Injury patterns and safety implications for electric bikes compared to mopeds in the United States

Electric bikes (e-bikes) are increasingly popular in the United States, with studies documenting increased injuries associated with their use. U.S. laws vary widely with licensure required in only 7 states, age restriction and helmet use varying by bike class in 35. This differs from the stricter regulations applied to higher-speed vehicles like mopeds. This study examines numbers of injuries and characteristics of serious injury events, comparing e-bikes to the more regulated moped.

Emergency department data from 2019 to 2023 was extracted from the U.S. Consumer Product Safety Commission's National Electronic Injury Surveillance System. Event narratives were parsed using text search algorithms to classify cases into e-bike and moped groups. Frequency, rider age, involvement of motor vehicles, drugs/alcohol use, and pedestrian involvement were examined. Regression analyses were conducted using R. Rao-Scott Pearson Chi-Square tests were used to compare case characteristics between vehicle types.

E-bikes accounted for 28.2% of the weighted 268,828 two-wheeled vehicle injury cases, with mopeds at 53.3%. E-bike injury case counts significantly increased with 7948 additional cases/year (r² = 0.96), significantly outpacing increases in moped injury counts. For both, head injuries were most common, however, helmet use/non-use documentation in the data set was low (37.9% for e-bike and 38.9% for moped) limiting assessment. Counts of e-bike injury in the 13-19 year age group showed rapid increase, becoming the second greatest frequency age group by 2023. More serious e-bike injuries also significantly increased. Drug (2.2%) and alcohol involvement (7.6%), as well as pedestrian involvement (1.6%), was rare. Motor vehicle interactions were a significantly higher proportion of the serious moped injuries (50.7%) in comparison to e-bikes (32.5%). Interaction with motor vehicles was noted more than twice as frequently in cases treated at urban versus rural hospitals for both e-bikes and mopeds. There was one e-bike and 16 moped fatalities (raw counts), with all but one associated with impact with a motor vehicle.

Injury counts for e-bikes increased significantly greater than moped injury counts and increasingly involved younger riders. Alcohol involvement was significantly lower in e-bike injuries compared to moped injuries. Low reported rates of drug or pedestrian involvement were observed. Helmet use was poorly documented, despite head injuries being the most common injury type. Given the high prevalence of internal head trauma, universal helmet laws for e-bike and moped users should be considered. While fatalities remain rare for e-bikes compared to mopeds, the consistent role of motor vehicle interactions in the most severe cases points to a systemic issue in roadway safety. These findings suggest that e-bikes are comparatively under regulated compared to mopeds. Policies, such as universal helmet laws, geofencing, pedestrian airbags, and infrastructure improvements could help mitigate both e-bike and moped injuries.