Background Cycling remains prevalent across most of India, though the levels are low and rapidly decreasing in large metropolitan areas. There is a lack of scientifically robust studies from the low-and-middle income countries (LMIC), investigating the safety of cyclists on the road.
Methods We extracted crash details from police reports of cycle fatalities that occurred in New Delhi, India. We used case-crossover and case-control methods to identify risk factors of cycle fatalities with crash locations as controls. We used Google Maps API, Google Earth, OpenStreetMap and high-resolution population mapping to collect data on traffic speed, built environment and land use. We conducted univariate comparisons of distribution of exposures to risk factors between cases and controls, along with multivariate logistic regression.
Results Fatal cyclists are almost all males. They are older and more likely to be residents of low-income neighbourhoods compared to general population. Most crashes are limited to a few roads across the city and a large majority occurred on mid-block sections. Traffic speed, major roads, presence of goods vehicles, and lower population density are among the major risk factors resulting in greater likelihood of cycle fatalities.
Conclusion Implementation and enforcement of speed limits and segregated cycle tracks on all major roads are likely to improve safety of cyclists. Our study shows that robust study designs can be used in LMICs however high levels of underreporting of injury cases limit investigation to fatality cases. We discuss the strengths and limitations of the two approaches in data-poor context of LMIC.
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