The effect of the Swedish bicycle helmet law for children: An interrupted time series study

Abstract

BackgroundPrevious population-based research has shown that bicycle helmet laws can reduce head injury rates among cyclists. According to deterrence theory, such laws are mainly effective if there is a high likelihood of being apprehended. In this study, we investigated the effect of the Swedish helmet law for children under the age of 15, a population that cannot be fined. MethodAn interrupted time series design was used. Monthly inpatient data on injured cyclists from 1998–2012, stratified by age (0–14, 15+), sex, and injury diagnosis, was obtained from the National Patient Register. The main outcome measure was the proportion of head injury admissions per month. Intervention effect estimates were obtained using generalized autoregressive moving average (GARMA) models. Pre-legislation trend and seasonality was adjusted for, and differences-in-differences estimation was obtained using adults as a non-equivalent control group. ResultsThere was a statistically significant intervention effect among male children, where the proportion of head injuries dropped by 7.8 percentage points. There was no evidence of an intervention effect on the proportion of head injuries among female children. ConclusionAccording to hospital admission data, the bicycle helmet law appears to have had an effect only on male children. Practical applicationsThis study, while quasi-experimental and thus not strictly generalizable, can contribute to increased knowledge regarding the effects of bicycle helmet laws.