Equestrian sport is one of the most popular activities in the world.1 In the UK alone, >4.3 million people ride annually. It is also one of the biggest industries in the UK, estimated to be worth £4 billion to the economy, in addition to generating an additional £5 billion in gambling turnover.2 With billions of pounds at stake, the inherent dangers of the sport are easily overlooked. It is known that professional jockeys experience large numbers of injuries, including career-ending injury.3^–5 Despite the known injury risk, the direct and indirect costs of injury in this sport remain hidden and this paper will form the basis of a more formal economic analysis.

This study investigated the insurance payments made to professional jockeys in Great Britain (England, Scotland and Wales, but not Northern Ireland) as a result of injuries sustained between 1996 and 2006.

Background

In order for the reader to appreciate the nature of professional horse racing, this background section will discuss the demographics of the sport in order to appreciate the injury cost data presented in the paper. This data in this section were provided by the Jockey Club (UK).

Racing statistics

Professional horse racing can be broadly divided into flat racing and jump racing (also referred to as National Hunt racing), both of which take place over a full 12-month season. The shortest flat race distance is 1 km (0.625 miles), and the longest race distance is 4.4 km (2.75 miles). For jump racing, the distance varies between 3.2 and 7.2 km (2–4.5 miles), and involves jumping over either hurdle or steeplechase fences.

In Great Britain, professional horse racing is conducted on 59 racecourses (2 in Wales, 5 in Scotland and 52 in England). Each racecourse holds an average of 22 race meetings per annum. For example, 1300 race meetings were held in 2005, at which 8588 races took place. At each flat meeting, an average of 34 jockeys is in attendance and at each jump meeting an average of 41 jockeys is in attendance.

During the 11-year period 1996–2006 inclusive, an average of 478 jump meetings and 706 flat meetings per annum occurred. The average annual figures for jump racing were 30 258 rides, 1943 falls and 478 injuries, and for flat racing were 49 279 rides, 220 falls and 77 injuries.

Jockeys

Jockeys usually start race riding at 16–18 years of age, and serve as ”apprentice” riders (flat jockeys) or ”conditional„ riders (jump jockeys) for up to 5 years, before becoming full professional jockeys. Jump jockeys normally retire before the age of 40 years, while flat jockeys ride into their 50s.

In the year 2006, there were 125 flat racing jockeys and 105 jump jockeys with full registration. An additional 184 apprentice riders and 124 conditional riders were also licensed. Professional horse racing in Great Britain is a male-dominated sport. Of the 538 licensed jockeys in 2006, only 41 were women, and of these, only 10 were full professional jockeys (8 flat and 2 jump jockeys). The full jockey registration data have been relatively stable over time and the details are published elsewhere.4 5

Jockeys’ income

Jockeys are paid a fixed fee for every ride and a fixed percentage of any prize money achieved for winning the race or being placed (around 8% of the prize money). In 2005, the riding fee was £85.79 per ride on the flat and £117.15 for every jump ride. The ability and popularity of a jockey determines how many rides they are offered and the top jockeys may have >1000 rides in 12 months (flat) or 800 rides (jump). The average jockey would expect to be booked for around 300 rides/year (flat) or 200 rides/year (jump), which is equivalent to an annual income in 2005 of £25 737 (flat) or £23 430 (jump). Jockeys are self-employed, and this figure does not include any prize money to which they may be entitled. It should also be noted that a proportion (normally 50%) of the riding fee and prize money earned by apprentice and conditional jockeys is paid to the trainer who holds the jockey’s license.

Medical care of jockeys

The Jockey Club closely regulates racing in Great Britain, and the medical arrangements on all racecourses must comply with a set of detailed instructions known as the Jockey Club General Instruction 11.

At every race meeting, two racecourse medical officers are required to be on duty solely to look after the medical needs of the jockeys. These doctors have specific training in equestrian injuries and are certified in advanced trauma life support techniques. Until 2002, all professional jockeys carried a “medical passport” or medical record book, which was examined by a designated racecourse medical officer when the jockey arrived at a race meeting.

All falls are recorded in the medical record book and on a separate sheet (MO1 form), which is subsequently returned to the Jockey Club Chief Medical Adviser. Since 1992, it has been compulsory for all racecourses to return a completed MO1 form for every race meeting. All jockeys who fall, become ill or are injured on a racecourse are required to report to a racecourse medical officer for examination. The results of all examinations must be recorded in the medical record book and on the MO1 form for return to the racing authority. Any jockey who has a recorded injury in their medical record book (from a previous race meeting) may not return to race riding until they have been cleared by the Jockey Club Chief Medical Adviser, or examined by a racecourse medical officer on a race day, and declared “fit to return to race riding”. This is then documented in the medical record book and on the MO1 form for that day.

Since 2002, this system has been computerised for professional jockeys, who no longer carry medical record books. All falls and injuries are still recorded on the MO1 form but this information is held centrally and a list of all suspended riders (the Red Entry List) is sent to each racecourse before racing commences. Any jockey who is on the Red Entry List must be examined and cleared as above.

The MO1 system enables details of all falls and injuries to be maintained centrally and for injuries to be monitored by the Jockey Club Chief Medical Adviser. This ensures that jockeys who are at additional risk (to themselves or of causing injury to other riders) are not allowed to return to racing before it is safe for them to do so.

METHODS

The relevant literature was searched through Medline. Keywords used in the searches included horse racing, sports injuries, jockeys, equestrian injuries, concussion and head injury.

The injury and Professional Riders Insurance Scheme (PRIS) data was provided by the Jockey Club, and is based on the medical evaluation of every injury sustained by the claimant.

Professional Riders Insurance Scheme

The PRIS, formerly the Compensation Fund for Jockeys, was established in 1974 with the aim of providing all professional jockeys (licensed, apprentice and conditional) in Great Britain with monetary compensation in the event of an injury.

The insurance scheme covers any work-related accident that the jockey might be involved in, including training and schooling of the horses, transport to and from the racecourses, and racing-related activities at the racecourse. The scheme is funded by contributions made for each ride by the owners of the horses.

The scheme provides jockeys with a weekly payment comparable with what they might have been earning from race riding fees if they had not been injured. The PRIS benefits are fixed amounts (ie not discretionary), and depend on the grade of the jockey, which is determined by the number of rides they have completed in the previous 12 months.

The jockeys are covered by the insurance scheme for the duration of the injury (ie the time off racing due to the injury). The maximum period of injury recognised under the scheme is 546 days off racing (78 weeks or 18 months), which is described as a career-ending injury. In this data set, none of the ”78 week„ riders returned to racing, and some sustained permanent disability.

In the event of permanent neurological disablement, the jockey will also receive a lump sum payment (capital sum). If a jockey is killed while covered by PRIS, the dependents will receive a lump sum payment (£150 000 in 1996 rising to £300 000 in 2006). If the jockey sustains a permanent disability (eg loss of an eye, paralysis, brain damage), they will receive a capital sum calculated on a sliding scale that reflects the seriousness of the disability (maximum of £500 000 for 100% total permanent disablement). Regardless of capital sum payments, the jockey is also eligible to receive weekly payments up to the maximum of 78 weeks.

RESULTS

Table 1 lists the numbers of jockeys by grade for the years 1996 and 2006. The amount paid out under the PRIS scheme differs for each grade, ranging from £127.95 for grade 1 up to £1318.41 for grade 9 (2006 figures).

In the 11-year period of this study (1 January 1996 to 31 December 2006), 1328 claims were made. These 1328 claims resulted in jockeys missing a total of 71 509 days of racing, and as a result, PRIS paid out a total of £4 496 019 in compensation (table 2). On average, each claim resulted in a jockey missing 53.8 days of racing and receiving £3385.56 in compensation.

Almost 45% of the claims received a payout of <£1000, and >80% of the claims received payouts under £5000. Although the amount paid out for each claim is influenced by the jockey’s grade (itself determined by the jockey’s popularity, skill and experience), the data shows that over the 11 years of the study, jockeys of all grades are equally represented. Table 3 lists a breakdown the payments received by the jockeys.

Most of the claims were for relatively minor injuries, with a third of all jockeys returning to racing within 2 weeks of getting injured (table 4). In total, <75% of all jockeys who made a claim returned to racing within 2 months of their injury, <10% of the jockeys were out of racing for more than 4 months, and only 2.5% of the jockeys were injured for >1 year.

The injury data in this cohort of jockeys has been reported previously.3^–5 Table 5 broadly classifies the injuries sustained by the jockeys. Almost half of the injuries occurred to the upper limb. Approximately 20% of injuries occurred to the head and neck, 16% to the torso and 18% to the leg. Fractures accounted for nearly 50% of all the claims. Fractures to the clavicle accounted for nearly 20% of all injuries sustained by jump jockeys. Other than clavicle fractures, the fracture rate was similar for both flat and jump jockeys.3^–5 Concussions accounted for nearly 15% of all the injuries.

In this study period, shoulder dislocations caused the highest average claims, with 3 months away from racing and payments of just over £7000 in compensation. More than half the total payout made by PRIS during the study period was for fractures. On average, every jockey who sustained a fracture was away from race riding for 72 days and received >£4000 in compensation. Fractures of the clavicle accounted for a third of all fractures and involved less time off compared with other fractures (an average of 35 days off riding and just over £2000 in compensation). In the study, there were more numbers of concussive injuries than dislocations, but on average concussions allowed a return to racing within a month compared with dislocations, which took approximately 3 months (table 6).

The data analysed during the 11-year period of the study included 25 jockeys who sustained career-ending injuries. There were also two fatalities during this period. Details of these career-ending injuries have been published elsewhere.6

DISCUSSION

Professional horse racing is a sport with a high risk of injury to its participants.3^–8 The cost of all these injuries has to date been unknown and no formal economic evaluation has been published in this area. This study has found that almost £4.5 million was spent on the 1328 injuries that were reported to PRIS during the 11-year time period 1996–2006 inclusive. A large percentage of the injuries were ”minor”, with relatively small financial payouts and little or no time off work. The most common injury sustained by jockeys was fracture (especially of the clavicle); however joint dislocations (eg shoulder) account for the longest time out of racing and the highest financial payout.

For such a high profile sport with such a high incidence of injuries, it is surprising that there is only a limited literature on injury epidemiology in professional horse racing.3^–6 9^–11 The data on injury prevalence in recent published studies is similar to the findings of this study.3^–6 Interestingly, some older studies found that approximately half of all injuries to professional jockeys occurred to the head and neck region,9^–11 whereas more recent studies have found that only around 20% of all injuries occurred to the head and neck region.4 12 The injury data in this study is similar to the two more recent studies,4 12 suggesting that either the early studies had significant selection bias for the head and neck, or that injury rates have actually decreased, possibly due to better protection provided by head gear.

A limitation of the study is the potential for relative under-reporting of minor injuries. It should be noted that due to the paperwork required to make a claim, which involves a visit to their own registered general practitioner before submission to the Jockey Club Medical Department, a number of jockeys who have minor injuries (ie resulting in 1-3 days away from race riding) may not therefore proceed with a claim.

One of the specific limitations of concussion diagnosis during this time period is that the management of concussive injuries by the Jockey Club has changed substantially. Before 2003, each concussed jockey was subject to a fixed period of suspension, dependent on the period of loss of consciousness (LOC). When the LOC was transient, the rider was suspended for 2 clear days; with a LOC of <1 minute, suspension was 6 clear days and when LOC was >1 minute, suspension was 20 clear days. Since October 2003, a standardised concussion management programme and return-to-play protocol has been used to determine concussive injury. This protocol sets no mandatory exclusion period for return to sport but rather uses computerised cognitive testing to measure recovery objectively. This approach is in agreement with international concussion management guidelines.13^–15 Although this change would not affect the injury rate per se, the variable time off riding has the potential to increase indirect insurance costs compared with the 2–6–20 day exclusion period system.

It is an accepted fact that participation in any sport comes with the inherent risk of an injury. For a professional jockey, injuries mean an interruption to their livelihood. The PRIS aims to provide jockeys with monetary compensation in the event of an injury, and over the study time period the annual cost was >£450 000 for approximately 120 injuries per annum. This study hopes to shed some light into the true direct and indirect costs of these injuries and to form the basis of a formal economic analysis.