Trends in and Risk Factors for Bicycle-Related Mortality in an Ageing Cycling-Centric Country: Analysis of Japanese Administrative Data.

Japan has the most ageing population in the world with a high population of bicycle users, and the percentage of older cyclists continues to grow as the population ages. At the same time, the proportion of bicycle-related collisions is increasing. The aim of this study is to analyse trends and risk factors for bicycle injuries and deaths in Japan in order to suggest preventive measures, using data from vital statistics and the National Police Agency to calculate incidence rate ratios (IRR), age-standardised mortality rates, and annual percent changes, by ten-year-interval age groups. Data from the Japan Trauma Data Bank was analysed for demographic information about injuries. The risk of casualties was high in the younger generation and lower in the older population. However, the risk of mortality increased rapidly with age, with people over 70 years old facing more than 10 times the risk of younger age groups (IRR = 12.62). Casualty and mortality rates were declining in all age groups until the year 2020 (range: -9.77% to -4.95%, -8.61% to -1.07%, respectively). However, lethality of bicycle collisions showed no significant reduction. Current methods have not been effective in reducing bicycle-related lethality in Japan, especially for the older population, and should be improved to ensure that bicycle transportation is safe for all road users.