{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,19]],"date-time":"2026-04-19T09:38:52Z","timestamp":1776591532511,"version":"3.51.2"},"reference-count":39,"publisher":"BMJ","issue":"10","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2021,3,16]]},"published-print":{"date-parts":[[2021,10]]},"abstract":"<jats:sec>\n                  <jats:title>Objectives<\/jats:title>\n                  <jats:p>To determine the existence of sex-based differences in the protective effects of helmets against common injuries in bicycle trauma.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>In a retrospective cohort study, we identified patients 18 years or older in the 2017 National Trauma Database presenting after bicycle crash. Sex-disaggregated and sex-combined multivariable logistic regression models were calculated for short-term outcomes that included age, involvement with motor vehicle collision, anticoagulant use, bleeding disorder and helmet use. The sex-combined model included an interaction term for sex and helmet use. The resulting exponentiated model parameter yields an adjusted OR ratio of the effects of helmet use for females compared with males.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>In total, 18\u2009604 patients of average age 48.1 were identified, and 18% were female. Helmet use was greater in females than males (48.0% vs 34.2%, p&lt;0.001). Compared with helmeted males, helmeted females had greater rates of serious head injury (37.7% vs 29.9%, p&lt;0.001) despite less injury overall. In sex-disaggregated models, helmet use reduced odds of intracranial haemorrhage and death in males (p&lt;0.001) but not females. In sex-combined models, helmets conferred to females significantly less odds reduction for severe head injury (p=0.002), intracranial bleeding (p&lt;0.001), skull fractures (p=0.001), cranial surgery (p=0.006) and death (p=0.017). There was no difference for cervical spine fracture.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Bicycle helmets may offer less protection to females compared with males. The cause of this sex or gender-based difference is uncertain, but there may be intrinsic incompatibility between available helmets and female anatomy and\/or sex disparity in helmet testing standards.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/jech-2020-215544","type":"journal-article","created":{"date-parts":[[2021,4,7]],"date-time":"2021-04-07T14:55:45Z","timestamp":1617807345000},"page":"994-1000","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":5,"title":["Sex-based differences in helmet performance in bicycle trauma"],"prefix":"10.1136","volume":"75","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9206-6394","authenticated-orcid":false,"given":"Joshua","family":"Feler","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adrian A","family":"Maung","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rick","family":"O'Connor","sequence":"additional","affiliation":[{"name":"Yale New Haven Health System, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kimberly A","family":"Davis","sequence":"additional","affiliation":[{"name":"Department of Surgery, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason","family":"Gerrard","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Yale School of Medicine, New Haven, Connecticut, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2021,4,7]]},"reference":[{"key":"2025100522370277000_75.10.994.1","unstructured":"McKenzie B . Modes less Traveled\u2014Bicycling and walking to work in the United States: 2008\u20132012."},{"key":"2025100522370277000_75.10.994.2","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.trd.2015.02.005","article-title":"Effects of e-bikes on bicycle use and mode share","volume":"36","author":"Fyhri","year":"2015","journal-title":"Transp Res D: Transp Environ"},{"key":"2025100522370277000_75.10.994.3","doi-asserted-by":"crossref","first-page":"112","DOI":"10.3141\/2387-13","article-title":"Are Bikeshare users different from regular cyclists?: a first look at short-term users, annual members, and area cyclists in the Washington, D C., region","volume":"2387","author":"Buck","year":"2013","journal-title":"Transp Res Rec J Transp Res Board"},{"key":"2025100522370277000_75.10.994.4","doi-asserted-by":"publisher","DOI":"10.1186\/1479-5868-9-106"},{"key":"2025100522370277000_75.10.994.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2007.07.010"},{"key":"2025100522370277000_75.10.994.6","doi-asserted-by":"crossref","first-page":"83","DOI":"10.1080\/03081060.2013.844903","article-title":"Exploring gendered cycling behaviours within a large-scale behavioural data-set","volume":"37","author":"Beecham","year":"2014","journal-title":"Transp Plan Technol"},{"key":"2025100522370277000_75.10.994.7","doi-asserted-by":"publisher","DOI":"10.1016\/S0001-4575(00)00048-8"},{"key":"2025100522370277000_75.10.994.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2011.01.007"},{"key":"2025100522370277000_75.10.994.9","doi-asserted-by":"crossref","first-page":"dyw360","DOI":"10.1093\/ije\/dyw360","article-title":"Bicycle injuries and helmet use: a systematic review and meta-analysis","volume":"46","author":"Olivier","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2025100522370277000_75.10.994.10","doi-asserted-by":"crossref","unstructured":"Thompson DC , Rivara F , Thompson R , et al . Helmets for preventing head and facial injuries in bicyclists. Cochrane Database Syst Rev 1999;308.doi:10.1002\/14651858.CD001855","DOI":"10.1002\/14651858.CD001855"},{"key":"2025100522370277000_75.10.994.11","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.aap.2018.03.026","article-title":"Bicycle helmets - To wear or not to wear? A meta-analyses of the effects of bicycle helmets on injuries","volume":"117","author":"H\u00f8ye","year":"2018","journal-title":"Accid Anal Prev"},{"key":"2025100522370277000_75.10.994.12","doi-asserted-by":"crossref","first-page":"1597","DOI":"10.1080\/02699052.2019.1650201","article-title":"Helmet use and bicycle-related trauma injury outcomes","volume":"33","author":"Scott","year":"2019","journal-title":"Brain Inj"},{"key":"2025100522370277000_75.10.994.13","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1097\/00005373-200105000-00021","article-title":"A review of serious injuries and deaths from bicycle accidents in Sweden from 1987 to 1994","volume":"50","author":"Bostr\u00f6m","year":"2001","journal-title":"J Trauma"},{"key":"2025100522370277000_75.10.994.14","doi-asserted-by":"publisher","DOI":"10.1136\/ip.3.2.110"},{"key":"2025100522370277000_75.10.994.15","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.amjsurg.2016.05.021","article-title":"Bicycle helmets work when it matters the most","volume":"213","author":"Joseph","year":"2017","journal-title":"Am J Surg"},{"key":"2025100522370277000_75.10.994.16","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2009.08.006"},{"key":"2025100522370277000_75.10.994.17","doi-asserted-by":"publisher","DOI":"10.1136\/ip.3.2.110"},{"key":"2025100522370277000_75.10.994.18","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006654"},{"key":"2025100522370277000_75.10.994.19","doi-asserted-by":"crossref","first-page":"621","DOI":"10.1016\/j.aap.2010.09.015","article-title":"Mixed logit analysis of bicyclist injury severity resulting from motor vehicle crashes at intersection and non-intersection locations","volume":"43","author":"Moore","year":"2011","journal-title":"Accid Anal Prev"},{"key":"2025100522370277000_75.10.994.20","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1177\/0361198118798968","article-title":"Modeling cyclist route choice using revealed preference data: an age and gender perspective","volume":"2672","author":"Misra","year":"2018","journal-title":"Transp Res Rec"},{"key":"2025100522370277000_75.10.994.21","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2013.12.019"},{"key":"2025100522370277000_75.10.994.22","doi-asserted-by":"crossref","first-page":"391","DOI":"10.1080\/17457300.2019.1653930","article-title":"Gender differences in cyclists' crashes: an analysis of routinely recorded crash data","volume":"26","author":"Prati","year":"2019","journal-title":"Int J Inj Contr Saf Promot"},{"key":"2025100522370277000_75.10.994.23","doi-asserted-by":"crossref","first-page":"90","DOI":"10.13004\/kjnt.2017.13.2.90","article-title":"Epidemiology and risk factors for bicycle-related severe head injury: a single center experience","volume":"13","author":"Park","year":"2017","journal-title":"Korean J Neurotrauma"},{"key":"2025100522370277000_75.10.994.24","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2015.07.030"},{"key":"2025100522370277000_75.10.994.25","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2006.07.002"},{"key":"2025100522370277000_75.10.994.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2014.05.024"},{"key":"2025100522370277000_75.10.994.27","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/153.3.219"},{"key":"2025100522370277000_75.10.994.28","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2011.300275"},{"key":"2025100522370277000_75.10.994.29","doi-asserted-by":"publisher","DOI":"10.1136\/ip.5.3.194"},{"key":"2025100522370277000_75.10.994.30","doi-asserted-by":"crossref","first-page":"268","DOI":"10.1080\/15389588.2014.931948","article-title":"Adjustment, and stability","volume":"16","author":"Thai","year":"2015","journal-title":"Traffic Inj Prev"},{"key":"2025100522370277000_75.10.994.31","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1016\/j.apergo.2014.11.008","article-title":"Evaluation of an anthropometric shape model of the human scalp","volume":"48","author":"Lacko","year":"2015","journal-title":"Appl Ergon"},{"key":"2025100522370277000_75.10.994.32","doi-asserted-by":"crossref","first-page":"194","DOI":"10.1016\/j.apergo.2016.02.008","article-title":"The Helmet Fit Index--An intelligent tool for fit assessment and design customisation","volume":"55","author":"Ellena","year":"2016","journal-title":"Appl Ergon"},{"key":"2025100522370277000_75.10.994.33","doi-asserted-by":"publisher","DOI":"10.1136\/tsaco-2019-000337"},{"key":"2025100522370277000_75.10.994.34","doi-asserted-by":"crossref","first-page":"e187381","DOI":"10.1001\/jamanetworkopen.2018.7381","article-title":"Injuries associated with standing electric scooter use","volume":"2","author":"Trivedi","year":"2019","journal-title":"JAMA Netw Open"},{"key":"2025100522370277000_75.10.994.35","doi-asserted-by":"crossref","first-page":"1531","DOI":"10.1016\/j.ajem.2019.05.003","article-title":"Emergency department visits for electric scooter-related injuries after introduction of an urban rental program","volume":"37","author":"Badeau","year":"2019","journal-title":"Am J Emerg Med"},{"key":"2025100522370277000_75.10.994.36","unstructured":"Which helmet for which activity? CPSC.gov, 2015. Available: https:\/\/www.cpsc.gov\/safety-education\/safety-guides\/sports-fitness-and-recreation-bicycles\/which-helmet-which-activity [Accessed 20 Feb 2020]."},{"key":"2025100522370277000_75.10.994.37","doi-asserted-by":"publisher","DOI":"10.1016\/j.trf.2018.10.026"},{"key":"2025100522370277000_75.10.994.38","doi-asserted-by":"publisher","DOI":"10.1016\/j.aap.2013.12.019"},{"key":"2025100522370277000_75.10.994.39","unstructured":"NHTSA . Fatal Accident Reporting System. National Highway Traffic Safety Administration. Available: https:\/\/cdan.dot.gov\/query [Accessed 14 Nov 2019]."}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2020-215544","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,6]],"date-time":"2025-10-06T05:37:13Z","timestamp":1759729033000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2020-215544"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,4,7]]},"references-count":39,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2021,9,9]]},"published-print":{"date-parts":[[2021,10]]}},"alternative-id":["10.1136\/jech-2020-215544"],"URL":"https:\/\/doi.org\/10.1136\/jech-2020-215544","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,4,7]]}}}