Original quantitative research – Lockdowns and cycling injuries: temporal analysis of rates in Quebec during the first year of the pandemic

Health Promotion and Chronic Disease Prevention in Canada Journal

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Nathalie Auger, Author reference footnote 1 Author reference footnote 2 Author reference footnote 3 Author reference footnote 4; Antoine Lewin, PhDAuthor reference footnote 5; Émilie Brousseau, MScAuthor reference footnote 1 Author reference footnote 2; Aimina Ayoub, MScAuthor reference footnote 1 Author reference footnote 2; Christine Blaser, PhDAuthor reference footnote 3; Thuy Mai Luu, MDAuthor reference footnote 6

https://doi.org/10.24095/hpcdp.43.7.03

This article has been peer reviewed.

Author references
Correspondence

Nathalie Auger, 190 Cremazie Blvd. E., Montréal, QC H2P 1E2; Tel: 514-864-1600; Fax: 514-864-1616; Email: nathalie.auger@inspq.qc.ca

Suggested citation

Auger N, Lewin A, Brousseau É, Ayoub A, Blaser C, Luu TM. Lockdowns and cycling injuries: temporal analysis of rates in Quebec during the first year of the pandemic. Health Promot Chronic Dis Prev Can. 2023;43(7):330-7. https://doi.org/10.24095/hpcdp.43.7.03

Abstract

Introduction: Cycling increased in popularity during the COVID-19 pandemic, but the impact on cycling injuries is not known. We examined the effect of lockdowns on cycling injury hospitalizations.

Methods: We identified hospitalizations for cycling injuries in Quebec, Canada, between April 2006 and March 2021. We used rate ratios (RR) and 95% confidence intervals (CI) to compare hospitalization rates by type of cycling injury and anatomical site during two waves of the pandemic. We performed interrupted time series regression to assess the effect of lockdowns on monthly cycling injury hospitalization rates, according to age, sex and other characteristics.

Results: There were 2020 hospitalizations for cycling injuries between March 2020 and March 2021, including 617 during the first lockdown and 67 during the second lockdown. Compared with the period before the pandemic, risk of cycling-related injuries during the first lockdown increased the most for fractures (RR = 1.44; 95% CI: 1.26–1.64) and head and neck injuries (RR = 1.59; 95% CI: 1.19–2.12). Cycling injury hospitalization rates increased significantly among adults, adolescents and individuals from socioeconomically advantaged neighbourhoods or those with low concentrations of racialized people every month of the first lockdown. The second lockdown was not associated with cycling injuries.

Conclusion: The first lockdown triggered a sharp increase in cycling injury hospitalizations, especially among adults, adolescents and individuals from socioeconomically advantaged and less racialized neighbourhoods.

Keywords: bicycling, COVID-19, exercise, transportation, wounds, injuries, fracture, socioeconomic factors

Highlights

  • Cycling injuries in Quebec increased among adults and adolescents during the COVID-19 pandemic.
  • Fractures and head and neck injuries increased the most.
  • Most injuries were due to falls from a bicycle rather than due to collisions.
  • People living in socioeconomically advantaged and less racialized neighbourhoods experienced the greatest increase in number of cycling injuries.

Introduction

Although cycling became more popular in cities around the world during the COVID-19 pandemic,Footnote 1 Footnote 2 Footnote 3 Footnote 4 the impact of lockdowns on cycling injuries is unclear. This growth in popularity came about when lockdowns triggered a reduction in public transport and made people consider other means of transportation.Footnote 5 The closures of gyms and community centres led people to try other forms of physical activity, including cycling.1 Many people went cycling with friends as a way to socialize while socially distancing.Footnote 4

Cycling has numerous physical and mental health benefits,Footnote 6 but it is also associated with an estimated 3.1 injuries per 1000 hours travelled, with the greatest risk of injury occurring among less experienced cyclists.Footnote 7 Although many adults took up cycling during the pandemic, the relationship with cycling injuries has received little attention as injury research has been largely limited to children and adolescents.Footnote 8 Footnote 9 A study of 1215 pediatric emergency department visits found that bicycle injuries among children and adolescents less than 18 years old increased significantly in Canada during the first eight months of the pandemic.Footnote 8 An Australian study reported a 43% increase in emergency department visits and a 49% increase in hospital admissions for bike-related injuries among children and adolescents 15 years old or younger during the first lockdown, compared with 2019.Footnote 9 The only study that examined adults' trauma-related injuries found an increase in emergency orthopaedic referrals during the first lockdown in the United Kingdom among those between 19 and 65 years old, but cycling and scooter injury data were combined.Footnote 10

Owing to the paucity of data, we assessed the effect of pandemic lockdowns on cycling injury hospitalizations in a population of children, adolescents and adults in the province of Quebec, Canada.

Methods

Study population

We carried out a natural experimental study of hospitalization rates for cycling injuries between 1 April 2006 and 31 March 2021 in Quebec. We extracted hospitalization records from the Maintenance et exploitation des données pour l'étude de la clientèle hospitalière (MED-ÉCHO) dataset, a registry of discharge abstracts for admissions throughout Quebec.Footnote 11

We received a waiver for a full ethical review from the institutional review board of the Centre hospitalier de l'Université de Montréal. Data used in the analysis were de-identified.

Measures

We considered three exposure periods in the analysis: two lockdown periods and a reopening period between them. In Quebec, the government declared COVID-19 a public health emergency on 13 March 2020.Footnote 12 The province was marked by two major lockdowns over the course of one year.Footnote 12 The first lockdown lasted from 13 March 2020 to 23 June 2020, and was followed by a period of partial reopening between 24 June 2020 and 14 December 2020. The second lockdown began on 15 December 2020 and continued past the end of the study on 31 March 2021. The lockdowns were characterized by stay-at-home orders, curfews and widespread closures of nonessential businesses and schools.Footnote 12 Restrictions eased during reopening.Footnote 12

We used three periods from before the pandemic as comparison groups. The comparison period for the first lockdown extended from 13 March 2019 to 23 June 2019, for the reopening from 24 June 2019 to 14 December 2019, and for the second lockdown from 15 December 2019 to 12 March 2020. These comparison periods match the calendar dates of the pandemic, to take into account, in part, effects of seasonality.

The outcome measure was cycling injury hospitalization. We used accident codes from the International Classification of Diseases, 10th Revision (ICD-10), to capture cycling injuries. We assessed the type (fracture, superficial wound, open wound, other), anatomical site (head and neck, spine/thorax/pelvis, upper limb, lower limb), place (roadway, other location, unspecified) and mechanism of injury (collision, fall, unspecified).

We accounted for patient characteristics that were potential determinants of cycling injury: age (<10, 10–19, 20–39, 40–59, ≥60 years), sex (male, female), neighbourhood socioeconomic disadvantage (very high, high, moderate, low, or very low) and racialized group concentration within neighbourhoods (very high, high, moderate, low, or very low). Both socioeconomic disadvantage and racialized group concentration were measured as composite indices, with socioeconomic disadvantage accounting for median income, education and unemployment, and racialized group concentration accounting for the proportion of racialized people, recent immigrants and refugees within local neighbourhoods.Footnote 13

The indices are representative of the population, as they were developed from census data13 and mapped to postal codes covering small areas with an average of 500 residents. Very high socioeconomic disadvantage and racialized group concentration represented the most deprived quintile of each index.

Statistical analysis

We examined the characteristics of patients hospitalized for cycling injuries before and during the pandemic. Sex-specific hospitalization rates for cycling injuries were computed using population estimates from the Institut de la statistique du Québec.Footnote 14 We estimated rate ratios (RR) and 95% confidence intervals (CI) for the first lockdown, reopening and second lockdown compared with their respective pre-pandemic periods.

We assessed trends over time using an interrupted time series analysis of monthly cycling injury hospitalization rates. Interrupted time series analysis is a quasi-experimental method designed to estimate the effect of a sudden intervention, such as a lockdown, on an outcome.Footnote 15 This method relies on the regression of a time series, while including an interaction term between time and the onset of each interruption (first lockdown, reopening, second lockdown).Footnote 15

For this analysis, we used an autoregressive time series model to remove the effect of seasonal patterns in bike injuries, and to account for rates that may be correlated from month to month.Footnote 15 We stratified the time series by age, sex, socioeconomic disadvantage and racialized group concentration. In sensitivity analyses, weekly hospitalization rates were used in the time series to ensure that monthly rates did not mask week-to-week trends during the pandemic.

We carried out data analyses using statistical package SAS version 9.4 (SAS Institute Inc., Cary, NC, US). We assessed statistical significance through p values and 95% CIs.

Results

There were 2020 cycling injury hospitalizations between 13 March 2020 and 31 March 2021. Of these injury hospitalizations, 617 occurred during the first lockdown, 1336 during reopening and 67 during the second lockdown (see Table 1). The majority of patients hospitalized for cycling injuries before and during the pandemic were male, aged 40 to 59 years, and resided in neighbourhoods with low socioeconomic disadvantage and with low racialized group concentration. The proportion of patients aged 10 to 19 years who were hospitalized for cycling injuries increased during each phase of the pandemic compared with the corresponding pre-pandemic period.

Table 1. Characteristics of patients hospitalized for cycling injuries before and during COVID-19 lockdowns, March 2020–March 2021, Quebec, Canada
Characteristic Number of hospitalizations, n (%)
First lockdownFootnote a ReopeningFootnote b Second lockdownFootnote c
Before During Before During Before During
Age, years
<10 31 (7.0) 49 (7.9) 57 (5.1) 46 (3.4) 0 <5
10–19 61 (13.8) 101 (16.4) 117 (10.4) 166 (12.4) <5 7 (10.5)
20–39 86 (19.5) 126 (20.4) 275 (24.4) 363 (27.2) 13 (23.6) 9 (13.4)
40–59 135 (30.6) 175 (28.4) 399 (35.3) 430 (32.2) 26 (47.3) 34 (50.8)
≥60 128 (29.0) 166 (26.9) 281 (24.9) 331 (24.8) 15 (27.3) 13 (19.4)
Sex
Male 309 (70.1) 421 (68.2) 783 (69.4) 913 (68.3) 41 (74.6) 53 (79.1)
Female 132 (29.9) 196 (31.8) 346 (30.7) 423 (31.7) 14 (25.5) 14 (20.9)
Socioeconomic disadvantage
Very low 84 (19.1) 137 (22.2) 199 (17.6) 245 (18.3) 6 (10.9) 16 (23.9)
Low 112 (25.4) 192 (31.1) 356 (31.5) 402 (30.1) 15 (27.3) 16 (23.9)
Moderate 124 (28.1) 137 (22.2) 261 (23.1) 332 (24.9) 17 (30.9) 16 (23.9)
High 74 (16.8) 99 (16.1) 185 (16.4) 211 (15.8) 13 (23.6) 9 (13.4)
Very high 34 (7.7) 37 (6.0) 93 (8.2) 107 (8.0) <5 9 (13.4)
Racialized group concentrationFootnote d
Very low 164 (37.2) 265 (43.0) 412 (36.5) 498 (37.3) 20 (36.4) 25 (37.3)
Low 137 (31.1) 160 (25.9) 346 (30.7) 379 (28.4) 18 (32.7) 21 (31.3)
Moderate 71 (16.1) 99 (16.1) 193 (17.1) 209 (15.6) 10 (18.2) 12 (17.9)
High 37 (8.4) 54 (8.8) 107 (9.5) 153 (11.5) <5 <5
Very high 19 (4.3) 24 (3.9) 36 (3.2) 58 (4.3) <5 <5
Total 441 (100) 617 (100) 1129 (100) 1336 (100) 55 (100) 67 (100)
Table 1 Footnote a

The first lockdown lasted from 13 March 2020 to 23 June 2020, and the pre-pandemic comparison period from 13 March 2019 to 23 June 2019.

Table 1 Return to footnote a referrer

Table 1 Footnote b

Partial reopening lasted from 24 June 2020 to 14 December 2020, and the pre-pandemic comparison period from 24 June 2019 to 14 December 2019.

Table 1 Return to footnote b referrer

Table 1 Footnote c

The second lockdown lasted from 15 December 2020 and continued past the end of the study on 31 March 2021; the pre-pandemic comparison period lasted from 15 December 2019 to 12 March 2020.

Table 1 Return to footnote c referrer

Table 1 Footnote d

Racialized group concentration refers to the proportion of racialized people, recent immigrants and refugees within neighbourhoods.

Table 1 Return to footnote d referrer

Hospitalization rates for cycling-related fractures increased considerably during the first lockdown (RR = 1.44; 95% CI: 1.26–1.64) and in the reopening period (RR = 1.16; 95% CI: 1.06–1.26), compared with their respective pre-pandemic comparison periods (see Table 2). The rates for head and neck injuries increased the most, followed by spine/thorax/pelvis, lower limb and upper limb injuries. Both upper limb and spine/thorax/pelvis injuries remained elevated during reopening. The first lockdown and reopening were marked by a rise in cycling-related falls and injuries on roadways. There was no difference in the type, site, place or mechanism of cycling injuries in the second lockdown compared with the previous calendar year.

Table 2. Type, site, place and mechanism of cycling injuries, before and during COVID-19 lockdowns, March 2020–March 2021, Quebec, Canada
Cycling injury characteristic First lockdownFootnote a ReopeningFootnote b Second lockdownFootnote c
Hospitalization rate per 100 000 RR
(95% CI)Footnote d
Hospitalization rate per 100 000 RR
(95% CI)Footnote d
Hospitalization rate per 100 000 RR
(95% CI)Footnote d
Before During Before During Before During
Type of injury
Any 18.4 25.6 1.39 (1.23–1.57) 27.9 32.8 1.18 (1.09–1.27) 2.6 2.7 1.01 (0.71–1.44)
Fracture 15.3 22.1 1.44 (1.26–1.64) 23.9 27.7 1.16 (1.06–1.26) 2.1 1.5 0.73 (0.47–1.13)
Superficial wound 1.6 2.3 1.43 (0.95–2.15) 2.3 2.7 1.17 (0.89–1.54) 0.0 0.1 1.65 (0.15–18.24)
Open wound 1.3 1.3 1.06 (0.64–1.74) 1.8 1.8 0.98 (0.71–1.36) 0.0 0.2 4.13 (0.48–35.39)
Other 5.6 7.5 1.33 (1.07–1.67) 8.2 9.8 1.20 (1.04–1.39) 0.8 1.1 1.45 (0.78–2.67)
Anatomical site
Head and neck 3.1 4.9 1.59 (1.19–2.12) 5.2 5.7 1.09 (0.90–1.31) 0.2 0.4 1.49 (0.50–4.44)
Spine, thorax, pelvis 3.5 4.9 1.39 (1.05–1.84) 4.9 6.0 1.23 (1.02–1.48) 0.2 0.2 0.99 (0.30–3.25)
Upper limb 11.1 14.7 1.33 (1.13–1.55) 17.8 20.5 1.16 (1.05–1.28) 1.0 1.4 1.42 (0.83–2.43)
Lower limb 5.0 6.8 1.35 (1.07–1.71) 6.6 7.6 1.16 (0.98–1.36) 1.2 0.9 0.73 (0.41–1.29)
Place of injury
Roadway 11.8 16.1 1.37 (1.17–1.59) 17.0 19.0 1.12 (1.01–1.24) 1.6 1.7 1.05 (0.67–1.64)
Other location 1.8 3.4 1.85 (1.28–2.67) 4.4 5.6 1.27 (1.05–1.55) 0.7 0.3 0.41 (0.17–1.02)
Unspecified 4.5 5.8 1.29 (1.00–1.65) 5.9 7.9 1.32 (1.12–1.56) 0.3 0.6 2.20 (0.86–5.63)
Mechanism
Collision 3.0 3.5 1.16 (0.85–1.59) 4.4 5.3 1.21 (0.99–1.48) 0.4 0.5 1.34 (0.56–3.24)
Fall 14.2 20.8 1.47 (1.28–1.68) 21.9 25.5 1.16 (1.06–1.27) 2.1 2.1 1.00 (0.67–1.50)
Unspecified 1.2 1.2 1.06 (0.64–1.78) 1.6 2.0 1.26 (0.91–1.76) 0.2 0.1 0.41 (0.08–2.26)

Abbreviations: CI, confidence interval; RR, rate ratio.

Table 2 Footnote a

The first lockdown lasted from 13 March 2020 to 23 June 2020, and the pre-pandemic comparison period from 13 March 2019 to 23 June 2019.

Table 2 Return to footnote a referrer

Table 2 Footnote b

The reopening lasted from 24 June 2020 to 14 December 2020, and the pre-pandemic comparison period from 24 June 2019 to 14 December 2019.

Table 2 Return to footnote b referrer

Table 2 Footnote c

The second lockdown lasted from 15 December 2020 and continued past the end of the study on 31 March 2021; the pre-pandemic comparison period lasted from 15 December 2019 to 12 March 2020.

Table 2 Return to footnote c referrer

Table 2 Footnote d

Rate ratio is for the first lockdown, reopening or second lockdown vs. the corresponding pre-pandemic comparison period for each type, site, place and mechanism of injury.

Table 2 Return to footnote d referrer

Interrupted time series analysis indicated that there was a sharp decline in cycling injuries the first month of the pandemic, with 11.4 fewer hospitalizations per 100 000 individuals in March 2020 (see Figure 1). During the remainder of the first lockdown, however, cycling injury hospitalization rates rose by 6.5 per 100 000 individuals each month. These trends were the same for both males and females.

Figure 1. Interrupted time series of monthly hospitalization rates for cycling injuries before and during the first COVID-19 lockdown and during reopening, 2006–2021, Quebec, CanadaFootnote aFootnote b
Figure 1. Text version below.
Figure 1 - Text description
Bike injury (both sexes) Bike injury (males) Bike injury (females)
Date Rate per 100 000 Date Rate per 100 000 Date Rate per 100 000
2006-04-01 18.1552124 2006-04-01 25.6570588 2006-04-01 10.1398801
2006-05-01 18.165268 2006-05-01 25.672715 2006-05-01 10.1515401
2006-06-01 18.1753236 2006-06-01 25.6883712 2006-06-01 10.1632002
2006-07-01 18.1853791 2006-07-01 25.7040275 2006-07-01 10.1748602
2006-08-01 18.1954347 2006-08-01 25.7196837 2006-08-01 10.1865203
2006-09-01 18.2054903 2006-09-01 25.73534 2006-09-01 10.1981803
2006-10-01 18.2155459 2006-10-01 25.7509962 2006-10-01 10.2098403
2006-11-01 18.2256015 2006-11-01 25.7666525 2006-11-01 10.2215004
2006-12-01 18.2356571 2006-12-01 25.7823087 2006-12-01 10.2331604
2007-01-01 18.2457127 2007-01-01 25.7979649 2007-01-01 10.2448205
2007-02-01 18.2557683 2007-02-01 25.8136212 2007-02-01 10.2564805
2007-03-01 18.2658239 2007-03-01 25.8292774 2007-03-01 10.2681406
2007-04-01 18.2758795 2007-04-01 25.8449337 2007-04-01 10.2798006
2007-05-01 18.2859351 2007-05-01 25.8605899 2007-05-01 10.2914607
2007-06-01 18.2959907 2007-06-01 25.8762462 2007-06-01 10.3031207
2007-07-01 18.3060463 2007-07-01 25.8919024 2007-07-01 10.3147808
2007-08-01 18.3161019 2007-08-01 25.9075586 2007-08-01 10.3264408
2007-09-01 18.3261575 2007-09-01 25.9232149 2007-09-01 10.3381009
2007-10-01 18.3362131 2007-10-01 25.9388711 2007-10-01 10.3497609
2007-11-01 18.3462687 2007-11-01 25.9545274 2007-11-01 10.361421
2007-12-01 18.3563243 2007-12-01 25.9701836 2007-12-01 10.373081
2008-01-01 18.3663799 2008-01-01 25.9858399 2008-01-01 10.3847411
2008-02-01 18.3764355 2008-02-01 26.0014961 2008-02-01 10.3964011
2008-03-01 18.3864911 2008-03-01 26.0171523 2008-03-01 10.4080612
2008-04-01 18.3965467 2008-04-01 26.0328086 2008-04-01 10.4197212
2008-05-01 18.4066023 2008-05-01 26.0484648 2008-05-01 10.4313813
2008-06-01 18.4166579 2008-06-01 26.0641211 2008-06-01 10.4430413
2008-07-01 18.4267135 2008-07-01 26.0797773 2008-07-01 10.4547014
2008-08-01 18.4367691 2008-08-01 26.0954336 2008-08-01 10.4663614
2008-09-01 18.4468247 2008-09-01 26.1110898 2008-09-01 10.4780215
2008-10-01 18.4568803 2008-10-01 26.1267461 2008-10-01 10.4896815
2008-11-01 18.4669359 2008-11-01 26.1424023 2008-11-01 10.5013416
2008-12-01 18.4769915 2008-12-01 26.1580585 2008-12-01 10.5130016
2009-01-01 18.487047 2009-01-01 26.1737148 2009-01-01 10.5246617
2009-02-01 18.4971026 2009-02-01 26.189371 2009-02-01 10.5363217
2009-03-01 18.5071582 2009-03-01 26.2050273 2009-03-01 10.5479818
2009-04-01 18.5172138 2009-04-01 26.2206835 2009-04-01 10.5596418
2009-05-01 18.5272694 2009-05-01 26.2363398 2009-05-01 10.5713019
2009-06-01 18.537325 2009-06-01 26.251996 2009-06-01 10.5829619
2009-07-01 18.5473806 2009-07-01 26.2676522 2009-07-01 10.594622
2009-08-01 18.5574362 2009-08-01 26.2833085 2009-08-01 10.606282
2009-09-01 18.5674918 2009-09-01 26.2989647 2009-09-01 10.6179421
2009-10-01 18.5775474 2009-10-01 26.314621 2009-10-01 10.6296021
2009-11-01 18.587603 2009-11-01 26.3302772 2009-11-01 10.6412622
2009-12-01 18.5976586 2009-12-01 26.3459335 2009-12-01 10.6529222
2010-01-01 18.6077142 2010-01-01 26.3615897 2010-01-01 10.6645823
2010-02-01 18.6177698 2010-02-01 26.3772459 2010-02-01 10.6762423
2010-03-01 18.6278254 2010-03-01 26.3929022 2010-03-01 10.6879024
2010-04-01 18.637881 2010-04-01 26.4085584 2010-04-01 10.6995624
2010-05-01 18.6479366 2010-05-01 26.4242147 2010-05-01 10.7112224
2010-06-01 18.6579922 2010-06-01 26.4398709 2010-06-01 10.7228825
2010-07-01 18.6680478 2010-07-01 26.4555272 2010-07-01 10.7345425
2010-08-01 18.6781034 2010-08-01 26.4711834 2010-08-01 10.7462026
2010-09-01 18.688159 2010-09-01 26.4868397 2010-09-01 10.7578626
2010-10-01 18.6982146 2010-10-01 26.5024959 2010-10-01 10.7695227
2010-11-01 18.7082702 2010-11-01 26.5181521 2010-11-01 10.7811827
2010-12-01 18.7183258 2010-12-01 26.5338084 2010-12-01 10.7928428
2011-01-01 18.7283814 2011-01-01 26.5494646 2011-01-01 10.8045028
2011-02-01 18.738437 2011-02-01 26.5651209 2011-02-01 10.8161629
2011-03-01 18.7484926 2011-03-01 26.5807771 2011-03-01 10.8278229
2011-04-01 18.7585482 2011-04-01 26.5964334 2011-04-01 10.839483
2011-05-01 18.7686038 2011-05-01 26.6120896 2011-05-01 10.851143
2011-06-01 18.7786594 2011-06-01 26.6277458 2011-06-01 10.8628031
2011-07-01 18.7887149 2011-07-01 26.6434021 2011-07-01 10.8744631
2011-08-01 18.7987705 2011-08-01 26.6590583 2011-08-01 10.8861232
2011-09-01 18.8088261 2011-09-01 26.6747146 2011-09-01 10.8977832
2011-10-01 18.8188817 2011-10-01 26.6903708 2011-10-01 10.9094433
2011-11-01 18.8289373 2011-11-01 26.7060271 2011-11-01 10.9211033
2011-12-01 18.8389929 2011-12-01 26.7216833 2011-12-01 10.9327634
2012-01-01 18.8490485 2012-01-01 26.7373395 2012-01-01 10.9444234
2012-02-01 18.8591041 2012-02-01 26.7529958 2012-02-01 10.9560835
2012-03-01 18.8691597 2012-03-01 26.768652 2012-03-01 10.9677435
2012-04-01 18.8792153 2012-04-01 26.7843083 2012-04-01 10.9794036
2012-05-01 18.8892709 2012-05-01 26.7999645 2012-05-01 10.9910636
2012-06-01 18.8993265 2012-06-01 26.8156208 2012-06-01 11.0027237
2012-07-01 18.9093821 2012-07-01 26.831277 2012-07-01 11.0143837
2012-08-01 18.9194377 2012-08-01 26.8469332 2012-08-01 11.0260438
2012-09-01 18.9294933 2012-09-01 26.8625895 2012-09-01 11.0377038
2012-10-01 18.9395489 2012-10-01 26.8782457 2012-10-01 11.0493639
2012-11-01 18.9496045 2012-11-01 26.893902 2012-11-01 11.0610239
2012-12-01 18.9596601 2012-12-01 26.9095582 2012-12-01 11.072684
2013-01-01 18.9697157 2013-01-01 26.9252145 2013-01-01 11.084344
2013-02-01 18.9797713 2013-02-01 26.9408707 2013-02-01 11.0960041
2013-03-01 18.9898269 2013-03-01 26.956527 2013-03-01 11.1076641
2013-04-01 18.9998825 2013-04-01 26.9721832 2013-04-01 11.1193242
2013-05-01 19.0099381 2013-05-01 26.9878394 2013-05-01 11.1309842
2013-06-01 19.0199937 2013-06-01 27.0034957 2013-06-01 11.1426443
2013-07-01 19.0300493 2013-07-01 27.0191519 2013-07-01 11.1543043
2013-08-01 19.0401049 2013-08-01 27.0348082 2013-08-01 11.1659644
2013-09-01 19.0501605 2013-09-01 27.0504644 2013-09-01 11.1776244
2013-10-01 19.0602161 2013-10-01 27.0661207 2013-10-01 11.1892845
2013-11-01 19.0702717 2013-11-01 27.0817769 2013-11-01 11.2009445
2013-12-01 19.0803273 2013-12-01 27.0974331 2013-12-01 11.2126045
2014-01-01 19.0903828 2014-01-01 27.1130894 2014-01-01 11.2242646
2014-02-01 19.1004384 2014-02-01 27.1287456 2014-02-01 11.2359246
2014-03-01 19.110494 2014-03-01 27.1444019 2014-03-01 11.2475847
2014-04-01 19.1205496 2014-04-01 27.1600581 2014-04-01 11.2592447
2014-05-01 19.1306052 2014-05-01 27.1757144 2014-05-01 11.2709048
2014-06-01 19.1406608 2014-06-01 27.1913706 2014-06-01 11.2825648
2014-07-01 19.1507164 2014-07-01 27.2070268 2014-07-01 11.2942249
2014-08-01 19.160772 2014-08-01 27.2226831 2014-08-01 11.3058849
2014-09-01 19.1708276 2014-09-01 27.2383393 2014-09-01 11.317545
2014-10-01 19.1808832 2014-10-01 27.2539956 2014-10-01 11.329205
2014-11-01 19.1909388 2014-11-01 27.2696518 2014-11-01 11.3408651
2014-12-01 19.2009944 2014-12-01 27.2853081 2014-12-01 11.3525251
2015-01-01 19.21105 2015-01-01 27.3009643 2015-01-01 11.3641852
2015-02-01 19.2211056 2015-02-01 27.3166206 2015-02-01 11.3758452
2015-03-01 19.2311612 2015-03-01 27.3322768 2015-03-01 11.3875053
2015-04-01 19.2412168 2015-04-01 27.347933 2015-04-01 11.3991653
2015-05-01 19.2512724 2015-05-01 27.3635893 2015-05-01 11.4108254
2015-06-01 19.261328 2015-06-01 27.3792455 2015-06-01 11.4224854
2015-07-01 19.2713836 2015-07-01 27.3949018 2015-07-01 11.4341455
2015-08-01 19.2814392 2015-08-01 27.410558 2015-08-01 11.4458055
2015-09-01 19.2914948 2015-09-01 27.4262143 2015-09-01 11.4574656
2015-10-01 19.3015504 2015-10-01 27.4418705 2015-10-01 11.4691256
2015-11-01 19.311606 2015-11-01 27.4575267 2015-11-01 11.4807857
2015-12-01 19.3216616 2015-12-01 27.473183 2015-12-01 11.4924457
2016-01-01 19.3317172 2016-01-01 27.4888392 2016-01-01 11.5041058
2016-02-01 19.3417728 2016-02-01 27.5044955 2016-02-01 11.5157658
2016-03-01 19.3518284 2016-03-01 27.5201517 2016-03-01 11.5274259
2016-04-01 19.361884 2016-04-01 27.535808 2016-04-01 11.5390859
2016-05-01 19.3719396 2016-05-01 27.5514642 2016-05-01 11.550746
2016-06-01 19.3819952 2016-06-01 27.5671204 2016-06-01 11.562406
2016-07-01 19.3920507 2016-07-01 27.5827767 2016-07-01 11.5740661
2016-08-01 19.4021063 2016-08-01 27.5984329 2016-08-01 11.5857261
2016-09-01 19.4121619 2016-09-01 27.6140892 2016-09-01 11.5973862
2016-10-01 19.4222175 2016-10-01 27.6297454 2016-10-01 11.6090462
2016-11-01 19.4322731 2016-11-01 27.6454017 2016-11-01 11.6207063
2016-12-01 19.4423287 2016-12-01 27.6610579 2016-12-01 11.6323663
2017-01-01 19.4523843 2017-01-01 27.6767141 2017-01-01 11.6440264
2017-02-01 19.4624399 2017-02-01 27.6923704 2017-02-01 11.6556864
2017-03-01 19.4724955 2017-03-01 27.7080266 2017-03-01 11.6673465
2017-04-01 19.4825511 2017-04-01 27.7236829 2017-04-01 11.6790065
2017-05-01 19.4926067 2017-05-01 27.7393391 2017-05-01 11.6906666
2017-06-01 19.5026623 2017-06-01 27.7549954 2017-06-01 11.7023266
2017-07-01 19.5127179 2017-07-01 27.7706516 2017-07-01 11.7139866
2017-08-01 19.5227735 2017-08-01 27.7863079 2017-08-01 11.7256467
2017-09-01 19.5328291 2017-09-01 27.8019641 2017-09-01 11.7373067
2017-10-01 19.5428847 2017-10-01 27.8176203 2017-10-01 11.7489668
2017-11-01 19.5529403 2017-11-01 27.8332766 2017-11-01 11.7606268
2017-12-01 19.5629959 2017-12-01 27.8489328 2017-12-01 11.7722869
2018-01-01 19.5730515 2018-01-01 27.8645891 2018-01-01 11.7839469
2018-02-01 19.5831071 2018-02-01 27.8802453 2018-02-01 11.795607
2018-03-01 19.5931627 2018-03-01 27.8959016 2018-03-01 11.807267
2018-04-01 19.6032183 2018-04-01 27.9115578 2018-04-01 11.8189271
2018-05-01 19.6132739 2018-05-01 27.927214 2018-05-01 11.8305871
2018-06-01 19.6233295 2018-06-01 27.9428703 2018-06-01 11.8422472
2018-07-01 19.6333851 2018-07-01 27.9585265 2018-07-01 11.8539072
2018-08-01 19.6434407 2018-08-01 27.9741828 2018-08-01 11.8655673
2018-09-01 19.6534963 2018-09-01 27.989839 2018-09-01 11.8772273
2018-10-01 19.6635519 2018-10-01 28.0054953 2018-10-01 11.8888874
2018-11-01 19.6736075 2018-11-01 28.0211515 2018-11-01 11.9005474
2018-12-01 19.6836631 2018-12-01 28.0368077 2018-12-01 11.9122075
2019-01-01 19.6937186 2019-01-01 28.052464 2019-01-01 11.9238675
2019-02-01 19.7037742 2019-02-01 28.0681202 2019-02-01 11.9355276
2019-03-01 19.7138298 2019-03-01 28.0837765 2019-03-01 11.9471876
2019-04-01 19.7238854 2019-04-01 28.0994327 2019-04-01 11.9588477
2019-05-01 19.733941 2019-05-01 28.115089 2019-05-01 11.9705077
2019-06-01 19.7439966 2019-06-01 28.1307452 2019-06-01 11.9821678
2019-07-01 19.7540522 2019-07-01 28.1464014 2019-07-01 11.9938278
2019-08-01 19.7641078 2019-08-01 28.1620577 2019-08-01 12.0054879
2019-09-01 19.7741634 2019-09-01 28.1777139 2019-09-01 12.0171479
2019-10-01 19.784219 2019-10-01 28.1933702 2019-10-01 12.028808
2019-11-01 19.7942746 2019-11-01 28.2090264 2019-11-01 12.040468
2019-12-01 19.8043302 2019-12-01 28.2246827 2019-12-01 12.0521281
2020-01-01 19.8143858 2020-01-01 28.2403389 2020-01-01 12.0637881
2020-02-01 19.8244414 2020-02-01 28.2559952 2020-02-01 12.0754482
2020-03-01 14.9555634 2020-03-01 22.0256111 2020-03-01 7.7813891
2020-04-01 21.4454834 2020-04-01 29.7230327 2020-04-01 12.9347292
2020-05-01 27.9354034 2020-05-01 37.4204544 2020-05-01 18.0880693
2020-06-01 34.4253234 2020-06-01 45.1178761 2020-06-01 23.2414094
2020-07-01 27.1016554 2020-07-01 35.5481986 2020-07-01 18.2424352
2020-08-01 25.9846329 2020-08-01 34.5711149 2020-08-01 17.1655988
2020-09-01 24.8676104 2020-09-01 33.5940311 2020-09-01 16.0887624
2020-10-01 23.7505878 2020-10-01 32.6169473 2020-10-01 15.011926
2020-11-01 22.6335653 2020-11-01 31.6398636 2020-11-01 13.9350895
2020-12-01 21.5165428 2020-12-01 30.6627798 2020-12-01 12.8582531
2021-01-01 20.3995203 2021-01-01 29.685696 2021-01-01 11.7814167
2021-02-01 19.2824978 2021-02-01 28.7086123 2021-02-01 10.7045803
2021-03-01 18.1654753 2021-03-01 27.7315285 2021-03-01 9.6277439

 

The trends were also superimposed onto a general pattern of increasing cycling injury rates over time that began well before the start of the pandemic. Cycling injury hospitalization rates declined and gradually returned to pre-pandemic levels during the reopening period. There were too few cycling injuries to estimate trends during the second lockdown.

Trends in cycling injury hospitalizations depended on patient age (see Figure 2). Before the pandemic, the 20 to 39, 40 to 59, and 60 years and older age groups all had steady increases in hospitalization rates for cycling injuries over time. In contrast, children aged 0 to 9 and adolescents aged 10 to 19 years had a steady decrease in hospitalization rates. In March 2020, rates fell significantly for all age groups except children less than 10 years old and adolescents 10 to 19 years old. The remainder of the first lockdown was marked by a sharp rise in cycling injury hospitalization rates among individuals 10 years and over, and particularly those aged between 10 and 19 years and between 40 and 59 years. Hospitalization rates declined for most age groups during reopening.

Figure 2. Interrupted time series of age-specific hospitalization rates for cycling injuries, 2006–2021, Quebec, CanadaFootnote aFootnote b
Figure 2. Text version below.
Figure 2 - Text description
Bike injury (<10 years) Bike injury (10-19 years) Bike injury (20-39 years) Bike injury (40-59 years) Bike injury (60 years and over)
Date Rate per 100 000 Date Rate per 100 000 Date Rate per 100 000 Date Rate per 100 000 Date Rate per 100 000
2006-04-01 19.7818548 2006-04-01 38.9970778 2006-04-01 13.7085896 2006-04-01 17.0969383 2006-04-01 12.6714603
2006-05-01 19.7127406 2006-05-01 38.8891165 2006-05-01 13.7401745 2006-05-01 17.149158 2006-05-01 12.7160689
2006-06-01 19.6436264 2006-06-01 38.7811552 2006-06-01 13.7717594 2006-06-01 17.2013777 2006-06-01 12.7606775
2006-07-01 19.5745122 2006-07-01 38.6731938 2006-07-01 13.8033442 2006-07-01 17.2535975 2006-07-01 12.8052862
2006-08-01 19.5053979 2006-08-01 38.5652325 2006-08-01 13.8349291 2006-08-01 17.3058172 2006-08-01 12.8498948
2006-09-01 19.4362837 2006-09-01 38.4572712 2006-09-01 13.866514 2006-09-01 17.3580369 2006-09-01 12.8945034
2006-10-01 19.3671695 2006-10-01 38.3493099 2006-10-01 13.8980988 2006-10-01 17.4102567 2006-10-01 12.939112
2006-11-01 19.2980553 2006-11-01 38.2413486 2006-11-01 13.9296837 2006-11-01 17.4624764 2006-11-01 12.9837206
2006-12-01 19.228941 2006-12-01 38.1333873 2006-12-01 13.9612686 2006-12-01 17.5146962 2006-12-01 13.0283292
2007-01-01 19.1598268 2007-01-01 38.025426 2007-01-01 13.9928534 2007-01-01 17.5669159 2007-01-01 13.0729378
2007-02-01 19.0907126 2007-02-01 37.9174647 2007-02-01 14.0244383 2007-02-01 17.6191356 2007-02-01 13.1175464
2007-03-01 19.0215984 2007-03-01 37.8095034 2007-03-01 14.0560231 2007-03-01 17.6713554 2007-03-01 13.162155
2007-04-01 18.9524841 2007-04-01 37.7015421 2007-04-01 14.087608 2007-04-01 17.7235751 2007-04-01 13.2067636
2007-05-01 18.8833699 2007-05-01 37.5935807 2007-05-01 14.1191929 2007-05-01 17.7757949 2007-05-01 13.2513722
2007-06-01 18.8142557 2007-06-01 37.4856194 2007-06-01 14.1507777 2007-06-01 17.8280146 2007-06-01 13.2959809
2007-07-01 18.7451415 2007-07-01 37.3776581 2007-07-01 14.1823626 2007-07-01 17.8802343 2007-07-01 13.3405895
2007-08-01 18.6760273 2007-08-01 37.2696968 2007-08-01 14.2139475 2007-08-01 17.9324541 2007-08-01 13.3851981
2007-09-01 18.606913 2007-09-01 37.1617355 2007-09-01 14.2455323 2007-09-01 17.9846738 2007-09-01 13.4298067
2007-10-01 18.5377988 2007-10-01 37.0537742 2007-10-01 14.2771172 2007-10-01 18.0368936 2007-10-01 13.4744153
2007-11-01 18.4686846 2007-11-01 36.9458129 2007-11-01 14.3087021 2007-11-01 18.0891133 2007-11-01 13.5190239
2007-12-01 18.3995704 2007-12-01 36.8378516 2007-12-01 14.3402869 2007-12-01 18.141333 2007-12-01 13.5636325
2008-01-01 18.3304561 2008-01-01 36.7298903 2008-01-01 14.3718718 2008-01-01 18.1935528 2008-01-01 13.6082411
2008-02-01 18.2613419 2008-02-01 36.621929 2008-02-01 14.4034567 2008-02-01 18.2457725 2008-02-01 13.6528497
2008-03-01 18.1922277 2008-03-01 36.5139676 2008-03-01 14.4350415 2008-03-01 18.2979922 2008-03-01 13.6974583
2008-04-01 18.1231135 2008-04-01 36.4060063 2008-04-01 14.4666264 2008-04-01 18.350212 2008-04-01 13.7420669
2008-05-01 18.0539992 2008-05-01 36.298045 2008-05-01 14.4982113 2008-05-01 18.4024317 2008-05-01 13.7866756
2008-06-01 17.984885 2008-06-01 36.1900837 2008-06-01 14.5297961 2008-06-01 18.4546515 2008-06-01 13.8312842
2008-07-01 17.9157708 2008-07-01 36.0821224 2008-07-01 14.561381 2008-07-01 18.5068712 2008-07-01 13.8758928
2008-08-01 17.8466566 2008-08-01 35.9741611 2008-08-01 14.5929658 2008-08-01 18.5590909 2008-08-01 13.9205014
2008-09-01 17.7775423 2008-09-01 35.8661998 2008-09-01 14.6245507 2008-09-01 18.6113107 2008-09-01 13.96511
2008-10-01 17.7084281 2008-10-01 35.7582385 2008-10-01 14.6561356 2008-10-01 18.6635304 2008-10-01 14.0097186
2008-11-01 17.6393139 2008-11-01 35.6502772 2008-11-01 14.6877204 2008-11-01 18.7157502 2008-11-01 14.0543272
2008-12-01 17.5701997 2008-12-01 35.5423159 2008-12-01 14.7193053 2008-12-01 18.7679699 2008-12-01 14.0989358
2009-01-01 17.5010854 2009-01-01 35.4343545 2009-01-01 14.7508902 2009-01-01 18.8201896 2009-01-01 14.1435444
2009-02-01 17.4319712 2009-02-01 35.3263932 2009-02-01 14.782475 2009-02-01 18.8724094 2009-02-01 14.188153
2009-03-01 17.362857 2009-03-01 35.2184319 2009-03-01 14.8140599 2009-03-01 18.9246291 2009-03-01 14.2327616
2009-04-01 17.2937428 2009-04-01 35.1104706 2009-04-01 14.8456448 2009-04-01 18.9768488 2009-04-01 14.2773703
2009-05-01 17.2246285 2009-05-01 35.0025093 2009-05-01 14.8772296 2009-05-01 19.0290686 2009-05-01 14.3219789
2009-06-01 17.1555143 2009-06-01 34.894548 2009-06-01 14.9088145 2009-06-01 19.0812883 2009-06-01 14.3665875
2009-07-01 17.0864001 2009-07-01 34.7865867 2009-07-01 14.9403994 2009-07-01 19.1335081 2009-07-01 14.4111961
2009-08-01 17.0172859 2009-08-01 34.6786254 2009-08-01 14.9719842 2009-08-01 19.1857278 2009-08-01 14.4558047
2009-09-01 16.9481716 2009-09-01 34.5706641 2009-09-01 15.0035691 2009-09-01 19.2379475 2009-09-01 14.5004133
2009-10-01 16.8790574 2009-10-01 34.4627027 2009-10-01 15.035154 2009-10-01 19.2901673 2009-10-01 14.5450219
2009-11-01 16.8099432 2009-11-01 34.3547414 2009-11-01 15.0667388 2009-11-01 19.342387 2009-11-01 14.5896305
2009-12-01 16.740829 2009-12-01 34.2467801 2009-12-01 15.0983237 2009-12-01 19.3946068 2009-12-01 14.6342391
2010-01-01 16.6717147 2010-01-01 34.1388188 2010-01-01 15.1299086 2010-01-01 19.4468265 2010-01-01 14.6788477
2010-02-01 16.6026005 2010-02-01 34.0308575 2010-02-01 15.1614934 2010-02-01 19.4990462 2010-02-01 14.7234564
2010-03-01 16.5334863 2010-03-01 33.9228962 2010-03-01 15.1930783 2010-03-01 19.551266 2010-03-01 14.768065
2010-04-01 16.4643721 2010-04-01 33.8149349 2010-04-01 15.2246631 2010-04-01 19.6034857 2010-04-01 14.8126736
2010-05-01 16.3952578 2010-05-01 33.7069736 2010-05-01 15.256248 2010-05-01 19.6557054 2010-05-01 14.8572822
2010-06-01 16.3261436 2010-06-01 33.5990123 2010-06-01 15.2878329 2010-06-01 19.7079252 2010-06-01 14.9018908
2010-07-01 16.2570294 2010-07-01 33.491051 2010-07-01 15.3194177 2010-07-01 19.7601449 2010-07-01 14.9464994
2010-08-01 16.1879152 2010-08-01 33.3830896 2010-08-01 15.3510026 2010-08-01 19.8123647 2010-08-01 14.991108
2010-09-01 16.1188009 2010-09-01 33.2751283 2010-09-01 15.3825875 2010-09-01 19.8645844 2010-09-01 15.0357166
2010-10-01 16.0496867 2010-10-01 33.167167 2010-10-01 15.4141723 2010-10-01 19.9168041 2010-10-01 15.0803252
2010-11-01 15.9805725 2010-11-01 33.0592057 2010-11-01 15.4457572 2010-11-01 19.9690239 2010-11-01 15.1249338
2010-12-01 15.9114583 2010-12-01 32.9512444 2010-12-01 15.4773421 2010-12-01 20.0212436 2010-12-01 15.1695424
2011-01-01 15.842344 2011-01-01 32.8432831 2011-01-01 15.5089269 2011-01-01 20.0734634 2011-01-01 15.2141511
2011-02-01 15.7732298 2011-02-01 32.7353218 2011-02-01 15.5405118 2011-02-01 20.1256831 2011-02-01 15.2587597
2011-03-01 15.7041156 2011-03-01 32.6273605 2011-03-01 15.5720967 2011-03-01 20.1779028 2011-03-01 15.3033683
2011-04-01 15.6350014 2011-04-01 32.5193992 2011-04-01 15.6036815 2011-04-01 20.2301226 2011-04-01 15.3479769
2011-05-01 15.5658872 2011-05-01 32.4114379 2011-05-01 15.6352664 2011-05-01 20.2823423 2011-05-01 15.3925855
2011-06-01 15.4967729 2011-06-01 32.3034765 2011-06-01 15.6668513 2011-06-01 20.334562 2011-06-01 15.4371941
2011-07-01 15.4276587 2011-07-01 32.1955152 2011-07-01 15.6984361 2011-07-01 20.3867818 2011-07-01 15.4818027
2011-08-01 15.3585445 2011-08-01 32.0875539 2011-08-01 15.730021 2011-08-01 20.4390015 2011-08-01 15.5264113
2011-09-01 15.2894303 2011-09-01 31.9795926 2011-09-01 15.7616058 2011-09-01 20.4912213 2011-09-01 15.5710199
2011-10-01 15.220316 2011-10-01 31.8716313 2011-10-01 15.7931907 2011-10-01 20.543441 2011-10-01 15.6156285
2011-11-01 15.1512018 2011-11-01 31.76367 2011-11-01 15.8247756 2011-11-01 20.5956607 2011-11-01 15.6602371
2011-12-01 15.0820876 2011-12-01 31.6557087 2011-12-01 15.8563604 2011-12-01 20.6478805 2011-12-01 15.7048458
2012-01-01 15.0129734 2012-01-01 31.5477474 2012-01-01 15.8879453 2012-01-01 20.7001002 2012-01-01 15.7494544
2012-02-01 14.9438591 2012-02-01 31.4397861 2012-02-01 15.9195302 2012-02-01 20.75232 2012-02-01 15.794063
2012-03-01 14.8747449 2012-03-01 31.3318248 2012-03-01 15.951115 2012-03-01 20.8045397 2012-03-01 15.8386716
2012-04-01 14.8056307 2012-04-01 31.2238634 2012-04-01 15.9826999 2012-04-01 20.8567594 2012-04-01 15.8832802
2012-05-01 14.7365165 2012-05-01 31.1159021 2012-05-01 16.0142848 2012-05-01 20.9089792 2012-05-01 15.9278888
2012-06-01 14.6674022 2012-06-01 31.0079408 2012-06-01 16.0458696 2012-06-01 20.9611989 2012-06-01 15.9724974
2012-07-01 14.598288 2012-07-01 30.8999795 2012-07-01 16.0774545 2012-07-01 21.0134187 2012-07-01 16.017106
2012-08-01 14.5291738 2012-08-01 30.7920182 2012-08-01 16.1090394 2012-08-01 21.0656384 2012-08-01 16.0617146
2012-09-01 14.4600596 2012-09-01 30.6840569 2012-09-01 16.1406242 2012-09-01 21.1178581 2012-09-01 16.1063232
2012-10-01 14.3909453 2012-10-01 30.5760956 2012-10-01 16.1722091 2012-10-01 21.1700779 2012-10-01 16.1509318
2012-11-01 14.3218311 2012-11-01 30.4681343 2012-11-01 16.203794 2012-11-01 21.2222976 2012-11-01 16.1955405
2012-12-01 14.2527169 2012-12-01 30.360173 2012-12-01 16.2353788 2012-12-01 21.2745173 2012-12-01 16.2401491
2013-01-01 14.1836027 2013-01-01 30.2522117 2013-01-01 16.2669637 2013-01-01 21.3267371 2013-01-01 16.2847577
2013-02-01 14.1144884 2013-02-01 30.1442503 2013-02-01 16.2985486 2013-02-01 21.3789568 2013-02-01 16.3293663
2013-03-01 14.0453742 2013-03-01 30.036289 2013-03-01 16.3301334 2013-03-01 21.4311766 2013-03-01 16.3739749
2013-04-01 13.97626 2013-04-01 29.9283277 2013-04-01 16.3617183 2013-04-01 21.4833963 2013-04-01 16.4185835
2013-05-01 13.9071458 2013-05-01 29.8203664 2013-05-01 16.3933031 2013-05-01 21.535616 2013-05-01 16.4631921
2013-06-01 13.8380315 2013-06-01 29.7124051 2013-06-01 16.424888 2013-06-01 21.5878358 2013-06-01 16.5078007
2013-07-01 13.7689173 2013-07-01 29.6044438 2013-07-01 16.4564729 2013-07-01 21.6400555 2013-07-01 16.5524093
2013-08-01 13.6998031 2013-08-01 29.4964825 2013-08-01 16.4880577 2013-08-01 21.6922753 2013-08-01 16.5970179
2013-09-01 13.6306889 2013-09-01 29.3885212 2013-09-01 16.5196426 2013-09-01 21.744495 2013-09-01 16.6416265
2013-10-01 13.5615746 2013-10-01 29.2805599 2013-10-01 16.5512275 2013-10-01 21.7967147 2013-10-01 16.6862352
2013-11-01 13.4924604 2013-11-01 29.1725986 2013-11-01 16.5828123 2013-11-01 21.8489345 2013-11-01 16.7308438
2013-12-01 13.4233462 2013-12-01 29.0646372 2013-12-01 16.6143972 2013-12-01 21.9011542 2013-12-01 16.7754524
2014-01-01 13.354232 2014-01-01 28.9566759 2014-01-01 16.6459821 2014-01-01 21.9533739 2014-01-01 16.820061
2014-02-01 13.2851177 2014-02-01 28.8487146 2014-02-01 16.6775669 2014-02-01 22.0055937 2014-02-01 16.8646696
2014-03-01 13.2160035 2014-03-01 28.7407533 2014-03-01 16.7091518 2014-03-01 22.0578134 2014-03-01 16.9092782
2014-04-01 13.1468893 2014-04-01 28.632792 2014-04-01 16.7407367 2014-04-01 22.1100332 2014-04-01 16.9538868
2014-05-01 13.0777751 2014-05-01 28.5248307 2014-05-01 16.7723215 2014-05-01 22.1622529 2014-05-01 16.9984954
2014-06-01 13.0086608 2014-06-01 28.4168694 2014-06-01 16.8039064 2014-06-01 22.2144726 2014-06-01 17.043104
2014-07-01 12.9395466 2014-07-01 28.3089081 2014-07-01 16.8354913 2014-07-01 22.2666924 2014-07-01 17.0877126
2014-08-01 12.8704324 2014-08-01 28.2009468 2014-08-01 16.8670761 2014-08-01 22.3189121 2014-08-01 17.1323212
2014-09-01 12.8013182 2014-09-01 28.0929855 2014-09-01 16.898661 2014-09-01 22.3711319 2014-09-01 17.1769299
2014-10-01 12.7322039 2014-10-01 27.9850241 2014-10-01 16.9302458 2014-10-01 22.4233516 2014-10-01 17.2215385
2014-11-01 12.6630897 2014-11-01 27.8770628 2014-11-01 16.9618307 2014-11-01 22.4755713 2014-11-01 17.2661471
2014-12-01 12.5939755 2014-12-01 27.7691015 2014-12-01 16.9934156 2014-12-01 22.5277911 2014-12-01 17.3107557
2015-01-01 12.5248613 2015-01-01 27.6611402 2015-01-01 17.0250004 2015-01-01 22.5800108 2015-01-01 17.3553643
2015-02-01 12.4557471 2015-02-01 27.5531789 2015-02-01 17.0565853 2015-02-01 22.6322305 2015-02-01 17.3999729
2015-03-01 12.3866328 2015-03-01 27.4452176 2015-03-01 17.0881702 2015-03-01 22.6844503 2015-03-01 17.4445815
2015-04-01 12.3175186 2015-04-01 27.3372563 2015-04-01 17.119755 2015-04-01 22.73667 2015-04-01 17.4891901
2015-05-01 12.2484044 2015-05-01 27.229295 2015-05-01 17.1513399 2015-05-01 22.7888898 2015-05-01 17.5337987
2015-06-01 12.1792902 2015-06-01 27.1213337 2015-06-01 17.1829248 2015-06-01 22.8411095 2015-06-01 17.5784073
2015-07-01 12.1101759 2015-07-01 27.0133724 2015-07-01 17.2145096 2015-07-01 22.8933292 2015-07-01 17.6230159
2015-08-01 12.0410617 2015-08-01 26.905411 2015-08-01 17.2460945 2015-08-01 22.945549 2015-08-01 17.6676246
2015-09-01 11.9719475 2015-09-01 26.7974497 2015-09-01 17.2776794 2015-09-01 22.9977687 2015-09-01 17.7122332
2015-10-01 11.9028333 2015-10-01 26.6894884 2015-10-01 17.3092642 2015-10-01 23.0499885 2015-10-01 17.7568418
2015-11-01 11.833719 2015-11-01 26.5815271 2015-11-01 17.3408491 2015-11-01 23.1022082 2015-11-01 17.8014504
2015-12-01 11.7646048 2015-12-01 26.4735658 2015-12-01 17.372434 2015-12-01 23.1544279 2015-12-01 17.846059
2016-01-01 11.6954906 2016-01-01 26.3656045 2016-01-01 17.4040188 2016-01-01 23.2066477 2016-01-01 17.8906676
2016-02-01 11.6263764 2016-02-01 26.2576432 2016-02-01 17.4356037 2016-02-01 23.2588674 2016-02-01 17.9352762
2016-03-01 11.5572621 2016-03-01 26.1496819 2016-03-01 17.4671886 2016-03-01 23.3110871 2016-03-01 17.9798848
2016-04-01 11.4881479 2016-04-01 26.0417206 2016-04-01 17.4987734 2016-04-01 23.3633069 2016-04-01 18.0244934
2016-05-01 11.4190337 2016-05-01 25.9337592 2016-05-01 17.5303583 2016-05-01 23.4155266 2016-05-01 18.069102
2016-06-01 11.3499195 2016-06-01 25.8257979 2016-06-01 17.5619431 2016-06-01 23.4677464 2016-06-01 18.1137106
2016-07-01 11.2808052 2016-07-01 25.7178366 2016-07-01 17.593528 2016-07-01 23.5199661 2016-07-01 18.1583193
2016-08-01 11.211691 2016-08-01 25.6098753 2016-08-01 17.6251129 2016-08-01 23.5721858 2016-08-01 18.2029279
2016-09-01 11.1425768 2016-09-01 25.501914 2016-09-01 17.6566977 2016-09-01 23.6244056 2016-09-01 18.2475365
2016-10-01 11.0734626 2016-10-01 25.3939527 2016-10-01 17.6882826 2016-10-01 23.6766253 2016-10-01 18.2921451
2016-11-01 11.0043483 2016-11-01 25.2859914 2016-11-01 17.7198675 2016-11-01 23.7288451 2016-11-01 18.3367537
2016-12-01 10.9352341 2016-12-01 25.1780301 2016-12-01 17.7514523 2016-12-01 23.7810648 2016-12-01 18.3813623
2017-01-01 10.8661199 2017-01-01 25.0700688 2017-01-01 17.7830372 2017-01-01 23.8332845 2017-01-01 18.4259709
2017-02-01 10.7970057 2017-02-01 24.9621075 2017-02-01 17.8146221 2017-02-01 23.8855043 2017-02-01 18.4705795
2017-03-01 10.7278914 2017-03-01 24.8541461 2017-03-01 17.8462069 2017-03-01 23.937724 2017-03-01 18.5151881
2017-04-01 10.6587772 2017-04-01 24.7461848 2017-04-01 17.8777918 2017-04-01 23.9899438 2017-04-01 18.5597967
2017-05-01 10.589663 2017-05-01 24.6382235 2017-05-01 17.9093767 2017-05-01 24.0421635 2017-05-01 18.6044053
2017-06-01 10.5205488 2017-06-01 24.5302622 2017-06-01 17.9409615 2017-06-01 24.0943832 2017-06-01 18.649014
2017-07-01 10.4514345 2017-07-01 24.4223009 2017-07-01 17.9725464 2017-07-01 24.146603 2017-07-01 18.6936226
2017-08-01 10.3823203 2017-08-01 24.3143396 2017-08-01 18.0041313 2017-08-01 24.1988227 2017-08-01 18.7382312
2017-09-01 10.3132061 2017-09-01 24.2063783 2017-09-01 18.0357161 2017-09-01 24.2510424 2017-09-01 18.7828398
2017-10-01 10.2440919 2017-10-01 24.098417 2017-10-01 18.067301 2017-10-01 24.3032622 2017-10-01 18.8274484
2017-11-01 10.1749776 2017-11-01 23.9904557 2017-11-01 18.0988858 2017-11-01 24.3554819 2017-11-01 18.872057
2017-12-01 10.1058634 2017-12-01 23.8824944 2017-12-01 18.1304707 2017-12-01 24.4077017 2017-12-01 18.9166656
2018-01-01 10.0367492 2018-01-01 23.774533 2018-01-01 18.1620556 2018-01-01 24.4599214 2018-01-01 18.9612742
2018-02-01 9.96763497 2018-02-01 23.6665717 2018-02-01 18.1936404 2018-02-01 24.5121411 2018-02-01 19.0058828
2018-03-01 9.89852075 2018-03-01 23.5586104 2018-03-01 18.2252253 2018-03-01 24.5643609 2018-03-01 19.0504914
2018-04-01 9.82940652 2018-04-01 23.4506491 2018-04-01 18.2568102 2018-04-01 24.6165806 2018-04-01 19.0951
2018-05-01 9.7602923 2018-05-01 23.3426878 2018-05-01 18.288395 2018-05-01 24.6688004 2018-05-01 19.1397087
2018-06-01 9.69117807 2018-06-01 23.2347265 2018-06-01 18.3199799 2018-06-01 24.7210201 2018-06-01 19.1843173
2018-07-01 9.62206385 2018-07-01 23.1267652 2018-07-01 18.3515648 2018-07-01 24.7732398 2018-07-01 19.2289259
2018-08-01 9.55294963 2018-08-01 23.0188039 2018-08-01 18.3831496 2018-08-01 24.8254596 2018-08-01 19.2735345
2018-09-01 9.4838354 2018-09-01 22.9108426 2018-09-01 18.4147345 2018-09-01 24.8776793 2018-09-01 19.3181431
2018-10-01 9.41472118 2018-10-01 22.8028813 2018-10-01 18.4463194 2018-10-01 24.929899 2018-10-01 19.3627517
2018-11-01 9.34560695 2018-11-01 22.6949199 2018-11-01 18.4779042 2018-11-01 24.9821188 2018-11-01 19.4073603
2018-12-01 9.27649273 2018-12-01 22.5869586 2018-12-01 18.5094891 2018-12-01 25.0343385 2018-12-01 19.4519689
2019-01-01 9.2073785 2019-01-01 22.4789973 2019-01-01 18.541074 2019-01-01 25.0865583 2019-01-01 19.4965775
2019-02-01 9.13826428 2019-02-01 22.371036 2019-02-01 18.5726588 2019-02-01 25.138778 2019-02-01 19.5411861
2019-03-01 9.06915005 2019-03-01 22.2630747 2019-03-01 18.6042437 2019-03-01 25.1909977 2019-03-01 19.5857947
2019-04-01 9.00003583 2019-04-01 22.1551134 2019-04-01 18.6358285 2019-04-01 25.2432175 2019-04-01 19.6304034
2019-05-01 8.93092161 2019-05-01 22.0471521 2019-05-01 18.6674134 2019-05-01 25.2954372 2019-05-01 19.675012
2019-06-01 8.86180738 2019-06-01 21.9391908 2019-06-01 18.6989983 2019-06-01 25.347657 2019-06-01 19.7196206
2019-07-01 8.79269316 2019-07-01 21.8312295 2019-07-01 18.7305831 2019-07-01 25.3998767 2019-07-01 19.7642292
2019-08-01 8.72357893 2019-08-01 21.7232682 2019-08-01 18.762168 2019-08-01 25.4520964 2019-08-01 19.8088378
2019-09-01 8.65446471 2019-09-01 21.6153068 2019-09-01 18.7937529 2019-09-01 25.5043162 2019-09-01 19.8534464
2019-10-01 8.58535048 2019-10-01 21.5073455 2019-10-01 18.8253377 2019-10-01 25.5565359 2019-10-01 19.898055
2019-11-01 8.51623626 2019-11-01 21.3993842 2019-11-01 18.8569226 2019-11-01 25.6087556 2019-11-01 19.9426636
2019-12-01 8.44712204 2019-12-01 21.2914229 2019-12-01 18.8885075 2019-12-01 25.6609754 2019-12-01 19.9872722
2020-01-01 8.37800781 2020-01-01 21.1834616 2020-01-01 18.9200923 2020-01-01 25.7131951 2020-01-01 20.0318808
2020-02-01 8.30889359 2020-02-01 21.0755003 2020-02-01 18.9516772 2020-02-01 25.7654149 2020-02-01 20.0764894
2020-03-01 12.726065 2020-03-01 14.9115794 2020-03-01 13.0606157 2020-03-01 17.8148833 2020-03-01 11.5331499
2020-04-01 12.8093758 2020-04-01 28.2066552 2020-04-01 18.1262381 2020-04-01 26.759843 2020-04-01 17.4266651
2020-05-01 12.8926867 2020-05-01 41.5017311 2020-05-01 23.1918605 2020-05-01 35.7048027 2020-05-01 23.3201803
2020-06-01 12.9759975 2020-06-01 54.7968069 2020-06-01 28.2574828 2020-06-01 44.6497624 2020-06-01 29.2136955
2020-07-01 4.96792103 2020-07-01 36.2765503 2020-07-01 34.6476931 2020-07-01 25.2236849 2020-07-01 30.5534746
2020-08-01 5.78604877 2020-08-01 34.3243962 2020-08-01 31.9227663 2020-08-01 25.4983678 2020-08-01 28.461176
2020-09-01 6.60417651 2020-09-01 32.3722422 2020-09-01 29.1978395 2020-09-01 25.7730508 2020-09-01 26.3688773
2020-10-01 7.42230425 2020-10-01 30.4200882 2020-10-01 26.4729127 2020-10-01 26.0477337 2020-10-01 24.2765787
2020-11-01 8.24043199 2020-11-01 28.4679342 2020-11-01 23.7479859 2020-11-01 26.3224166 2020-11-01 22.1842801
2020-12-01 9.05855973 2020-12-01 26.5157802 2020-12-01 21.0230591 2020-12-01 26.5970995 2020-12-01 20.0919814
2021-01-01 9.87668747 2021-01-01 24.5636262 2021-01-01 18.2981323 2021-01-01 26.8717825 2021-01-01 17.9996828
2021-02-01 10.6948152 2021-02-01 22.6114722 2021-02-01 15.5732056 2021-02-01 27.1464654 2021-02-01 15.9073841
2021-03-01 11.512943 2021-03-01 20.6593182 2021-03-01 12.8482788 2021-03-01 27.4211483 2021-03-01 13.8150855
Period <10 years 10-19 years 20-39 years 40-59 years ≥60 years
Monthly change p value Monthly change p value Monthly change p value Monthly change p value Monthly change p value
Pre-pandemic -0.069 0.04 -0.108 <0.01 0.032 0.04 0.052 <0.01 0.045 <0.01
First month of lockdown 4.33 0.51 -19.46 0.06 -10.96 0.04 -16.90 <0.01 -14.44 0.02
Remainder of first lockdown 0.08 0.97 13.30 <0.01 5.07 0.01 8.94 <0.01 5.89 0.01
First month of reopening -8.83 0.16 -16.57 0.10 9.12 0.08 -19.70 <0.01 3.43 0.58
Remainder of follow-up 0.82 0.36 -1.95 0.19 -2.72 <0.01 0.27 0.76 -2.09 0.06

 

The impact of the pandemic on cycling injury hospitalizations depended on socioeconomic status and neighbourhood racialized group concentration (see Figure 3). Hospitalization rates for cycling injuries decreased in March 2020, but increased during the remainder of the first lockdown for individuals from neighbourhoods with very low socioeconomic disadvantage and racialized group concentration. Individuals from neighbourhoods with very low socioeconomic disadvantage had 9.6 additional hospitalizations per 100 000 each month, and individuals living in neighbourhoods with very low racialized group concentration had 19.2 additional hospitalizations per 100 000 each month. In contrast, rates increased only slightly for patients from socioeconomically disadvantaged neighbourhoods and those with very high racialized group concentration. During reopening, rates returned to pre-pandemic levels in all groups. In sensitivity analyses of weekly rates, trends resembled monthly rates.

Figure 3. Interrupted time series of cycling injury hospitalization rates according to neighbourhood socioeconomic status and racialized group concentration, 2006–2021, Quebec, CanadaFootnote aFootnote b
Figure 3. Text version below.
Figure 3 - Text description
Bike injury (socioeconomic disadvantage - low) Bike injury (socioeconomic disadvantage - high) Bike injury (ethnic concentration - low) Bike injury (ethnic concentration - high)
Date Rate per 100 000 Date Rate per 100 000 Date Rate per 100 000 Date Rate per 100 000
2006-04-01 12.1060827 2006-04-01 7.94199474 2006-04-01 32.495474 2006-04-01 4.15830115
2006-05-01 12.1406012 2006-05-01 7.94213117 2006-05-01 32.5183952 2006-05-01 4.1554557
2006-06-01 12.1751197 2006-06-01 7.9422676 2006-06-01 32.5413164 2006-06-01 4.15261025
2006-07-01 12.2096382 2006-07-01 7.94240403 2006-07-01 32.5642376 2006-07-01 4.1497648
2006-08-01 12.2441566 2006-08-01 7.94254046 2006-08-01 32.5871588 2006-08-01 4.14691935
2006-09-01 12.2786751 2006-09-01 7.94267689 2006-09-01 32.6100799 2006-09-01 4.14407391
2006-10-01 12.3131936 2006-10-01 7.94281332 2006-10-01 32.6330011 2006-10-01 4.14122846
2006-11-01 12.3477121 2006-11-01 7.94294975 2006-11-01 32.6559223 2006-11-01 4.13838301
2006-12-01 12.3822306 2006-12-01 7.94308618 2006-12-01 32.6788435 2006-12-01 4.13553756
2007-01-01 12.4167491 2007-01-01 7.94322261 2007-01-01 32.7017646 2007-01-01 4.13269211
2007-02-01 12.4512676 2007-02-01 7.94335904 2007-02-01 32.7246858 2007-02-01 4.12984666
2007-03-01 12.485786 2007-03-01 7.94349547 2007-03-01 32.747607 2007-03-01 4.12700121
2007-04-01 12.5203045 2007-04-01 7.9436319 2007-04-01 32.7705282 2007-04-01 4.12415577
2007-05-01 12.554823 2007-05-01 7.94376833 2007-05-01 32.7934494 2007-05-01 4.12131032
2007-06-01 12.5893415 2007-06-01 7.94390476 2007-06-01 32.8163705 2007-06-01 4.11846487
2007-07-01 12.62386 2007-07-01 7.94404119 2007-07-01 32.8392917 2007-07-01 4.11561942
2007-08-01 12.6583785 2007-08-01 7.94417762 2007-08-01 32.8622129 2007-08-01 4.11277397
2007-09-01 12.6928969 2007-09-01 7.94431405 2007-09-01 32.8851341 2007-09-01 4.10992852
2007-10-01 12.7274154 2007-10-01 7.94445048 2007-10-01 32.9080552 2007-10-01 4.10708307
2007-11-01 12.7619339 2007-11-01 7.94458691 2007-11-01 32.9309764 2007-11-01 4.10423763
2007-12-01 12.7964524 2007-12-01 7.94472334 2007-12-01 32.9538976 2007-12-01 4.10139218
2008-01-01 12.8309709 2008-01-01 7.94485977 2008-01-01 32.9768188 2008-01-01 4.09854673
2008-02-01 12.8654894 2008-02-01 7.9449962 2008-02-01 32.99974 2008-02-01 4.09570128
2008-03-01 12.9000079 2008-03-01 7.94513263 2008-03-01 33.0226611 2008-03-01 4.09285583
2008-04-01 12.9345263 2008-04-01 7.94526906 2008-04-01 33.0455823 2008-04-01 4.09001038
2008-05-01 12.9690448 2008-05-01 7.94540549 2008-05-01 33.0685035 2008-05-01 4.08716493
2008-06-01 13.0035633 2008-06-01 7.94554192 2008-06-01 33.0914247 2008-06-01 4.08431949
2008-07-01 13.0380818 2008-07-01 7.94567835 2008-07-01 33.1143458 2008-07-01 4.08147404
2008-08-01 13.0726003 2008-08-01 7.94581478 2008-08-01 33.137267 2008-08-01 4.07862859
2008-09-01 13.1071188 2008-09-01 7.94595121 2008-09-01 33.1601882 2008-09-01 4.07578314
2008-10-01 13.1416373 2008-10-01 7.94608764 2008-10-01 33.1831094 2008-10-01 4.07293769
2008-11-01 13.1761557 2008-11-01 7.94622407 2008-11-01 33.2060306 2008-11-01 4.07009224
2008-12-01 13.2106742 2008-12-01 7.9463605 2008-12-01 33.2289517 2008-12-01 4.06724679
2009-01-01 13.2451927 2009-01-01 7.94649693 2009-01-01 33.2518729 2009-01-01 4.06440135
2009-02-01 13.2797112 2009-02-01 7.94663336 2009-02-01 33.2747941 2009-02-01 4.0615559
2009-03-01 13.3142297 2009-03-01 7.94676979 2009-03-01 33.2977153 2009-03-01 4.05871045
2009-04-01 13.3487482 2009-04-01 7.94690622 2009-04-01 33.3206364 2009-04-01 4.055865
2009-05-01 13.3832666 2009-05-01 7.94704265 2009-05-01 33.3435576 2009-05-01 4.05301955
2009-06-01 13.4177851 2009-06-01 7.94717908 2009-06-01 33.3664788 2009-06-01 4.0501741
2009-07-01 13.4523036 2009-07-01 7.94731551 2009-07-01 33.3894 2009-07-01 4.04732865
2009-08-01 13.4868221 2009-08-01 7.94745194 2009-08-01 33.4123212 2009-08-01 4.04448321
2009-09-01 13.5213406 2009-09-01 7.94758837 2009-09-01 33.4352423 2009-09-01 4.04163776
2009-10-01 13.5558591 2009-10-01 7.9477248 2009-10-01 33.4581635 2009-10-01 4.03879231
2009-11-01 13.5903776 2009-11-01 7.94786123 2009-11-01 33.4810847 2009-11-01 4.03594686
2009-12-01 13.624896 2009-12-01 7.94799766 2009-12-01 33.5040059 2009-12-01 4.03310141
2010-01-01 13.6594145 2010-01-01 7.94813409 2010-01-01 33.5269271 2010-01-01 4.03025596
2010-02-01 13.693933 2010-02-01 7.94827052 2010-02-01 33.5498482 2010-02-01 4.02741051
2010-03-01 13.7284515 2010-03-01 7.94840696 2010-03-01 33.5727694 2010-03-01 4.02456507
2010-04-01 13.76297 2010-04-01 7.94854339 2010-04-01 33.5956906 2010-04-01 4.02171962
2010-05-01 13.7974885 2010-05-01 7.94867982 2010-05-01 33.6186118 2010-05-01 4.01887417
2010-06-01 13.832007 2010-06-01 7.94881625 2010-06-01 33.6415329 2010-06-01 4.01602872
2010-07-01 13.8665254 2010-07-01 7.94895268 2010-07-01 33.6644541 2010-07-01 4.01318327
2010-08-01 13.9010439 2010-08-01 7.94908911 2010-08-01 33.6873753 2010-08-01 4.01033782
2010-09-01 13.9355624 2010-09-01 7.94922554 2010-09-01 33.7102965 2010-09-01 4.00749237
2010-10-01 13.9700809 2010-10-01 7.94936197 2010-10-01 33.7332177 2010-10-01 4.00464693
2010-11-01 14.0045994 2010-11-01 7.9494984 2010-11-01 33.7561388 2010-11-01 4.00180148
2010-12-01 14.0391179 2010-12-01 7.94963483 2010-12-01 33.77906 2010-12-01 3.99895603
2011-01-01 14.0736364 2011-01-01 7.94977126 2011-01-01 33.8019812 2011-01-01 3.99611058
2011-02-01 14.1081548 2011-02-01 7.94990769 2011-02-01 33.8249024 2011-02-01 3.99326513
2011-03-01 14.1426733 2011-03-01 7.95004412 2011-03-01 33.8478235 2011-03-01 3.99041968
2011-04-01 14.1771918 2011-04-01 7.95018055 2011-04-01 33.8707447 2011-04-01 3.98757424
2011-05-01 14.2117103 2011-05-01 7.95031698 2011-05-01 33.8936659 2011-05-01 3.98472879
2011-06-01 14.2462288 2011-06-01 7.95045341 2011-06-01 33.9165871 2011-06-01 3.98188334
2011-07-01 14.2807473 2011-07-01 7.95058984 2011-07-01 33.9395083 2011-07-01 3.97903789
2011-08-01 14.3152657 2011-08-01 7.95072627 2011-08-01 33.9624294 2011-08-01 3.97619244
2011-09-01 14.3497842 2011-09-01 7.9508627 2011-09-01 33.9853506 2011-09-01 3.97334699
2011-10-01 14.3843027 2011-10-01 7.95099913 2011-10-01 34.0082718 2011-10-01 3.97050154
2011-11-01 14.4188212 2011-11-01 7.95113556 2011-11-01 34.031193 2011-11-01 3.9676561
2011-12-01 14.4533397 2011-12-01 7.95127199 2011-12-01 34.0541141 2011-12-01 3.96481065
2012-01-01 14.4878582 2012-01-01 7.95140842 2012-01-01 34.0770353 2012-01-01 3.9619652
2012-02-01 14.5223767 2012-02-01 7.95154485 2012-02-01 34.0999565 2012-02-01 3.95911975
2012-03-01 14.5568951 2012-03-01 7.95168128 2012-03-01 34.1228777 2012-03-01 3.9562743
2012-04-01 14.5914136 2012-04-01 7.95181771 2012-04-01 34.1457989 2012-04-01 3.95342885
2012-05-01 14.6259321 2012-05-01 7.95195414 2012-05-01 34.16872 2012-05-01 3.9505834
2012-06-01 14.6604506 2012-06-01 7.95209057 2012-06-01 34.1916412 2012-06-01 3.94773796
2012-07-01 14.6949691 2012-07-01 7.952227 2012-07-01 34.2145624 2012-07-01 3.94489251
2012-08-01 14.7294876 2012-08-01 7.95236343 2012-08-01 34.2374836 2012-08-01 3.94204706
2012-09-01 14.7640061 2012-09-01 7.95249986 2012-09-01 34.2604047 2012-09-01 3.93920161
2012-10-01 14.7985245 2012-10-01 7.95263629 2012-10-01 34.2833259 2012-10-01 3.93635616
2012-11-01 14.833043 2012-11-01 7.95277272 2012-11-01 34.3062471 2012-11-01 3.93351071
2012-12-01 14.8675615 2012-12-01 7.95290915 2012-12-01 34.3291683 2012-12-01 3.93066526
2013-01-01 14.90208 2013-01-01 7.95304558 2013-01-01 34.3520895 2013-01-01 3.92781982
2013-02-01 14.9365985 2013-02-01 7.95318201 2013-02-01 34.3750106 2013-02-01 3.92497437
2013-03-01 14.971117 2013-03-01 7.95331844 2013-03-01 34.3979318 2013-03-01 3.92212892
2013-04-01 15.0056354 2013-04-01 7.95345487 2013-04-01 34.420853 2013-04-01 3.91928347
2013-05-01 15.0401539 2013-05-01 7.9535913 2013-05-01 34.4437742 2013-05-01 3.91643802
2013-06-01 15.0746724 2013-06-01 7.95372773 2013-06-01 34.4666954 2013-06-01 3.91359257
2013-07-01 15.1091909 2013-07-01 7.95386416 2013-07-01 34.4896165 2013-07-01 3.91074712
2013-08-01 15.1437094 2013-08-01 7.95400059 2013-08-01 34.5125377 2013-08-01 3.90790168
2013-09-01 15.1782279 2013-09-01 7.95413702 2013-09-01 34.5354589 2013-09-01 3.90505623
2013-10-01 15.2127464 2013-10-01 7.95427345 2013-10-01 34.5583801 2013-10-01 3.90221078
2013-11-01 15.2472648 2013-11-01 7.95440988 2013-11-01 34.5813012 2013-11-01 3.89936533
2013-12-01 15.2817833 2013-12-01 7.95454631 2013-12-01 34.6042224 2013-12-01 3.89651988
2014-01-01 15.3163018 2014-01-01 7.95468274 2014-01-01 34.6271436 2014-01-01 3.89367443
2014-02-01 15.3508203 2014-02-01 7.95481917 2014-02-01 34.6500648 2014-02-01 3.89082898
2014-03-01 15.3853388 2014-03-01 7.9549556 2014-03-01 34.672986 2014-03-01 3.88798354
2014-04-01 15.4198573 2014-04-01 7.95509203 2014-04-01 34.6959071 2014-04-01 3.88513809
2014-05-01 15.4543758 2014-05-01 7.95522846 2014-05-01 34.7188283 2014-05-01 3.88229264
2014-06-01 15.4888942 2014-06-01 7.95536489 2014-06-01 34.7417495 2014-06-01 3.87944719
2014-07-01 15.5234127 2014-07-01 7.95550132 2014-07-01 34.7646707 2014-07-01 3.87660174
2014-08-01 15.5579312 2014-08-01 7.95563776 2014-08-01 34.7875918 2014-08-01 3.87375629
2014-09-01 15.5924497 2014-09-01 7.95577419 2014-09-01 34.810513 2014-09-01 3.87091084
2014-10-01 15.6269682 2014-10-01 7.95591062 2014-10-01 34.8334342 2014-10-01 3.8680654
2014-11-01 15.6614867 2014-11-01 7.95604705 2014-11-01 34.8563554 2014-11-01 3.86521995
2014-12-01 15.6960051 2014-12-01 7.95618348 2014-12-01 34.8792766 2014-12-01 3.8623745
2015-01-01 15.7305236 2015-01-01 7.95631991 2015-01-01 34.9021977 2015-01-01 3.85952905
2015-02-01 15.7650421 2015-02-01 7.95645634 2015-02-01 34.9251189 2015-02-01 3.8566836
2015-03-01 15.7995606 2015-03-01 7.95659277 2015-03-01 34.9480401 2015-03-01 3.85383815
2015-04-01 15.8340791 2015-04-01 7.9567292 2015-04-01 34.9709613 2015-04-01 3.8509927
2015-05-01 15.8685976 2015-05-01 7.95686563 2015-05-01 34.9938824 2015-05-01 3.84814726
2015-06-01 15.9031161 2015-06-01 7.95700206 2015-06-01 35.0168036 2015-06-01 3.84530181
2015-07-01 15.9376345 2015-07-01 7.95713849 2015-07-01 35.0397248 2015-07-01 3.84245636
2015-08-01 15.972153 2015-08-01 7.95727492 2015-08-01 35.062646 2015-08-01 3.83961091
2015-09-01 16.0066715 2015-09-01 7.95741135 2015-09-01 35.0855672 2015-09-01 3.83676546
2015-10-01 16.04119 2015-10-01 7.95754778 2015-10-01 35.1084883 2015-10-01 3.83392001
2015-11-01 16.0757085 2015-11-01 7.95768421 2015-11-01 35.1314095 2015-11-01 3.83107457
2015-12-01 16.110227 2015-12-01 7.95782064 2015-12-01 35.1543307 2015-12-01 3.82822912
2016-01-01 16.1447455 2016-01-01 7.95795707 2016-01-01 35.1772519 2016-01-01 3.82538367
2016-02-01 16.1792639 2016-02-01 7.9580935 2016-02-01 35.200173 2016-02-01 3.82253822
2016-03-01 16.2137824 2016-03-01 7.95822993 2016-03-01 35.2230942 2016-03-01 3.81969277
2016-04-01 16.2483009 2016-04-01 7.95836636 2016-04-01 35.2460154 2016-04-01 3.81684732
2016-05-01 16.2828194 2016-05-01 7.95850279 2016-05-01 35.2689366 2016-05-01 3.81400187
2016-06-01 16.3173379 2016-06-01 7.95863922 2016-06-01 35.2918578 2016-06-01 3.81115643
2016-07-01 16.3518564 2016-07-01 7.95877565 2016-07-01 35.3147789 2016-07-01 3.80831098
2016-08-01 16.3863748 2016-08-01 7.95891208 2016-08-01 35.3377001 2016-08-01 3.80546553
2016-09-01 16.4208933 2016-09-01 7.95904851 2016-09-01 35.3606213 2016-09-01 3.80262008
2016-10-01 16.4554118 2016-10-01 7.95918494 2016-10-01 35.3835425 2016-10-01 3.79977463
2016-11-01 16.4899303 2016-11-01 7.95932137 2016-11-01 35.4064636 2016-11-01 3.79692918
2016-12-01 16.5244488 2016-12-01 7.9594578 2016-12-01 35.4293848 2016-12-01 3.79408373
2017-01-01 16.5589673 2017-01-01 7.95959423 2017-01-01 35.452306 2017-01-01 3.79123829
2017-02-01 16.5934858 2017-02-01 7.95973066 2017-02-01 35.4752272 2017-02-01 3.78839284
2017-03-01 16.6280042 2017-03-01 7.95986709 2017-03-01 35.4981484 2017-03-01 3.78554739
2017-04-01 16.6625227 2017-04-01 7.96000352 2017-04-01 35.5210695 2017-04-01 3.78270194
2017-05-01 16.6970412 2017-05-01 7.96013995 2017-05-01 35.5439907 2017-05-01 3.77985649
2017-06-01 16.7315597 2017-06-01 7.96027638 2017-06-01 35.5669119 2017-06-01 3.77701104
2017-07-01 16.7660782 2017-07-01 7.96041281 2017-07-01 35.5898331 2017-07-01 3.77416559
2017-08-01 16.8005967 2017-08-01 7.96054924 2017-08-01 35.6127543 2017-08-01 3.77132015
2017-09-01 16.8351152 2017-09-01 7.96068567 2017-09-01 35.6356754 2017-09-01 3.7684747
2017-10-01 16.8696336 2017-10-01 7.9608221 2017-10-01 35.6585966 2017-10-01 3.76562925
2017-11-01 16.9041521 2017-11-01 7.96095853 2017-11-01 35.6815178 2017-11-01 3.7627838
2017-12-01 16.9386706 2017-12-01 7.96109496 2017-12-01 35.704439 2017-12-01 3.75993835
2018-01-01 16.9731891 2018-01-01 7.96123139 2018-01-01 35.7273601 2018-01-01 3.7570929
2018-02-01 17.0077076 2018-02-01 7.96136782 2018-02-01 35.7502813 2018-02-01 3.75424745
2018-03-01 17.0422261 2018-03-01 7.96150425 2018-03-01 35.7732025 2018-03-01 3.75140201
2018-04-01 17.0767445 2018-04-01 7.96164068 2018-04-01 35.7961237 2018-04-01 3.74855656
2018-05-01 17.111263 2018-05-01 7.96177711 2018-05-01 35.8190449 2018-05-01 3.74571111
2018-06-01 17.1457815 2018-06-01 7.96191354 2018-06-01 35.841966 2018-06-01 3.74286566
2018-07-01 17.1803 2018-07-01 7.96204997 2018-07-01 35.8648872 2018-07-01 3.74002021
2018-08-01 17.2148185 2018-08-01 7.9621864 2018-08-01 35.8878084 2018-08-01 3.73717476
2018-09-01 17.249337 2018-09-01 7.96232283 2018-09-01 35.9107296 2018-09-01 3.73432931
2018-10-01 17.2838555 2018-10-01 7.96245926 2018-10-01 35.9336507 2018-10-01 3.73148387
2018-11-01 17.3183739 2018-11-01 7.96259569 2018-11-01 35.9565719 2018-11-01 3.72863842
2018-12-01 17.3528924 2018-12-01 7.96273212 2018-12-01 35.9794931 2018-12-01 3.72579297
2019-01-01 17.3874109 2019-01-01 7.96286856 2019-01-01 36.0024143 2019-01-01 3.72294752
2019-02-01 17.4219294 2019-02-01 7.96300499 2019-02-01 36.0253355 2019-02-01 3.72010207
2019-03-01 17.4564479 2019-03-01 7.96314142 2019-03-01 36.0482566 2019-03-01 3.71725662
2019-04-01 17.4909664 2019-04-01 7.96327785 2019-04-01 36.0711778 2019-04-01 3.71441117
2019-05-01 17.5254849 2019-05-01 7.96341428 2019-05-01 36.094099 2019-05-01 3.71156573
2019-06-01 17.5600033 2019-06-01 7.96355071 2019-06-01 36.1170202 2019-06-01 3.70872028
2019-07-01 17.5945218 2019-07-01 7.96368714 2019-07-01 36.1399413 2019-07-01 3.70587483
2019-08-01 17.6290403 2019-08-01 7.96382357 2019-08-01 36.1628625 2019-08-01 3.70302938
2019-09-01 17.6635588 2019-09-01 7.96396 2019-09-01 36.1857837 2019-09-01 3.70018393
2019-10-01 17.6980773 2019-10-01 7.96409643 2019-10-01 36.2087049 2019-10-01 3.69733848
2019-11-01 17.7325958 2019-11-01 7.96423286 2019-11-01 36.2316261 2019-11-01 3.69449303
2019-12-01 17.7671143 2019-12-01 7.96436929 2019-12-01 36.2545472 2019-12-01 3.69164759
2020-01-01 17.8016327 2020-01-01 7.96450572 2020-01-01 36.2774684 2020-01-01 3.68880214
2020-02-01 17.8361512 2020-02-01 7.96464215 2020-02-01 36.3003896 2020-02-01 3.68595669
2020-03-01 12.2488317 2020-03-01 4.2460801 2020-03-01 23.6195693 2020-03-01 1.37182677
2020-04-01 21.8515038 2020-04-01 4.80741945 2020-04-01 42.840773 2020-04-01 2.94677418
2020-05-01 31.454176 2020-05-01 5.36875879 2020-05-01 62.0619766 2020-05-01 4.52172159
2020-06-01 41.0568482 2020-06-01 5.93009813 2020-06-01 81.2831803 2020-06-01 6.096669
2020-07-01 24.4320716 2020-07-01 15.0605644 2020-07-01 49.7980215 2020-07-01 8.68180177
2020-08-01 23.580332 2020-08-01 13.8663049 2020-08-01 47.6694335 2020-08-01 7.83414697
2020-09-01 22.7285924 2020-09-01 12.6720455 2020-09-01 45.5408455 2020-09-01 6.98649218
2020-10-01 21.8768528 2020-10-01 11.4777861 2020-10-01 43.4122575 2020-10-01 6.13883738
2020-11-01 21.0251132 2020-11-01 10.2835266 2020-11-01 41.2836695 2020-11-01 5.29118259
2020-12-01 20.1733737 2020-12-01 9.08926719 2020-12-01 39.1550815 2020-12-01 4.44352779
2021-01-01 19.3216341 2021-01-01 7.89500776 2021-01-01 37.0264935 2021-01-01 3.595873
2021-02-01 18.4698945 2021-02-01 6.70074833 2021-02-01 34.8979055 2021-02-01 2.74821821
2021-03-01 17.6181549 2021-03-01 5.50648889 2021-03-01 32.7693175 2021-03-01 1.90056341
Period Low disadvantage High disadvantage Nonracialized Racialized
Monthly change p value Monthly change p value Monthly change p value Monthly change p value
Pre-pandemic 0.035 0.07 0.000 0.98 0.023 0.36 -0.003 0.71
First month of lockdown -15.19 <0.01 -4.28 0.24 -31.90 <0.01 -3.89 0.15
Remainder of first lockdown 9.60 <0.01 0.56 0.68 19.22 <0.01 1.57 0.12
First month of reopening -15.77 <0.01 10.32 <0.01 -29.36 <0.01 3.43 0.18
Remainder of follow-up -0.85 0.28 -1.19 0.03 2.13 0.12 -0.85 0.02

Discussion

In this study of data from Quebec, hospitalization rates for cycling injuries increased significantly during the first COVID-19 lockdown. The increase in cycling injury hospitalizations was highest among adolescents and adults, and among individuals from socioeconomically advantaged neighbourhoods with low racialized group concentration.

The lockdown was marked by a predominance of cycling-related fractures and injuries to the head and neck. Most of the increase in the number of cycling injuries was due to falls rather than collisions. The findings suggest that cycling behaviours and associated injuries changed considerably during the pandemic, and that cycling should be included in injury prevention policies to reduce morbidity during lockdowns.

A number of studies have examined bike injuries experienced by children and adolescents less than 18 years old during the pandemic, as this group was thought to be most at risk of sustaining cycling accidents.Footnote 8 Footnote 9 Between March and October 2020, the average number of emergency department visits for cycling injuries in this population reached 84.5 per month in Canada, an amount considerably greater than the average of 33.7 visits per month seen in the two years preceding the pandemic.Footnote 8 Children aged 6 to 10 years were more likely to present to emergency rooms for bike injuries than younger children (0–5 years) or older children and adolescents (11–18 years).Footnote 8

In Australia, pediatric emergency department visits and hospital admissions for cycling-related injuries among individuals younger than 16 went up by 43% and 49%, respectively, during the first lockdown compared with the previous year.Footnote 9 We found that cycling injury hospitalization rates increased primarily for adolescents aged 10 to 19 years.

Adults' cycling injuries have received less attention. A multicentre study from the United Kingdom found that emergency referrals for scooter and bike injuries increased for patients aged 19 to 65 years between March and June 2020.Footnote 10 Bike injuries, however, were not specifically examined.Footnote 10 Rajput et al.Footnote 16 observed a significant increase in bike injuries during lockdown among adults, but examined only road traffic collisions. In Ireland, Foley et al.Footnote 17 reported no difference in emergency room visits for cycling injuries during the first lockdown compared with 2019, although the data combined adults and adolescents. Other studies of cycling injuries in the general population did not report rates separately for adults and adolescents.Footnote 18 Footnote 19

Our data show that adults' cycling injury hospitalization rates increased considerably during the first lockdown. As exercise facilities were closed during lockdowns,Footnote 1 cycling may have been the sport of choice for many adults as a way of complying with social distancing measures.Footnote 4 Adults may also have used bikes to ride to work or to run errands as a way of avoiding public transportation.

During the pandemic, many cities promoted cycling by closing streets to motor vehicle traffic.Footnote 4 This, together with an expanded network of bike paths, as documented in Montréal,Footnote 4 the largest city in Quebec, may have enticed more people to try cycling. Bicycle sales increased by 39%,Footnote 4 and it is possible that many individuals took up cycling for the first time or after a long break. One study found that less experienced cyclists were 69% more likely to sustain injuries requiring medical attention.Footnote 7 These factors together may have resulted in a higher number of inexperienced cyclists and exacerbated cycling injury hospitalizations, particularly among adults.

Increased availability of bike lanes along with reduced motor vehicle traffic may have led to more fall-related injuries rather than collisions. A study in Ireland found that emergency department visits decreased for injuries due to motor vehicle collisions, while those due to isolated cycling crashes increased substantially.Footnote 17 Similarly, a multicentre study from Scotland reported a decrease in the number of cycling injuries involving car collisions, while the number of orthopaedic interventions for falls from bikes increased compared with the period preceding the pandemic.Footnote 18 Our study found that patients admitted to hospital for cycling injuries during the first lockdown were 47% more likely to have had isolated falls; collisions were rare. Efforts to increase the safety of bike paths may be needed to decrease the burden of injury not due to collisions.

Other factors may have contributed to the overall increase in cycling hospitalizations, as the risk of injury was not evenly distributed across racialized and socioeconomic backgrounds at the neighbourhood level. The first lockdown was marked by an increase in cycling injuries in neighbourhoods with low racialized group concentration and high socioeconomic advantage. A recent study of 22 major American cities found that the presence of dedicated cycling lanes correlated strongly with bike commuting in neighbourhoods with high socioeconomic status and few Hispanic residents.Footnote 20 Remote work during lockdowns was more prevalent among individuals with high socioeconomic status and may have increased the leisure time available for cycling,Footnote 21 as commuting was no longer needed. Thus, cycling routes may have benefited socioeconomically advantaged groups during the pandemic, but also led to more injuries in this population. Individuals in socioeconomically disadvantaged neighbourhoods with high concentrations of racialized people may have been less likely to cycle, despite the overall greater availability of bike paths during the pandemic.Footnote 4

The type and anatomical site of cycling injuries during the pandemic appears to have changed. A single-centre study from the U.S. found that fractures from pediatric bike accidents increased during the first month of the pandemic,Footnote 22 while other Canadian and Australian investigations found no difference.Footnote 8 Footnote 9 In Scotland, the proportion of cycling injuries requiring surgery for fractures increased in the general population.Footnote 18 The first lockdown also led to an increase in fractures in our study population. However, head and neck injuries increased more than those of spine/thorax/pelvis, lower limb and upper limb. This differs from Ireland, where head injuries decreased.Footnote 17 In both Ireland and Scotland, upper limb injuries increased more.Footnote 17 Footnote 18 Some of the difference may be due to helmet laws in Quebec, where cyclists are not required to wear helmets except while using electric bikes.Footnote 23 Greater emphasis on use of helmets and other safety equipment while cycling may be beneficial.

Prior studies have not considered long-term trends in cycling injuries. The pandemic has only been compared with the period immediately preceding it.Footnote 8 Footnote 9 Footnote 10 Footnote 16 Footnote 17 Footnote 18 Footnote 19 Yet, our data suggest that cycling injuries began increasing many years prior to the pandemic. As a result, it is not clear if some of the increase reported in other studies reflects secular trends in cycling injuries,Footnote 15 rather than the pandemic itself. We eliminated the effect of secular trends by using an autoregressive interrupted time series,Footnote 15 allowing us to attribute the increase in cycling injuries seen at the beginning of the pandemic to the first lockdown.

Strengths and limitations

This study has a number of limitations. The data we used are rigorously validated,Footnote 11 but coding errors can occur, resulting in misclassification of outcomes or other characteristics. We could not identify minor cycling injuries that did not require hospital admission, and we did not have information on the number of hours spent cycling per day, the types of roads used for travel, the use of reserved bike lanes and the extent to which cycling routes were expanded during the pandemic. Data on helmet use or other protective equipment were also not available.

Statistical power was limited for the second lockdown, although this limitation may be because winter conditions decreased the number of cyclists. Our study reflects the situation in the population of Quebec, where cycling is a common means of transportation.Footnote 24 Data from other provinces were not available. It remains unclear whether our findings can be applied to regions where cycling is less prevalent.

Conclusion

The first COVID-19 lockdown led to a significant rise in cycling injury hospitalizations among adolescents and adults in Quebec, while the reopening period and second lockdown had a more limited effect. Individuals from socioeconomically advantaged and less racialized neighbourhoods were most affected by cycling injuries. Falls not involving a collision were the principal mechanism of injury. Fractures and injuries to the head and neck also increased. Awareness campaigns promoting bike safety and helmet use to prevent severe cycling injuries should be ongoing, even during public health crises such as a pandemic.

Acknowledgements

This work was supported by the Canadian Institutes of Health Research (WI2-179928) and the Fonds de recherche du Québec – Santé (296785). The study sponsors had no role in the study design, collection, analysis and interpretation of data, writing of the report, or decision to submit the report for publication.

Conflicts of interest

The authors have no conflicts of interest to declare.

Authors' contributions and statement

NA – Conceptualization, Study design, Writing – Original Draft; AL – Conceptualization, Writing – Review & Editing; ÉB – Conceptualization, Study design, Formal analysis, Visualization, Writing – Original Draft; AA – Conceptualization, Study design, Writing – Review & Editing; CB – Conceptualization, Writing – Review & Editing; TML – Conceptualization, Writing – Review & Editing.

All authors read and approved the final manuscript.

The content and views expressed herein are those of the authors and do not necessarily reflect those of the Government of Canada.

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