Cycling-related injuries demonstrate the highest hospitalization proportion, whereas exercise-related activities account for the largest injury burden: a 12-year national epidemiological analysis

Sports- and recreation-related injuries represent a substantial public health burden, yet comprehensive national analyses comparing high-volume activities across all age groups remain limited. The purpose of this study was to describe temporal patterns, demographic distributions, injury patterns, and hospitalization profiles of the five most common sports and recreational activities associated with emergency department (ED) visits in the United States. A retrospective epidemiological analysis was conducted using data from the National Electronic Injury Surveillance System (NEISS) between 2013 and 2024. Injuries associated with basketball, bicycle and accessories, exercise/exercise equipment, football, and playground equipment were included. Weighted national estimates were generated using NEISS sampling weights. Outcomes included injury type, injured body region, and hospitalization status. Multivariable logistic regression analyses were performed to evaluate independent associations of activity type, age, sex, and body region with fracture, strain/sprain, dislocation, and hospitalization outcomes. Hospitalization status was evaluated as an indirect proxy for injury severity. An estimated 21.8 million sports- and recreation-related injuries were identified during the study period. Exercise-related activities (5.49 million estimated injuries) and cycling-related activities (5.31 million estimated injuries) accounted for the greatest injury burden. Individuals aged 5 to 14 years represented the most affected age group, and males accounted for 71.9% of injuries. Strain/sprain injuries predominated overall, particularly in basketball (37.1%) and exercise-related activities (27.8%), whereas fractures were more common in playground-related (34.4%) and cycling-related injuries (23.6%). Head/neck injuries were most frequent in cycling-related (30.1%) and playground-related injuries (34.3%). Cycling-related injuries demonstrated the highest hospitalization proportion (11.1%), whereas basketball demonstrated the lowest proportion (1.6%). Multivariable analysis confirmed that cycling-related injuries were associated with higher odds of hospitalization than basketball, football, and exercise-related injuries, whereas hospitalization odds were comparable to playground-related injuries. Advancing age, particularly age ≥ 65 years, was associated with greater odds of hospitalization among ED-treated injury cases. Temporally, injury volumes declined sharply in 2020, followed by a rebound exceeding pre-pandemic levels. Exercise-related activities accounted for the greatest overall injury volume, whereas cycling-related injuries demonstrated the highest hospitalization proportion, an indirect proxy for injury severity. Injury burden was greatest among individuals aged 5–14 years, whereas advancing age was associated with greater odds of hospitalization among ED-treated injury cases.