{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T20:17:01Z","timestamp":1781727421516,"version":"3.54.5"},"reference-count":49,"publisher":"BMJ","issue":"8","funder":[{"name":"National Council of Science and Technology of Mexico","award":["410668"],"award-info":[{"award-number":["410668"]}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,7,31]]},"published-print":{"date-parts":[[2019,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To quantify the magnitude of associations between cyclist fatalities and both cyclist and environment related characteristics in Spain during the first 24\u2009hours after a crash.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Spain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>65\u2009977 cyclists injured in road crashes recorded between 1993 and 2013 in the Spanish Register of Road Crashes with Victims.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome<\/jats:title>\n                    <jats:p>Death within the first 24\u2009hours after the crash.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A multiple imputation procedure was used to mitigate the effect of missing values. Differences between regions were assumed and managed with multilevel analysis at the cyclist and province levels. Incidence density ratios (IDR) with 95%\u2009CI were calculated with a multivariate Poisson model.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Non-use of a helmet was directly associated with death (IDR 1.43, 95%\u2009CI 1.25 to 1.64). Among other cyclist characteristics, age after the third decade of life was also directly associated with death, especially in older cyclists (\u2018over 74\u2019 category, IDR 4.61, 95%\u2009CI 3.49 to 6.08). The association with death did not differ between work-related cycling and other reasons for cycling.<\/jats:p>\n                    <jats:p>There was an inverse association with death for crashes in urban areas and on community roads. Any adverse meteorological condition also showed a direct association with death, whereas altered road surfaces showed an inverse association. Crashes during nighttime were directly associated with death, with a peak between 3:00 and 5:59 am (IDR 1.58, 95%\u2009CI 1.03 to 2.41).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>We found strong direct and inverse associations between several cyclist and environment related variables and death. These variables should be considered in efforts to prioritise public health measures aimed at reducing the number of cycling-related fatalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2018-028039","type":"journal-article","created":{"date-parts":[[2019,8,23]],"date-time":"2019-08-23T04:55:19Z","timestamp":1566536119000},"page":"e028039","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":9,"title":["Individual and environmental factors associated with death of cyclists involved in road crashes in Spain: a cohort study"],"prefix":"10.1136","volume":"9","author":[{"given":"Daniel","family":"Molina-Soberanes","sequence":"first","affiliation":[{"name":"Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain"},{"name":"Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginia","family":"Mart\u00ednez-Ruiz","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain"},{"name":"Centros de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Barcelona, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada (ibs.GRANADA), Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pablo","family":"Lardelli-Claret","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain"},{"name":"Centros de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Barcelona, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada (ibs.GRANADA), Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9","family":"Pulido-Manzanero","sequence":"additional","affiliation":[{"name":"Centros de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Barcelona, Spain"},{"name":"Escuela Nacional de Sanidad, Instituto de Salud Carlos III, Madrid, Spain"},{"name":"Department of Public Health & Maternal and Child Health, Complutense University of Madrid, Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Luis Miguel","family":"Mart\u00edn-delosReyes","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain"},{"name":"Doctoral Program in Clinical Medicine and Public Health, University of Granada, Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elena","family":"Moreno-Rold\u00e1n","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain"},{"name":"Centros de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Barcelona, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada (ibs.GRANADA), Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eladio","family":"Jim\u00e9nez-Mej\u00edas","sequence":"additional","affiliation":[{"name":"Department of Preventive Medicine and Public Health, School of Medicine, University of Granada, Granada, Spain"},{"name":"Centros de Investigaci\u00f3n Biom\u00e9dica en Red de Epidemiolog\u00eda y Salud P\u00fablica (CIBERESP), Barcelona, Spain"},{"name":"Instituto de Investigaci\u00f3n Biosanitaria de Granada (ibs.GRANADA), Granada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,8,22]]},"reference":[{"key":"2025121409074821000_9.8.e028039.1","unstructured":"World Health Organization (WHO) . 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