Electric-bicycle-related injury: a rising traffic injury burden in China
- 1The 1st Affiliated Hospital, Zhejiang University, Hangzhou, PR China
- 2Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
- 3Traffic Police Division, Hangzhou Police Bureau, Hangzhou, PR China
- 4Zhejiang Police Agency, Hangzhou, PR China
- Correspondence to Dr Tao Jin, The 1st Affiliated Hospital, Zhejiang University, 79 QingChun Road, Hangzhou 310003, PR China;
Contributors All authors contributed suitably to the following: conception and design, acquisition of data or analysis and interpretation of data; drafting the article or revising it critically for important intellectual content; final approval of the version published.
- Accepted 10 April 2010
- Published Online First 24 June 2010
Objective To examine the rising casualty rate related to electric bicycle usage.
Design Analysis of the Hangzhou Police Bureau's data on electric-bicycle-related injuries and deaths.
Setting Hangzhou, China, 2004–2008.
Patients or subjects Electric-bicycle riders.
Main outcome measure Electric-bicycle-related casualty rates in Hangzhou from 2004 to 2008.
Results There was a significant average annual increase in electric-bicycle-related casualty rates of 2.7 per 100 000 population (95% CI 1.5 to 3.9, p=0.005). At the same time, overall road traffic and manual-bicycle-related deaths and injuries decreased.
Conclusion As it is difficult to ban the use of electric bicycles in China, laws, rules and regulations need to be reinforced and strengthened. New regulations should be created for the safety of electric bicycle riders and others on the road, and mandatory helmet use should be considered.
In 1998, the electric bicycle (EB) entered China's market. A transportation vehicle powered by rechargeable battery and characterised as an energy-saving, environmentally friendly, convenient mode of transport, its cost of US$150–300 is affordable for most Chinese families.1 Hangzhou, a famous medium-sized tourist city in southeastern China with a 2007 population of 6 604 000, pioneered the use of EBs mainly to reduce carbon dioxide emissions. On a fully charged battery, the EB's range is 20–30 km; its maximum speed is 50–60 km/h, and it can also be powered manually by pedalling. Reasons for the popularity of the EB in China include its range, low maintenance cost, and the ease associated with parking it. It is an ideal and suitable transportation vehicle for Chinese people and is becoming very popular among commuters in middle-sized cities. Currently, no licence, insurance, or obligatory helmet use is required to operate the EB.
Along with its rise in popularity is a concomitant increase in EB-related casualty (injury or death) rate; the injury and death burden associated with this vehicle should be of concern to authorities. We set out to investigate the circumstances of road traffic injuries and deaths from 2004 to 2008, and propose suitable injury prevention strategies for the predicted large-scale EB use in China and potentially other countries.
We analysed Hangzhou Police Bureau's data on electric bicycle-related injuries and deaths for Hangzhou, China from 2004 to 2008. Local traffic police officers record all road traffic collisions, and related personal injuries and deaths are reported monthly to the Hangzhou Public Security Bureau, Traffic Police Branch. The Hangzhou Police Road Traffic Dataset is compiled annually. Information in the dataset includes sex, age, identification number, time of day of incident, and injury severity. Whether the victim is a permanent or temporary resident can be determined from the identification number. Injury severity is classified as fatal (death on the spot or within 7 days of hospitalisation) or injured (non-fatal injury with or without disability, including those who died after 7 days of hospitalisation). The Zhejiang University Ethics Committee and Zhejiang Province Traffic Agency approved the study.
Censuses were carried out in 2001, 2006 and 2008 by the Hangzhou Municipal Statistics Bureau. Our population data were obtained from this bureau. The number of registered EBs was obtained from the Department of Vehicle Management, which is affiliated with the Hangzhou Public Security Bureau, Traffic Police Branch. No data are available for the manual bicycle (MB) after 2006, which is when the government stopped requiring MB registration. The number of registered MBs was around 1 000 000 in 2005. This is thought to have remained relatively stable from 2006 to 2008 for several reasons: firstly, there is no official requirement to discard the MB; secondly, once a bicycle is bought, it can be used for tens of years with very low maintenance; thirdly, the EB is consuming a portion of the MB market share; and fourthly, there are 1380 public MB service stations and 33 000 public MBs available in Hangzhou, making it easy for a citizen to ‘rent’ a bicycle for nothing at almost every corner of the city.
Overall traffic, EB-related and MB-related casualty rates for each year were estimated by dividing counts of injuries and deaths by the corresponding population estimate. A Poisson regression model was used to estimate rate ratios for the average annual changes in casualty rates. Residence type, age, gender and time of collision were recorded on the police report. Evidence for residence type, gender, age and rush hour differences in the average annual change in injury and death rates was assessed in a linear regression model.
From 2004 to 2008, the total road traffic collision death1 rate decreased in Hangzhou (table 1; casualty data from Police Department of Hangzhou; population data from Hangzhou Municipal Statistics Bureau). On the basis of the regression model, mortality decreased annually by 1.1 per 100 000 persons (p=0.011).
However, although the total numbers of road traffic collisions and death rates in Hangzhou have been decreasing, EB-related casualties are increasing (table 2; data from Police Department of Hangzhou). The death rate increased more than sixfold between 2004 and 2008, and the injury rate increased almost fourfold during the same time period. Although the number of casualties per 100 000 registered EBs appears to be decreasing, this can be attributed to the fact that the total number of registered EBs is increasing faster than the population.
Also, as shown in table 3, MB-related mortality and non-fatal injuries decreased, while the total number of registered MBs is thought to have remained stable at around 1 000 000 from 2004 to 2008 in Hangzhou.
Figure 1 depicts the decreasing trend of MB-related deaths and non-fatal injury cases compared with increasing EB-related deaths and non-fatal injury cases from 2004 to 2008.
A linear regression model was used to analyse EB-related and MB-related casualties. We found that the unadjusted EB-related road traffic injuries and deaths increased at a rate of 145 persons per year (95% CI 51.7 to 239.1, p=0.016). After adjustment for population, the average increase in EB-related casualties was 2.7 persons per 100 000 per year (95% CI 1.50 to 3.86, p=0.005). The unadjusted EB-related deaths increased at a rate of 32 persons per year (95% CI 19.7 to 43.5, p=0.003); after adjustment for population, the increase was 0.4 deaths per 100 000 per year (95% CI 0.24 to 0.54, p=0.004).
Among the 397 cases of EB-related deaths, nearly 58% involved people younger than 30 years old; female victims accounted for ∼61%, almost 66% involved temporary residents, and nearly 66% occurred around rush hour.
This is the first study to examine EB-related road traffic casualty rates in China, and perhaps the world. While we found a decline in total road traffic casualty rates and MB-related casualties, we found that EB-related casualties increased from 2004 to 2008. Our results provide evidence that EB-related injury and death should be of concern to authorities, especially since the EB is an increasingly popular, convenient transportation vehicle for commuters.
Since most injuries are minor, police officers do not record a large percentage of the injuries. Thus the numbers are thought to be under-reported. Police officers will often suggest that both parties involved in a traffic collision negotiate with each other if neither is severely injured. On the other hand, numbers of EB-related deaths are likely to be accurate because of current laws and regulations in China.
Implications for prevention and intervention
Currently, although the EB has economic and environmental advantages, it is still forbidden in most large cities such as Beijing, Guangzhou, Shanghai and Shenzhen. Government reasons for forbidding EBs in large cities centre around battery pollution. The demand for EBs is high, since many people can only afford this mode of transport. The EB is widely used even in cities where it is forbidden. The authority of the law is essentially disrespected, especially by temporary residents who are originally from rural areas and are working or living temporarily in Hangzhou because of the rapid industrialisation and urbanisation of this area.
The circumstances surrounding EB usage and the government's position have changed dramatically. To cooperate with the carbon reduction promise that the Chinese government made at the recent Copenhagen Climate Summit, the new national general technical standard for EB was promulgated on 8 December 2009 and took effect in January 2010. Under the terms of the new classification of EBs, those under 40 kg in weight with a top speed of 20 km/h will be classified as EBs, while those over 40 kg in weight with a top speed of 20 km/h will be classified as electric motorcycles. According to such classification, EBs should abide by the designated MB laws already in place, and most cities will give official entry permits for EBs.
On the basis of our research, proposed policies and suggestions should focus on regulating the use of EBs and reinforcing laws and regulations to improve safety and prevent injuries and deaths. Per police agency reports, the leading cause of EB-related death is speeding; other causes include using motor vehicle lanes, carrying goods or children while riding the EB, and failing to obey traffic signals. Regulations that should be considered include: mandatory helmet usage,2–4 since helmets are not currently required; special EB traffic lanes in urban areas; a licence to operate an EB; and mandatory insurance cover for EB owners.
What is already known on this subject
Electric bicycles are a widely used, popular mode of transport in China.
Banning use of electric bicycles is not feasible, and injury prevention strategies are needed.
What this study adds
New information suggests that electric bicycle (EB)-related casualties are increasing in Hangzhou, China.
A clear comparison between EB-related and manual bicycle (MB)-related casualty rates.
Suitable injury prevention strategy suggestions for authorities in China and around the world where EBs are used.
Competing interests None.
Ethics approval This study was conducted with the approval of the Zhejiang University Ethics Committee and Zhejiang Province Traffic Agency.
Provenance and peer review Not commissioned; externally peer reviewed.