An Ignored killer: the burden of Cyclist road injuries in China from the Global Burden of Disease Study 2021

Objective To quantify the burden, trends, and gender-specific disparities of cyclist road injuries in China following the micro-mobility revolution and identify systemic drivers of rising mortality among reproductive-aged women. Methods Using Global Burden of Disease (GBD) 2021 subnational data (1990–2021), we analyzed age-standardized incidence (ASIR), mortality (ASMR), and disability-adjusted life year rates (ASDAR) for cyclist injuries. Joinpoint regression identified temporal inflection points. Infrastructure deficits were mapped via OpenStreetMap. ARIMAX models projected burdens to 2050, incorporating Socio-Demographic Index (SDI) and demographic covariates. Results Road injuries are China’s leading cause of death among reproductive-aged adults (15–49 years; ASMR 16.8/100,000). Cyclist injuries exhibit a uniquely severe burden: China ranks 6th globally for ASDAR, with women aged 15–49 years bearing the planet’s highest cyclist mortality (ASMR rank 1st; 60% higher than males). A 2016 inflection point reversed decades of declining ASMR/ASDAR, coinciding with uncontrolled micro-mobility expansion (> 20 million vehicles). Systemic failures drove this: dedicated bike lanes cover only 0.3% of roads, regulatory frameworks neglect bicycle-specific protections (e.g., lighting, passing distances), and occupational cycling exposes women to high-risk corridors. By 2050, ASIR among reproductive-aged women is projected to rise 23.7%, while ASDAR (disability burden) will increase 19.4%, signaling a crisis of long-term impairment from fractures and neurotrauma. Conclusions China’s cycling safety crisis constitutes a demographic emergency, with women facing catastrophic mortality due to infrastructural abandonment, regulatory neglect, and unmitigated micro-mobility risks. Urgent gender-responsive interventions—mandating segregated lanes, enforcing WHO-aligned bicycle legislation (helmets, lighting), and integrating bone health into occupational safety—are essential to avert 81,000 projected disability life-years lost annually by 2050 and align green mobility goals with equitable health protection.