{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:01:26Z","timestamp":1789995686988,"version":"4.0.1"},"reference-count":39,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T00:00:00Z","timestamp":1785196800000},"content-version":"vor","delay-in-days":57,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T00:00:00Z","timestamp":1780272000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,6]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>Bicyclist injuries are a major public health concern in the United States, with limited understanding of variations in injury severity and discharge outcomes by rurality. This study provides a national assessment of bicycling\u2010related hospitalizations, focusing on differences by rurality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using HCUP\u2010NIS data (2016\u20132020), bicycling\u2010related hospitalizations were identified. Descriptive analyses characterized demographic and regional trends. Multivariable logistic regression, stratified by rural\/urban patient residence, was used to assess factors associated with non\u2010routine discharges.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>\n                      Between 2016 and 2020, an estimated 124,000 bicyclist\u2010related hospitalizations occurred, resulting in more than $10 billion in hospital costs. Overall, 31.2% resulted in non\u2010routine discharge, including 1.4% deaths. Hospitalizations were stable through 2019 but increased by &gt;20% in 2020. Urban residents accounted for most cases (91.1%). Cases were predominantly male (80%); aged 31\u201370 (65.4%) and hospitalized in the South (31.2%) or West (36.4%). Increasing age showed a strong dose\u2013response relationship with non\u2010routine discharge in both settings (e.g., age\u00a0\u2265\u00a071: OR\n                      <jats:sub>rural<\/jats:sub>\n                      \u00a0=\u00a015.71, 95% confidence interval [CI]: 9.52\u201325.93; OR\n                      <jats:sub>urban<\/jats:sub>\n                      \u00a0=\u00a012.18, 95% CI: 10.21\u201314.52). Motor\u2010vehicle involvement increased the odds of non\u2010routine discharge in both settings (OR\n                      <jats:sub>rural<\/jats:sub>\n                      \u00a0=\u00a02.53, 95% CI: 1.89\u20133.40; OR\n                      <jats:sub>urban<\/jats:sub>\n                      \u00a0=\u00a01.68, 95% CI: 1.55\u20131.82).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Bicyclist hospitalizations persisted and slightly increased over the study period. Age was the strongest predictor of non\u2010routine discharge across settings, whereas sex and income effects were significantly associated with outcomes in urban areas. Findings highlight the need for tailored prevention strategies and equitable infrastructure improvements across rural and urban settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70194","type":"journal-article","created":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:48:56Z","timestamp":1785239336000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["National Burden of Bicyclist Hospitalizations in the United States by Rurality, 2016\u20132020"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6796-7388","authenticated-orcid":false,"given":"Amir","family":"Ghanbari","sequence":"first","affiliation":[{"name":"Department of Epidemiology University of Iowa  Iowa City Iowa USA"},{"name":"Injury Prevention Research Center University of Iowa  Iowa City Iowa USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan 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