RT Journal Article SR Electronic T1 Nonuse of bicycle helmets and risk of fatal head injury: a proportional mortality, case–control study JF Canadian Medical Association Journal JO CMAJ FD Canadian Medical Association SP cmaj.120988 DO 10.1503/cmaj.120988 A1 Navindra Persaud A1 Emily Coleman A1 Dorothy Zwolakowski A1 Bert Lauwers A1 Dan Cass YR 2012 UL http://www.cmaj.ca/content/early/2012/10/15/cmaj.120988.abstract AB Background: The effectiveness of helmets at preventing cycling fatalities, a leading cause of death among young adults worldwide, is controversial, and safety regulations for cycling vary by jurisdiction. We sought to determine whether nonuse of helmets is associated with an increased risk of fatal head injury. Methods: We used a case–control design involving 129 fatalities using data from a coroner's review of cycling deaths in Ontario, Canada, between 2006 and 2010. We defined cases as cyclists who died as a result of head injuries; we defined controls as cyclists who died as a result of other injuries. The exposure variable was nonuse of a bicycle helmet. Results: Not wearing a helmet while cycling was associated with an increased risk of dying as a result of sustaining a head injury (adjusted odds ratio [OR] 3.1, 95% confidence interval [CI] 1.3–7.3). We saw the same relationship when we excluded people younger than 18 years from the analysis (adjusted OR 3.5, 95% CI 1.4–8.5) and when we used a more stringent case definition (i.e., only a head injury with no other sub stantial injuries; adjusted OR 3.6, 95% CI 1.2–10.2). Interpretation: Not wearing a helmet while cycling is associated with an increased risk of sustaining a fatal head injury. Policy changes and educational programs that increase the use of helmets while cycling may prevent deaths.