High levels of underreporting in non-fatal crashes limit our understanding of bicycling safety. We examined self-reported bicycle crashes and quantified their risks in a cohort of cyclists in Delhi.
Using on-road intercept surveys of bicyclists (n=844) at locations selected through spatially stratified sampling of the road network, we recorded self-reported bicycle crashes using both retrospective (14-month recall) and prospective (monthly follow-up) cohort designs and compared those with police-reported fatal and non-fatal cases. Using prospectively collected data, we estimated overall and factor-specific exposure-adjusted incidence rates.
Of the 218 self-reported crashes, 3% were reported to the police, half involved collisions with motorcycles and <2% were single-bicycle crashes. Police-reported crashes were more likely to involve heavy vehicles and severe injuries. The rate of crashes resulting in a medically attended injury was 16.8 per million km (95% CI 11.1, 23.2) and its ratio to those resulting in any injury and to those including no injury was 1:1.7:2.6. Crash rates declined with cyclists’ age though differences lacked statistical significance.
The near-absence of single-bicycle crashes in our study, compared with their large share (40–70%) in high-income contexts, may be attributable to low cycling speeds resulting from the widespread use of heavy-duty roadster bicycles. The injury rate (28.6 per million km cycled) was comparable to those reported in Australia, Norway and the USA. In contrast, it was 60–200 times higher than in Denmark, Germany and the Netherlands, countries with extensive cycling infrastructure, supporting the critical role of infrastructure improvements for reducing bicyclist injuries.