epidemiology, cycle tracks compared with reference streets and there rates.15 The warnings, which in the USA result in
Harvard School of Public Health,
Boston, MA, USA were 8.5 injuries and 10.5 crashes per million bicycle- striped bike lanes but not cycle tracks, come
7
Department of Environmental kilometres. The RR of injury on cycle tracks was 0.72 without any substantial study of the safety of
Health, Harvard School of Public (95% CI 0.60 to 0.85) compared with bicycling in North American cycle tracks. Using existing crash
Health, Boston, MA, USA reference streets. These data suggest that the injury risk and injury data from Montreal, Canada, a city with
8
Department of Orthopaedic a network of cycle tracks in use for more than
Surgery, Brigham and Women’s of bicycling on cycle tracks is less than bicycling in
Hospital, Harvard Medical streets. The construction of cycle tracks should not be 20 years, this study compared bicyclists’ injury and
School, Boston, MA, USA discouraged. crash rates with published data and bicyclists’
injury rates on cycle tracks versus in the street.
Correspondence to
Dr Anne Lusk, Harvard School of
Public Health, 665 Huntington
Bicycling could address obesity, cancer, stroke,
diabetes, asthma, mortality and pollution;1 2 METHODS
Avenue, Building II, Room 314,
Boston, MA 02115, USA; however, the bicycling environment is a limiting We studied six cycle tracks in Montreal that are
annelusk@hsph.harvard.edu factor. The predominant bicycle facilities in The two-way on one side of the street. Each cycle track
Netherlands and Denmark are cycle tracks, or was compared with one or two reference streets
Accepted 1 December 2010 without bicycle facilities that were considered
Published Online First bicycle paths along streets that are physically
separated from motor traffic, bicycle-exclusive and alternative bicycling routes. One reference street
9 February 2011
with a parallel sidewalk.3 Due to the separation was a continuation of the street with the cycle
from vehicles afforded by 29 000 km of cycle tracks track; the remaining streets were parallel to the
in The Netherlands plus other initiatives,4 27% of cycle track with the same cross streets as endpoints
Dutch trips are by bicycle, 55% are women, and the and, therefore, subject to approximately the same
bicyclist injury rate is 0.14 injured/million km.5 In intersection frequency and cross traffic as the cycle
the USA, 0.5% of commuters bicycle to work, only track.
24% of adult cyclists are women,6 and the injury
rate of bicyclists is at least 26 times greater than in Injury and vehicle/bicycle crash rates per
The Netherlands.5 The chief obstacle to bicycling, bicycle-kilometre
especially for women,7 children8 and seniors9 is The injury and crash rates for each cycle track were
perceived danger of vehicular traffic. This perceived determined from the emergency medical response
danger from cars appears to be real,10 as corrobo- (EMR) database16 and police-recorded vehicle/
rated by survey participants who prefer cycle tracks bicycle crashes and estimated on the cycle tracks
over roads.11 per bicycle-km. Automated 24-h bicycle counts on
Cycle track construction has been hampered in Montreal cycle tracks are available for selected
the USA by engineering guidance in the American years, with 20e64 days in each sample from May
Association of State Highway and Transportation to September. We used linear interpolation between
Officials (AASHTO) ‘Guide for the development of the 2000 and 2008 samples to determine average
bicycle facilities’12 which cautions against building daily use for the date ranges of the injury and crash
This paper is freely available two-way paths along, but physically separated counts. Average daily use was converted to annual
online under the BMJ Journals
unlocked scheme, see http:// from, a parallel road. AASHTO states that sidewalk use by multiplying by 200 ‘effective days’ in the
injuryprevention.bmj.com/site/ bikeways are unsafe and implies the same about 1 April to 15 November bicycling season (when
about/unlocked.xhtml shared-use paths parallel to roads, listing numerous seasonal cycle tracks are open), recognising that

Injury Prevention 2011;17:131e135. doi:10.1136/ip.2010.028696 131

 Brief report

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bicycle use tends to be less in April, October and November than

million bike-km
Crashes per
in the sampled months. Use estimates were converted to bicycle-
km by multiplying by segment length and the fraction of the
cycle track’s length ridden per cyclist. This fraction, which

10.5
1.9

15.7

16.4

3.2

19.3

13.9
ranged from 0.6 to 0.9, was determined using expert judgement
considering the cycle track length and opportunities for turning

million bike-km
on and off.

Injuries per
Relative Risk (RR) of injury for cycle tracks

8.5
4.1

11.6

12.5

2.3

14.1

12.3
The RR of the cycle track compared with the reference street
was estimated using bicyclist counts and injuries from the EMR

Crashes/
database.16 Although injury (EMR) and bicycle/vehicle crash

yearzz
1.8

17.0

10.2

2.6

9.2

3.2

44.0
data from police records overlap strongly, the injury data have
been shown to be more exhaustive17 and were available for
a longer period. Injury counts were determined for the 1 April to

year yy
Injuries/
15 November bicycling season and within 15 m of each street

3.9

12.6

7.8

1.9

6.7

2.8

35.7
centerline. For comparability with exposure data, it was
important to exclude individuals injured at intersections who

(millions){ **
Bike-km/year
may have been riding on a cross street; however, the EMR
database does not indicate which street the injured cyclist was
using. Therefore, using the police crash database we determined

0.96

1.08

0.62

0.81

0.48

0.23

4.18
for each section studied the fraction of bicycle/vehicle crashes
involving cyclists who were riding on cross streets, and reduced

1999e2008 x
Cyclists/day,
injury counts by that fraction.
Historical bicycle counts were available for the cycle tracks

yyInjuries (data source e emergency medical response) between 1 April and 15 November for the period 1 April 1999 to 31 July 2008 divided by 9.53.
but not the reference streets. To obtain an unbiased measure of
5316

2581

2778

2379

921

1108
relative exposure, simultaneous 2 h bicycle counts were
conducted at parallel counting sites on each cycle track and its
factorz
Length

reference street(s). Using a ratio of simultaneous counts elimi-

**Demand is lower in April, October and November and, therefore, bicycle volume for a ‘year’ is assumed to be 200 times the daily volume.
0.9

0.6

0.8

0.9

0.7

0.8
nates systematic effects on bicycle use such as weather, time and
day. The simultaneous counts were made during mild weather
Lengthy

commuting hours in 2009.

yLength of the section studied, which may be less that the entire cycle track length for comparability with reference streets.
The RR of injury for each cycle track was calculated as:
(km)

zzBicycleemotor vehicle crashes (data source e police reports) between 1 April and 15 November 2002e6, divided by 5.
1.0

3.5

1.4

1.9

3.7

1.3
injuriestrack
bikestrack
RR ¼
Delineator posts and parking lane

Raised median, delineator posts,

Raised median, delineator posts,

injuriesref Raised median, delineator posts,

bikesref
Curb and (part) planting strip
Injury and vehicle/bicycle crash rates for cycle tracks in Montreal, Quebec*

where injuriestrack and injuriesref are the count of injuries on the

cycle track and reference street(s), respectively, and bikestrack and

{‘Year’ is the 7.5 month period (1 April to 15 November) when the seasonal cycle tracks are open.
bikesref are the corresponding cyclist counts.
and parking lane
Delineator posts

Ninety-five percent CI were calculated using the variance of

parking lane

parking lane
Separation

log(ratio) based on a Poisson distribution for incidents. CI that

did not include 1 were considered statistically significant. RR for
all cycle tracks was calculated similarly using the summed data
from all the observations.
*Whole segments of the cycle track were studied and not just intersections.

xAverage for the May to September period over the period 1999e2008.

Relative danger from vehicular traffic

2-Way, 1 side of two-way street,

2-Way, 1 side of two-way street,

2-Way, 1 side of two-way street,

2-Way, 1 side of two-way street,

2-Way, 1 side of one-way street,

2-Way, 1 side of one-way street,

Reference streets were selected with vehicular traffic danger

zFraction of the study section’s length ridden by a typical rider.

(volume, speed, heavy vehicles) as similar as possible to their

cycle track; however, it was impossible to achieve exact simi-
street/sidewalk level

larity. Therefore, to compare the vehicular traffic danger, we

also calculated the ratio of motor vehicle occupant (MVO)
sidewalk level
Configuration

injuries on the cycle track street to MVO injuries on the refer-

street level

street level

street level

street level

ence street. MVO injury counts are considered a surrogate for

traffic danger a bicyclist might face on a given street apart from
any treatment.
5. Chr Colombe (seasonal)
4. Maisonneuve, w. island

RESULTS
1. Brébeuf (seasonal)

6. René-Levesque

All six cycle tracks were two-way on one side of the street and
separated from traffic by raised medians, parking lanes, or
Cycle track

(seasonal)

delineator posts. There were 8.5 injuries and 10.5 crashes per
Table 1

2. Rachel

3. Berri

million bicycle-km. The Brébeuf and Maisonneuve cycle tracks

All

stand out as safer than the other four (table 1).

132 Injury Prevention 2011;17:131e135. doi:10.1136/ip.2010.028696

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Table 2 RR of injury for cycle tracks compared to similar on-street routes for Montreal, Quebec*
Cycle track Reference street
2-h EMR- 2-h EMR-
Length bike reported bike reported
Cycle tracky Reference streetz Limiting cross streets (km) count injuriesx count injuriesx RR (95% CI){
1. Brébeuf St Denis (N) Rachel e Laurier 1.0 1193 37 437 32 0.42 (0.26 to 0.68)
2. Rachel Mont Royal St Urbain e Marquette 3.5 990 120 613 63 1.18 (0.87 to 1.60)
3. Berri St Denis (S) Cherrier e Viger 1.4 763 74 134 27 0.48 (0.31 to 0.75)
4. Maisonneuve Both Claremont e Wood 1.9 547 18 176** 18 0.32 (0.17 to 0.62)
Sherbrooke (W) 129 14 0.30
Ste Catherine 47 4 0.39
5. Christophe Colomb Both Gouin e Jarry 3.7 407 64 122 19 1.01 (0.61 to 1.68)
Saint-Hubert 45 9 0.79
Christophe Colomb (S) Villeray e Rosemont 2.3 77 10 1.21
6. René Levesque Sherbrooke (E) Lorimier e St Hubert 1.3 109 27 130 32 1.01 (0.60 to 1.68)
All 15.1 4009 340 1612 191 0.72 (0.60 to 0.85)
*Statistically significant comparisons are shown in bold.
yAll cycle tracks are two-way on one side of the street.
zAn on-street bike route on a parallel street in close proximity of the cycle track.
xInjuries recorded by emergency medical response (EMR) services between 1 April 1999 and 31 July 2008 for the season 1 April to 15 November.
{95%CI calculated using the variance of log(RR) based on a Poisson distribution.
**For comparisons having two reference streets, the total number of bicyclists is used from both streets.

Compared with bicycling on a reference street, the overall RR or similar injury rates compared with bicycling in the street
of injury on a cycle track was 0.72 (95% CI 0.60 to 0.85); thus, without bicycle provisions. This lowered risk is also in spite of the
these cycle tracks had a 28% lower injury rate. Three of the cycle less-than-ideal design of the Montreal cycle tracks, such as lacking
tracks exhibited RR less than 0.5, and none showed a signifi- parking setbacks at intersections, a recommended practice.18
cantly greater risk than its reference street. Overall, 2.5 times as While the goal of this study was to consider both one and two-
many cyclists used the cycle tracks compared with the reference way cycle tracks, all of the Montreal cycle tracks were two-way
streets (table 2). with half the bicyclists riding in a direction opposite to that of
The relative danger from vehicular traffic of the cycle tracks the closest vehicular traffic, a practice not favoured by AASHTO.
compared with their reference streets was close to 1.0 overall, Although the Montreal cycle tracks were two-way, they had
but with a wide range (table 3). Not surprisingly, the Brébeuf lower or similar risk compared with the road. The Dutch CROW
and Maisonneuve cycle tracks with lowest crash rate and rela- bicycle guidelines suggest that one-way cycle tracks are even
tive injury risk (tables 1 and 2) also had the lowest relative safer.3
danger from vehicular traffic (table 3). Yet even for the four cycle The crash rate for Montreal’s cycle tracks (10.5 crashes per
tracks on streets with vehicular traffic danger similar to or million bicycle-km) is low compared with the few and incon-
greater than its reference street, the cycle tracks still had less or sistent crash rates in the literature. When calculated to include
a similar risk of injury. only vehicle/bicycle crashes, these rates range from 3.755 to 5419
in the USA and from 4620 to 6721 in Canada. The injury rate (8.5
DISCUSSION injuries per million bicycle-km) lacks comparable data in the
Contrary to AASHTO’s safety cautions about road-parallel literature, partly because few communities have accessible
paths and its exclusion of cycle tracks, our results suggest that bicycle-incident ambulance records. Although the Brébeuf and
two-way cycle tracks on one side of the road have either lower Maisonneuve cycle tracks were safer, the sample of six cycle

Table 3 Relative danger from vehicular traffic*

MVO injuriesy
Cycle track Reference Relative traffic danger of cycle
Cycle track street Reference street street street track street (95% CI)z
1. Brébeuf St Denis (N) 8 90 0.09 (0.04 to 0.18)
2. Rachel Mont Royal 86 69 1.25 (0.91 to 1.73)
3. Berri St Denis (S) 127 116 1.09 (0.85 to 1.41)
4. Maisonneuve Both 13 59x 0.22 (0.12 to 0.40)
Sherbrooke (W) 72
Ste Catherine 46
5. Christophe Colomb Both 367 217x 1.69 (1.43 to 2.00)
Saint-Hubert 268
Christophe Colomb (S) 166
6. René Levesque Sherbrooke (E) 196 205 0.96 (0.79 to 1.16)
All All 797 756 1.05 (0.95 to 1.16)
*Statistically significant comparisons are shown in bold.
yInjuries to motor vehicle occupants recorded by emergency medical response (EMR) services between 1 January 1999 and 31 July
2008.
z95% CI calculated using the variance of log(RR) based on a Poisson distribution.
xFor comparisons having two reference streets, the average number of injuries of the reference streets is used.
MVO, motor vehicle occupant.

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Table 4 Crash RR from Wachtel and Lewiston22 data with non-intersection crashes included*
Sidewalk Roadway All
RR, sidewalk versus
Riders Crashes Riders Crashes Riders Crashes in-street (95% CI)y p Valuez
Intersection onlyx
All cyclists 971 41 2005 48 2976 89 1.76 (1.16 to 2.68) 0.01
Bicycling in same direction 656 13 1897 43 2553 56 0.87 (0.47 to 1.63) 0.56
as closest traffic lane
All crashes{
All cyclists 971 41 2005 79 2976 120 1.07 (0.73 to 1.56) 0.79
Bicycling in same direction 656 13 1897 71 2553 84 0.53 (0.29 to 0.96) 0.02
as closest traffic lane
*Statistically significant comparisons are shown in bold.
y95% CI calculated using the variance of log(IRR) based on a Poisson distribution.
zSignificance, calculated using the variance of log(IRR) based on a Poisson distribution (for comparison with original article).
xAuthors’ original data.
{Non-intersection crashes amounting to 26% of total crashes added to roadway crashes.

tracks was too small to determine which factors make some between the sidewalk bikeway and the street (table 4). For
safer. bicyclists riding in the same direction as traffic, as would be case
In one of the few comparisons of bicycling in the street versus with one-way cycle tracks, sidewalk bikeways carried only half
bicycling on a separated path parallel to the street in the USA, the risk of the street. Therefore, the Wachtel and Lewiston22
Wachtel and Lewiston22 determined a relative crash risk of 1.8 data, when corrected to include non-intersection crashes,
for bicycling on sidewalks which had been designated as bike- corroborate our findings that separated paths are safer or at least
ways, compared with bicycling in the adjacent street in Palo no more dangerous than bicycling in the street. Furthermore, as
Alto, California. However, their study considered only intersec- the most common cause of fatal bicyclist collisions in urban
tion crashes, omitting non-intersection crashes that include areas is overtaking,23 it is probable that an analysis accounting
being hit from behind, sideswiped, or struck by a car door. The for the severity of injury would be still more favourable towards
authors, though, reported that 26% of cyclistemotor vehicle cycle tracks.
collisions city-wide in Palo Alto were non-intersection crashes. If Our study considered whole segments of cycle tracks and not
non-intersection crashes are included to match this 26% just intersections, measured bicycle exposure directly, and
proportion, reanalysis of the Wachtel and Lewiston22 data in the included appropriate comparison groups. The study, though,
article shows that there is no significant difference in risk only included analysis of six cycle tracks, all of which were two-
way and in the same city, and lacked injury severity data. This
research underscores the need for better bicycle counting and
injury surveillance and for additional safety studies, particularly
What is already known on this subject of one-way cycle tracks, intersections, injury severity and other
factors that affect cycle track safety.
< Individuals, in particular women, children, and seniors, prefer
to bicycle separated from motor traffic. IMPLICATIONS FOR POLICY
< Cycle tracks (physically-separated bicycle-exclusive paths Public health and bicycling advocates in the USA have faced
along roads) exist and continue to be built in The Netherlands a dichotomy, believing from surveys and European experience
where 27% of all trips are by bicycle and 55% of bicycle riders that cycle tracks encourage more bicycling, yet being warned
are female. that they lead to higher crash and injury rates. Our results
< Engineering guidance in the United States has discouraged suggest that cycle tracks lessen, or at least do not increase, crash
bicycle facilities that resemble cycle tracks, including parallel and injury rates compared with the street. The construction of
sidepaths and sidewalk bikeways, suggesting that these cycle tracks should not be discouraged.
facilities and cycle tracks are more dangerous than bicycling
in the street. Acknowledgements The authors would like to thank Kevin Manaugh (McGill
University) and Nathalie Valois (Montreal police), who performed the geographical
queries to extract data from the crash database, and Qi Sun and Elaine Hoffman for
a review of the statistics.
Funding ACL was supported by a Ruth L Kirschstein National Research Service
What this study adds Award, F32 HL083639 from the National Institutes for Health, National Heart, Lung
and Blood Institute. LFM-M is supported for data collection by the Natural Sciences
< Overall, 2 ½ times as many cyclists rode on the cycle tracks and Engineering Research Council of Canada (discovery grant e individual).
compared with the reference streets. Competing interests None.
< There were 8.5 injuries and 10.5 crashes per million-bicycle Ethics approval The Harvard School of Public Health IRB reviewed this protocol and
kilometers respectively on cycle tracks compared to published found that approval was not required. The HSPH IRB made an exemption
injury rates ranging from 3.75 to 67 for bicycling on streets. determination.
The relative risk of injury on the cycle track was 0.72 (95% Contributors PGF had full access to the data in the study and takes responsibility for
CI=0,60-0.85) compared with bicycling in the reference the integrity of the data and the accuracy of the data analysis. Conception and design:
streets. ACL and PGF. Acquisition of data: ACL, PGF, PM and LFM-M. Analysis and
interpretation of data: ANL, PGF, PM, LFM-M, WCW and JTD. Drafting of manuscript:
< Cycle tracks lessen, or at least do not increase, crash and
ACL, PGF. Critical revision for intellectual content: ACL, PGF, PM, LFM-M, WCW and
injury rates compared to bicycling in the street. JTD. Statistical expertise: ACL, PGF, PM, LFM-M, WCW and JTD. Administrative,
technical or material support: WCW. Study supervision: PGF, WCW and JTD.

134 Injury Prevention 2011;17:131e135. doi:10.1136/ip.2010.028696

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11. Winters M, Teschke K. Route preferences among adults in the near market
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Dog attacks in Canada’s North

Following a recent mauling of a 6-year-old girl by four dogs in an Inuit community, a study by
a veterinarian in Thunder Bay, Ontario, based on media reports, revealed that ‘native commu-
nities suffer bite wounds or mauling deaths from dogs at rates more than 100 times that of the
rest of Canada’. (Postmedia news, Gazette, December 17, 2010)
Collected and edited by Barry Pless

Injury Prevention 2011;17:131e135. doi:10.1136/ip.2010.028696 135