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Objective: To investigate trends of motorcyclist fatalities and identify at-risk populations by motorcyclist demographics and crash characteristics. Methods: We used the Fatality Analysis Reporting System (FARS) database (2000-2016) to track fatality rate trends, which were quantified by using Poisson mixed-effects regression models comparing 2000-2001 and 2007-2008, as well as 2009-2010 and 2015-2016. Results: The overall fatality rate per 100,000 population increased from 2000 to 2016, defined by two trend lines-before and after the economic recession in 2008-2009. The overall fatality rate ratio between 2000-2001 and 2007-2008 was 1.60 [95% Confidence Interval (CI): 1.51-1.70], and between 2009-2010 and 2015-2016 was 1.09 (95% CI: 1.02-1.18). Fatality rates increased among all age groups, particularly for motorcyclists aged 60 and older. Those aged 18-29 had the highest fatality rates overall. Age-and-sex standardized state fatality rates were consistently highest in Wyoming, South Dakota, and South Carolina and lowest in Massachusetts, New York and New Jersey. Conclusion: Motorcycle fatality rates increased overall and across all age groups between 2000 and 2016. Fatalities for the oldest riders showed the steadiest increasing trends. Results highlight the continued public health burden of motorcyclist fatalities and, by extension, the importance of improving motorcycle safety.

Objectives: To compare the risk of fatal injury across helmet types among collision-involved motorcyclists., Methods: We used data from a cohort of motorcyclists involved in police-reported traffic collisions. Eighty-four law enforcement agencies in California collected detailed information on helmet and rider characteristics during collision investigations in June 2012 through July 2013. Multiply-adjusted risk ratios were estimated with log-binomial regression., Results: The adjusted fatal injury risk ratio for novelty helmets was 1.95 (95% CI 1.11-3.40, p 0.019), comparing novelty helmets with full-face helmets. The risk ratios for modular, open-face, and half-helmets, compared with full-face helmets, were not significant., Conclusions: A more complete understanding of the inadequacy of novelty helmets can be used in educational and law enforcement countermeasures to improve helmet use among motorcycling populations in California and other US states. Law enforcement approaches to mitigating novelty helmet use would seem attractive given that novelty helmets can be visually identified by law enforcement officers with sufficient training., (Copyright © 2017 Elsevier Ltd. All rights reserved.)

Most studies find strong evidence that motorcycle helmets protect against injury, but a small number of controversial studies have reported a positive association between helmet use and neck injury. The most commonly cited paper is that of Goldstein (1986). Goldstein obtained and reanalyzed data from the Hurt Study, a prospective, on-scene investigation of 900 motorcycle collisions in the city of Los Angeles. The Goldstein results have been adopted by the anti-helmet community to justify resistance to compulsory motorcycle helmet use on the grounds that helmets may cause neck injuries due to their mass. In the current study, we replicated Goldstein's models to understand how he obtained his unexpected results, and we then applied modern statistical methods to estimate the association of motorcycle helmet use with head injury, fatal injury, and neck injury among collision-involved motorcyclists. We found Goldstein's analysis to be critically flawed due to improper data imputation, modeling of extremely sparse data, and misinterpretation of model coefficients. Our new analysis showed that motorcycle helmets were associated with markedly lower risk of head injury (RR 0.40, 95% CI 0.31-0.52) and fatal injury (RR 0.44, 95% CI 0.26-0.74) and with moderately lower but statistically significant risk of neck injury (RR 0.63, 95% CI 0.40-0.99), after controlling for multiple potential confounders., (Copyright © 2016 Elsevier Ltd. All rights reserved.)

Objective: The use of helmets that do not comply with safety standards is common in California. The objective of this study was to describe the use of these nonstandard helmets among San Francisco Bay-area (SFBA) motorcyclists and to identify personal and motorcycle characteristics that are associated with the use of nonstandard helmets., Methods: A survey of 860 SFBA motorcyclists was conducted. Log-binomial regression was used to estimate risk ratios to compare probabilities of nonstandard helmet use., Results: Fifteen percent of motorcyclists reported wearing a nonstandard helmet sometimes or often. BMW riders had the lowest use of nonstandard helmet (5%) and Harley-Davidson riders had the highest use (51%). Among non-Harley-Davidsons, riders of cruiser-style motorcycles were 3.1 times as likely to wear a nonstandard helmet as riders of motorcycles of other styles. African American riders were more than twice as likely to use nonstandard helmets compared to riders with other self-reported race., Discussion: Behavioral countermeasures are needed to improve motorcycle helmet choice in California. This study identified riders of Harley-Davidsons and riders of cruiser-style motorcycles of other brands as potential targets of interventions.

Study Objective: We describe the associations among facial fracture, helmet use, skull fracture, and traumatic brain injury in injured motorcycle riders., Methods: The study population consisted of 5,790 motorcycle riders who sustained an injury from a crash in 1991, 1992, or 1993 and were identified from emergency department or hospital records in 28 hospitals in 11 California counties. Diagnostic information was abstracted from ED or hospital records and coded to the 1990 Abbreviated Injury Scale. The risk of traumatic brain injury was examined by using odds ratios and 95% confidence intervals. Logistic regression analysis was used to examine the associations among helmet use, skull fracture, facial fracture, and traumatic brain injury., Results: Facial injury was diagnosed in 24.4% of all injured riders, including 411 with one or more facial fractures. The odds of traumatic brain injury were 3.5 times greater with than without a facial injury and 6.5 times greater with a facial fracture than with no facial injury. Significantly increased odds of traumatic brain injury were observed for fracture of all bones of the face, but the highest odds of traumatic brain injury were found in riders with fractures to bones of the upper face. Helmet use status and the presence of skull fracture were found to be significant effect modifiers. Facial fracture with concurrent skull fracture increased the risk of traumatic brain injury dramatically. Facial fractures are more strongly associated with traumatic brain injury in helmeted riders., Conclusion: The presence of facial fractures increases the risk of traumatic brain injury. Riders with facial fractures should be screened for brain injury, regardless of helmet use status.