Objectives: To describe bicyclist fatalities in a traffic-dense, urban environment.

Methods: Multiple New York City (NYC) agencies provided information on bicyclist deaths. Fatality Analysis Reporting System (FARS) data were used to compare NYC's bicyclist fatality rate involving motor vehicles with rates in comparable urban centers.

Results: Between 1996 and 2005, 225 bicyclists died in NYC. Most fatalities resulted from motor vehicle crashes (92%). Men in NYC had higher death rates than women, and no age group had higher risk. Most of NYC's bicyclist fatalities occurred at intersections (88%). Head injuries contributed to 77 percent of deaths; helmet use was rare (3%). Most fatal crashes (91%) involved motorist and bicyclist factors, such as inattention and unsafe speed. Alcohol was detected in 21 percent of bicyclists dying within 3 hours of a crash; motorist alcohol use was a contributing factor in 6 percent of crashes. Over half were on multi-lane roads (53%). Large vehicles were involved in 30 percent of crashes but comprise 5-17 percent of road vehicles. Bicyclist fatality rates involving motor vehicles in NYC were comparable to those of other cities.

Conclusion: Findings suggest the merits of multipronged efforts to prevent crashes and to improve bicyclist safety in NYC and in other dense, urban environments. Motorists and bicyclists should be made aware of the risks of alcohol use and the benefits of helmet-wearing. Road users should pay attention to traffic control measures and travel at safe speeds. Interventions that control traffic at intersections and on multilane streets, that dedicate and demarcate routes for motorists and cyclists, and that improve visibility, especially for large vehicles, warrant consideration.