Objectives Bicycling is a popular means of transportation that is sometimes associated with injury from collisions. The authors analysed national data for the USA to evaluate bicyclist deaths associated with motor vehicle impacts.

Methods The authors conducted a population-based case–control analysis of road deaths reported by the National Highway Traffic Safety Administration. The authors included bicyclist deaths from 1 January 2008 to 31 December 2008 (cases), along with the non-bicyclist road deaths immediately before and after the bicyclist death in the same state (controls). Analyses also included linkages to auto appraisal websites to estimate type, size and cost of the motor vehicle involved in each death.

Results A total of 711 bicyclist deaths were included, equivalent to a rate of 2 deaths per million population annually. No state had a rate statistically significantly below the national average whereas Florida was a high outlier with three times the national rate (p<0.001). The typical bicyclist who died was a man travelling in the afternoon or evening. The average estimated resale value of the involved motor vehicle was about one-third higher for bicyclist deaths than control deaths (US$10 603 vs US$8118, p<0.001). Analyses based on median estimated resale value and luxury resale value yielded similar findings. Stratified analyses based on demographics, time and posted speed limits yielded similar discrepancies. Larger motor vehicles were particularly common in bicyclist deaths compared to control deaths, especially freight trucks (11% vs 8%, p=0.008) and large automobiles (43% vs 37%, p=0.004). Conversely, motorcycles were distinctly infrequent in bicyclist deaths compared to control deaths (1% vs 14%, p<0.001).

Conclusions Large expensive motor vehicles account for a disproportionate share of bicyclist deaths. Bicyclists, motorists, policy-makers and vehicle manufacturers need to consider more imaginative solutions to help prevent future deaths.