Objective This paper examines the relationship between the amount of bicycle use and the number of single-bicycle crashes (ie, only one cyclist involved) in Dutch municipalities. Previous research has focused on crashes between bicycles and motor vehicles; however, most cyclists admitted to hospital are victims of single-bicycle crashes.

Methods This correlational study used three data sets which included data relating to single-bicycle crashes and kilometres travelled by bicycle. Negative binomial regression was used to compare the amount of bicycling with the number of injuries incurred in single-bicycle crashes in Dutch municipalities.

Results The likelihood of single-bicycle crashes varied inversely with the level of bicycle use. The exponent for the change in the number of single-bicycle crashes in response to changes in bicycle volumes was <1 in all analyses (ie, the increase in the number of single-bicycle crashes in a given municipality is proportionally less than the increase in the number of bicycle kilometres travelled by its inhabitants). The value was reduced in analyses of single-bicycle crashes with more severe injuries.

Conclusions Cyclists are less likely to be involved in a severe single-bicycle crash in municipalities with a high amount of cycling. Given the large numbers of patients admitted to hospital as a result of single-bicycle crashes, it is important to include the risks of these in road safety and health effect evaluations, and to take into account the non-linearity of the relationship between single-bicycle crashes and bicycle use if road safety measures are to affect the level of bicycle use.