Safety in numbers in Australia: more walkers and bicyclists, safer walking and bicycling.

ISSUE ADDRESSED Overseas research shows that fatality and injury risks per cyclist and pedestrian are lower when there are more cyclists and pedestrians. Do Australian data follow the same exponential 'growth rule' where (Injuries)/(Amount of cycling) is proportional to ((Amount of cycling)-0.6)? METHOD Fatality and injury risks were compared using three datasets: 1) fatalities and amounts of cycling in Australian States in the 1980s; 2) fatality and injury rates over time in Western Australia as cycling levels increased; and 3) deaths, serious head injuries and other serious injuries to cyclists and pedestrians in Victoria, before and after the fall in cycling with the helmet law. RESULTS In Australia, the risks of fatality and injury per cyclist are lower when cycling is more prevalent. Cycling was safest and most popular in the Australian Capital Territory (ACT), Queensland and Western Australia (WA). New South Wales residents cycled only 47% as much as residents of Queensland and WA, but had 53% more fatalities per kilometre, consistent with the growth rule prediction of 52% more for half as much cycling. Cycling also became safer in WA as more people cycled. Hospitalisation rates per 10,000 regular cyclists fell from 29 to 15, and reported deaths and serious injuries from 5.6 to 3.8 as numbers of regular cyclists increased. In Victoria, after the introduction of compulsory helmets, there was a 30% reduction in cycling and it was associated with a higher risk of death or serious injury per cyclist, outweighing any benefits of increased helmet wearing. CONCLUSIONS As with overseas data, the exponential growth rule fits Australian data well. If cycling doubles, the risk per kilometre falls by about 34%; conversely, if cycling halves, the risk per kilometre will be about 52% higher. Policies that adversely influence the amount of cycling (for example, compulsory helmet legislation) should be reviewed.