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Objective: This study examined the epidemiological characteristics of bicycle injuries and the wearing of a helmet. Methods: A cross-sectional observational study was conducted using the emergency department-based Injury In-depth Surveillance data from 2013 to 2016. The study population consisted of patients related to bicycles of all ages. The variables associated with helmet wearing were sex, age, type of location, activity at injury, alcohol use at injury, and time of injury. Multivariable logistic regression analysis was conducted to estimate the risks of nonuse of helmets. Results: Among the 31,923 eligible patients, 3,304 patients (10.3%) were wearing helmets at the time of the injury. The adjusted logistic regression model showed that females (adjusted odds ratio [aOR], 0.675; 95% confidence interval [CI], 0.614-0.742), teenagers (aOR, 0.265; 95% CI, 0.232-0.302), old age (aOR, 0.378; 95% CI, 0.326-0.438), road except for bicycle lanes (aOR, 0.510; 95% CI, 0.467-0.557), leisure (aOR, 0.290; 95% CI, 0.252-0.334) or vital activity (aOR, 0.188; 95% CI, 0.162-0.218) at injury, alcohol use at injury (aOR, 0.329; 95% CI, 0.253-0.427), night time (aOR, 0.609; 95% CI, 0.560-0.663), and winter (aOR 0.734; 95% CI 0.619-0.872) were significantly associated with the nonuse of helmets. Conclusion: This study identified the factors associated with helmet use during bicycle riding. Strategies aimed at increasing the use of bicycle helmets targeting the risk population are needed.