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

Lookup NU author(s): Dr Claire WelshORCiD, Dr Carlos Celis Morales



This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0).


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.

Publication metadata

Author(s): Welsh CE, Celis-Morales CA, Ho FK, Lyall DM, Mackay D, Ferguson L, Sattar N, Gray SR, Gill JMR, Pell J, Welsh P

Publication type: Article

Publication status: Published

Journal: British Medical Journal

Year: 2020

Volume: 368

Print publication date: 31/03/2020

Online publication date: 11/03/2020

Acceptance date: 16/01/2020

Date deposited: 17/08/2021

ISSN (print): 0959-8138

ISSN (electronic): 1756-1833

Publisher: BMJ Group


DOI: 10.1136/bmj.m336


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