A Study on Bicycle-Related Injuries and Their Costs in Shanghai, China
Yan-Hong, Li, Rahim, Yousif, De-Ding, Zhou, Journal of Environmental Health
Injury-related fatalities in China are an under-recognized public-health problem, with more than 800,000 deaths per year. Traffic-related injuries are the most common cause of injury-related death. The proportion of all injury-related deaths due to traffic injuries increased from 15% in 1987-1988 to 34% in 2005-2006; the corresponding death rate increased by 81%, from 12.4 per 100,000 to 22.4 per 100,000 (Wang et al., 2008). An estimated 1.4 billion bicycles are in the world, and 0.44 billion of them are in China (Wang, 1998). Unlike Europe, the U.S., and other
developed countries, China is a developing country with a large population. Bicycles are the most important means of transportation for ordinary Chinese people, and the frequent images of masses of cyclists earned China the nickname of the "Bicycle Kingdom." In 1992 Shanghai had over 6.3 million bicycles, and this number increased to over 10.2 million in 2004 (Shanghai Municipal Statistics Bureau, 2004). Most bicycles are used by workers and students commuting to and from work or school (Li et al., 2002).
Bicyclists are vulnerable to severe injury on roads all over the world; however, sharp differences exist among countries regarding bicycle-related injuries. In the U.S., bicycle fatalities accounted for 1% of all traffic fatalities, with a fatality rate of 0.25 per 100,000 population in 2004 (U.S. Department of Transportation, 2004). In Europe, bicyclists accounted for 5%6% of deaths and 7%-8% of injuries (Mohan, 2002a). Bicyclists accounted for 5% of road deaths in Malaysia (Kareem, 2003). In India, bicyclists represented between 12% and 21% of road user fatalities, the second-largest category after pedestrians (Sarin et al., 1990). In Wuhan, bicyclists accounted for about 45% of all traffic fatalities (Li & Baker, 1997). In Beijing, about a third of all traffic deaths involved bicyclists (World Health Organization [WHO], 2004). In Shanghai, injuries have become the fourth-leading cause of death for Shanghai's population, and road-traffic injuries ranked as the first-leading cause of injuries. Over 1,500 deaths occurred due to traffic-related injuries annually in Shanghai from 1987 to 2003, and this is rising year by year with rapid motorization. The annual rate of increase was 3.59% in fatalities (from 7.78 to 14.18 per 100,000 population) and 10.46% in nonfatalities (from 53.93 to 264.98 per 100,000 population) during this period. The argument that bicycle injuries are frequent and unavoidable has been encountered often in China (Li et al., 2006a; Li et al., 2006b; Shanghai Municipal Statistics Bureau, 2004). Traditionally, most efforts have focused on motor vehicle crashes. Bicycle-related injuries are not given proper recognition as a public health problem and attract little attention in research and city designs in China. The nature and extent of such injuries remain largely unknown. Thus an urgent need exists to recognize the worsening situation in bicycle-related deaths and injuries and to take appropriate action at once (Thompson & Rivara, 2001).
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The study discussed here examined the circumstances and nature of bicycling injuries and estimated their cost in the city of Shanghai, China, in the context of epidemiological, technological, and cultural transitions.
Sources of Data
Data for our study were collected from the following sources.
1. Information on morbidity rates and their constitutional proportion from bicycle-related injuries in Shanghai were from a retrospective survey about injury disease burden conducted in all 19 districts of Shanghai in 2005. The data for bicycle-related injuries were abstracted from the cross-sectional survey for the purpose of the study
2. Information on cases of hospitalization and fatalities due to bicycle-related injuries in Shanghai's 494 hospitals from 1992 to 2004 was analyzed. …