Inj Prev 8:47-52 doi:10.1136/ip.8.1.47
  • Original Article

State level estimates of the incidence and economic burden of head injuries stemming from non-universal use of bicycle helmets

  1. J Schulman1,
  2. J Sacks2,
  3. G Provenzano1
  1. 1Battelle Memorial Institute, Centers for Public Health Research and Evaluation, Atlanta, Georgia, USA
  2. 2Division of Unintentional Injury Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to:
 Dr Jane Schulman, Battelle Memorial Institute, Centers for Public Health Research and Evaluation, 2971 Flowers Road, Suite 233, Atlanta, GA 30341, USA;


    Objective: To develop national and state level estimates for preventable bicycle related head injuries (BRHIs) and associated direct and indirect health costs from the failure to use bicycle helmets.

    Methods: Information on the effectiveness and prevalence of use of bicycle helmets was combined to estimate the avoidable fraction, that is, the proportion of BRHIs that could be prevented through the use of bicycle helmets. The avoidable fraction multiplied by the expected number of BRHIs gives an estimate of the number of preventable cases. Direct and indirect health costs are estimated from a social perspective for the number of preventable BRHIs to assess potential cost savings that would be achieved if all riders wore helmets.

    Results: Approximately 107 000 BRHIs could have been prevented in 1997 in the United States. These preventable injuries and deaths represent an estimated $81 million in direct and $2.3 billion in indirect health costs. Estimates range from 200 preventable BRHIs and $3 million in health costs in Wyoming (population 480 000) to 13 700 preventable BRHIs and $320 million in health costs in California (population 32.3 million).

    Conclusions: A number of successful approaches to increasing bicycle helmet use exist, including mandatory use laws and community based programs. The limited use of these strategies may be related to the fact that too little information is available to state agencies about the public health and economic burden of these preventable injuries. In conjunction with information on program costs, our estimates can assist state planners in better quantifying the number of preventable BRHIs and the costs and benefits of helmet promotion programs.

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