Towards a safer sport: Risk factors for cross-country horse falls at British Eventing competition.

Background: Equestrian eventing is a dangerous Olympic sport, with 16 rider and 69 horse fatalities at competition in the last 10 years. Despite this, there is limited research that aims to improve safety within the sport.

Objectives: The purpose of this study was to identify risk factors for horse falls, which are the leading cause of rider fatality within the sport.

Study Design: Retrospective cohort study.

Methods: Competition data between January 2005 and December 2015 were analysed. Descriptive statistics followed by univariable logistic regression to identify risk factors for inclusion in a multivariable logistic regression model were conducted. Models were constructed stepwise using a bidirectional process and assessed using the Akaike information criterion. A total of 749 534 cross-country starts were analysed for association with the risk of horse falls.

Results: Sixteen risk factors were identified including: higher event levels, higher dressage penalties and higher number of days since horses' last start. For example, horse and rider combinations competing at BE100 (OR 1.64, confidence interval (CI) 1.37-1.96, p < 0.001), novice (OR 3.58, CI 3.03-4.24, p < 0.001), intermediate (OR 8.00, CI 6.54-9.78, p < 0.001), advanced (OR 12.49, CI 9.42-16.57, p < 0.001) and international (OR 4.63, CI 3.50-6.12, p < 0.001) all had a higher risk of having a horse fall in comparison to combinations competing at BE90 level. Furthermore, for every additional 10 dressage penalties awarded to a horse and rider combination, there was a higher risk of a horse fall (OR 1.20, CI 1.12-1.28, p < 0.001).

Main Limitations: The study is not geographically comprehensive (UK only) and does not include any information on training activity of horses and riders.

Conclusions: This is the largest-scale study ever conducted on horse falls during eventing competition. Study results can be used by sport governing bodies to inform policy which has the potential to reduce the risk of injury and fatality to sport participants.