The escalating burden of cyclist road injuries among reproductive-aged women in china: a longitudinal and gender-specific analysis of the global burden of disease study 1990-2021.

OBJECTIVE: To quantify the burden, trends, and gender-specific disparities of cyclist road injuries in China following the micro-mobility revolution and identify systemic drivers of rising mortality among reproductive-aged women. METHODS: Using Global Burden of Disease (GBD) 2021 subnational data (1990-2021), we analyzed age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life year rates (ASDAR) for cyclist injuries. Joinpoint regression identified temporal inflection points. Infrastructure deficits were mapped via OpenStreetMap. ARIMAX models projected burdens to 2050, incorporating Socio-Demographic Index (SDI) and demographic covariates. RESULTS: Road injuries were the leading cause of death among reproductive-aged adults (15-49 years) in China in 2021 (ASMR 16.8 per 100,000). Cyclist injuries constituted a uniquely severe burden, with China ranking 6th globally in ASDAR. Women aged 15-49 years experienced the planet's highest cyclist mortality (ASMR rank 1st; ≈60% higher than males). A 2016 inflection point reversed previous declines in ASMR/ASDAR, coinciding with rapid micro-mobility expansion. Systemic failures likely contributed: dedicated bike lanes covered only 0.3% of roads, regulatory frameworks lacked bicycle-specific protections, and occupational cycling heightened exposure among women. By 2050, ASIR and ASDAR among reproductive-aged women are projected to rise by 23.7% and 19.4%, respectively, signaling a crisis of long-term disability from fractures and neurotrauma. CONCLUSIONS: China's cycling safety crisis constitutes a demographic emergency, with women facing catastrophic mortality due to infrastructural abandonment, regulatory neglect, and unmitigated micro-mobility risks. Urgent gender-responsive interventions-mandating segregated lanes, enforcing WHO-aligned bicycle legislation (helmets, lighting), and integrating bone health into occupational safety-are essential to avert 81,000 projected disability life-years lost annually by 2050 and align green mobility goals with equitable health protection.