Safe system approach to preventing cyclist fatalities: safety by design for urban and rural environments.

BACKGROUND: Cyclists are vulnerable road users, with preventable deaths increasing by 48% over the past decade. This study aimed to review the epidemiology of cyclist fatalities to identify risk factors for targeted interventions through a safe system approach, with a focus on urban and rural environments. METHODS: Data on fatal cyclist and motor vehicle collisions (CMVC) and injuries were collected from the Office of the Chief Coroner (2013-19), including selected crash investigations and expert reviews by a multidisciplinary team. Descriptive analyses were conducted, and urban vs. rural CMVC were compared using Pearson chi-square and Mann-Whitney U tests. RESULTS: There were 83 fatal cyclist collisions (81% male), with 6% children, 13% youth, 69% adults, and 12% seniors (median age = 48, ISS = 75). The head was the most severely injured body region across all age groups (median AIS = 5), except for children, whose thoracic injuries were more severe. Overall, 62% of cyclists were not wearing helmets, and 24% were impaired. Expert review found that 60% of child cyclist fatalities were run over, all of whom were ≤ 6 years. Distractions from cell phones (1%) or headphones (8%) may have contributed to CMVC. Urban collisions (49 cyclists; 59%) accounted for all child deaths and had significantly more collisions involving intersections (57% vs. 6%; p < 0.001), low-speed crashes (33% vs. 0%; p < 0.001), bike lanes (29% vs. 0%; p < 0.001), and heavy vehicles (31% vs. 6%; p = 0.006). Rural collisions were associated with higher speeds (> 50 km/h, 94% vs. 49%; p < 0.001), dark lighting (44% vs. 4%; p < 0.001), and riding on the roadway with traffic (56% vs. 16%; p < 0.001). No rural CMVCs had sidewalks or bike lanes (0% vs. 84%; 0% vs. 33%; p < 0.001). CONCLUSION: Cyclists face severe injury and death risks in both urban and rural settings. A safe system approach recognizes human vulnerability and the inevitability of mistakes. Engineering countermeasures, such as road separation, better lighting in rural areas, traffic calming, and vehicle safety features (i.e., guard rails, advanced headlights, and cyclist detection), support CMVC prevention. Public health campaigns and legislative action, along with equitable implementation across urban and rural areas, facilitate improving cyclists' safety.