• William P Meehan, Lois K Lee, Christopher M Fischer, and Rebekah C Mannix.
• Micheli Center for Sports Injury Prevention, Waltham, MA, USA. concussion.sportsmed@childrens.harvard.edu
• J. Pediatr. 2013 Sep 1; 163 (3): 726-9.

ObjectiveTo assess the association between bicycle helmet legislation and bicycle-related deaths sustained by children involved in bicycle-motor vehicle collisions.Study DesignWe conducted a cross-sectional study of all bicyclists aged 0-16 years included in the Fatality Analysis Reporting System who died between January 1999 and December 2010. We compared fatality rates in age-specific state populations between states with helmet laws and those without helmet laws. We used a clustered Poisson multivariate regression model to adjust for factors previously associated with rates of motor vehicle fatalities: elderly driver licensure laws, legal blood alcohol limit (<0.08% vs ≥ 0.08%), and household income.ResultsA total of 1612 bicycle-related fatalities sustained by children aged <16 years were evaluated. There were no statistically significant differences in median household income, the proportion of states with elderly licensure laws, or the proportion of states with a blood alcohol limit of >0.08% between states with helmet laws and those without helmet laws. The mean unadjusted fatality rate was lower in states with helmet laws (2.0/1,000,000 vs 2.5/1,000,000; P = .03). After adjusting for potential confounding factors, lower fatality rates persisted in states with mandatory helmet laws (adjusted incidence rate ratio, 0.84; 95% CI, 0.70-0.98).ConclusionBicycle helmet safety laws are associated with a lower incidence of fatalities in child cyclists involved in bicycle-motor vehicle collisions.Copyright © 2013 Mosby, Inc. All rights reserved.

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