Odds of sickness absence and disability pension after bicycle injuries: A Norwegian nationwide register study

Introduction: Increased bicycling is a key strategy for health and environmental goals, yet it may increase the number of cycling injuries, which is a risk factor for subsequent work disability. Low socioeconomic status (SES) is a known risk factor for both general traffic injuries and work disability, but less is known about social inequalities in long-term work disability following bicycle-specific accidents. This study assessed the risk of work disability among injured bicyclists and investigated associations with SES and injury severity. Method: We conducted a nationwide population-based case-control study, linking Norwegian Trauma Registry data (2015–2018) with administrative registries on welfare benefits and SES. The sample included 975 injured bicyclists (cases) aged 18–58 and 4,875 matched controls. Work disability, operationalized as receipt of sickness benefits, work assessment allowance, and disability pension, was assessed for four years post-injury. Injury severity was classified using the New Injury Severity Score (NISS). Results: Cases had significantly higher rates of work disability than controls. Four years post-accident, the odds of being on work assessment allowance or disability pension were more than doubled for cases (OR 2.44, 95% CI: 1.82–3.27). The odds increased markedly with injury severity (OR 7.40 for NISS ≥ 16). Bicycle injuries were more common among higher-income individuals (52% in the highest income quartile), in contrast to patterns observed for other road user groups. The relative increase in work disability associated with injury was stronger among high-income individuals (OR 3.32) than among low-income individuals (OR 1.26). Conclusions: Bicycle injuries substantially increased the odds of long-term work disability. Injured cyclists had a high socioeconomic profile, but injury severity was the strongest predictor of long-term work disability. Practical Applications: These findings indicate that assessment of the burden of cycling injuries should incorporate long-term functional and socioeconomic consequences.