Background:Eventing is an equestrian sport that tests athletes' and horses' skill over three phases: dressage, jumping and cross-country. Falls during the cross-country phase can have very serious outcomes up to and including death for both horse and athlete. Therefore, understanding risk factors associated with falls is essential for improving equine and human welfare.Objectives: To provide descriptive statistics and identify risk factors at the horse-, athlete-and course-level affecting horses competing in Fédération Equestre Internationale (FEI) events worldwide. Study design: Retrospective cohort study.Methods: Data collected by the FEI of every horse start worldwide in all international (CI), championship (CH), Olympics (OG) and World Equestrian Games (WEG) competitions between January 2008 and December 2018 were analysed. Descriptive statistics followed by univariable logistic regression to identify risk factor candidates for inclusion in the final multivariable logistic regression model. Models were constructed stepwise using a bi-directional process and assessed using the Akaike information criterion.Results: Factors associated with increased risk of falls and or unseated rider included: higher event levels, longer course distances, more starters at cross-country phase and less experienced horses and athletes. Main limitations:The data set is geographically comprehensive but covers only FEI competitions, not National Federation events, that is not every competition started by every individual horse. Nor does the data set include any prior veterinary information or data on training or schooling. Conclusions: This is the first large-scale epidemiological study of cross-country falls in FEI eventing. Results suggest that a potential risk profile can be constructed for each horse-athlete combination prior to entering a given competition, based on individual histories and course-level factors. This could lead to interventions that can reduce the number of falls, thus protecting equine and human welfare.

Background: The equestrian discipline of eventing tests athletes' and horses' skill over three phases: dressage, jumping and cross-country. Falls during cross-country can be particularly serious and result in serious or fatal injury for both horse and athlete. Cross-country course and fence design are crucial contributory factors to safety.Objectives: To provide descriptive statistics and identify fence-level risk factors for horses competing in Fédération Equestre Internationale (FEI) events worldwide.Study Design: Retrospective cohort study.Methods: Data were collected for every horse start worldwide in all international (CI), championship (CH), Olympics (OG) and World Equestrian Games (WEG) eventing competitions between January 2008 and December 2018 and univariable logistic regression, followed by multivariable logistic regression were applied. The final model was built in a stepwise bi-directional process, with each step assessed by the Akaike information criterion.Results: Risk factors were identified at the fence level covering aspects of fence design and course design. Ten fence types were at increased odds of a fall occurring compared with square spread fences, and seven types were at reduced odds. Fences with an approach downhill (odds ratio [OR] 1.35, 95% confidence interval [CI] 1.19-1.52), with landing into water (OR 1.82, CI 1.62-2.01), frangible devices (OR 1.28, and later elements of combined obstacles (OR 1.33 CI 1.25-1.42 for the second element, OR 1.21 CI 1.10-1.32 for later elements) were associated with increased risk of falls occurring.Main Limitations: Although the dataset covers every international competition worldwide, it does not include national-level competitions.Conclusions: It is recommended that the most challenging fences are placed near the beginning of the course, and not in downhill or water settings. The complexity of individual elements in combined fences should be reduced. Adopting evidence-based course design is a crucial intervention for reducing the incidence of horse falls and associated serious and fatal injuries to horse and human athletes.

BackgroundEquestrian 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.ObjectivesThe purpose of this study was to identify risk factors for horse falls, which are the leading cause of rider fatality within the sport.Study designRetrospective cohort study.MethodsCompetition 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.ResultsSixteen 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 limitationsThe study is not geographically comprehensive (UK only) and does not include any information on training activity of horses and riders.ConclusionsThis 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.