Safety of e-bikes compared to conventional bicycles: What role does cyclists' health condition play?

Abstract

Introduction The rising use of e-bikes (EBs) presents an opportunity to increase active transportation but may compromise road safety due to increased travel speed and weight compared to conventional bicycle (CBs). Evidence comparing the safety of EBs and CBs is limited while the influence of cyclists’ health status has been neglected. Methods This cross-sectional case-control study compared EB and CB users in the Netherlands. Data were gathered 1) through a survey among crash casualties treated at emergency departments aged >16 (N = 2383) and 2) control group data were collected among cyclists without any known crash experience, randomly drawn from a panel of the Dutch population (N = 1860). Using logistic regressions, we assessed the likelihood of crashes and crash severity while adjusting for bicycle use and health status. Results EB users had poorer health than CB users, but they were not more likely to be involved in a crash or to sustain more severe injuries. However, older female cyclists did have an elevated risk on EBs and sustained more severe injuries. Health-related factors such as the presence of morbid conditions, medication use, and the body mass index were neither associated with crash likelihood nor associated with injury severity and accordingly did not explain the findings for older females. However, balance and coordination problems, and the use of anti-epileptic drugs were associated with crashes. Conclusion Our findings provide support that EB users have a poorer health status than CB users, while general health status is unrelated to the likelihood and severity of bicycle crashes. EBs enable more vulnerable groups to cycle or keep cycling but, after controlling for bicycle use, EB users are not more likely to be involved in a crash or to sustain severe injuries. As older females run a higher risk on an EB and are more likely to fall while (dis)mounting, we recommend to promote EBs enabling safer (dis)mounting such as by reduced saddle height.