Misconceptions regarding case-control studies of bicycle helmets and head injury

A number of published case-control studies have reported that bicycle helmets are associated with a reduced risk of head injury and brain injury among bicyclists who crashed. A paper in this journal offered several criticisms of these studies and of a systematic review of these studies. Many of those criticisms stem from misconceptions about the studies that have been done and about case-control studies in general. In this manuscript we review case-control study design, particularly as it applies to bicycle helmet studies, and review some aspects of the analysis of case-control data.