Bicycle and Electric Scooter Fatalities: A Systematic Review of Micromobility-Related Deaths

Two-wheelers, including bicycles and electric scooters (e-scooters), account for a significant portion of road traffic fatalities. Although there are several measures, including alcohol and helmet legislation, mortality rates remain high, specifically in low- and middle-income countries. This systematic review aims to identify and synthesize factors associated with fatal outcomes in bicycle and e-scooter collisions. We conducted a systematic search across PubMed, Scopus, and Web of Science from 2014 to April 2026. The included studies were observational (cohort, case-control, and cross-sectional) and examined fatal bicycle and e-scooter crashes. Data extraction centered on helmet use, substance use involvement, injury patterns, and demographic variables. Study quality was assessed using the Joanna Briggs Institute (JBI) methodology for systematic reviews. Due to substantial heterogeneity in study design, populations, vehicle type, outcome definitions, and reported variables, a meta-analysis was not performed. Instead, findings were synthesized using a narrative approach. A total of 26 studies were included, including data from across the globe. Age, as well as sex distribution, was reported in 23 studies. Helmet use was reported in 14 studies. Injury patterns were described in 18 studies. Toxicological findings were reported in 14 studies. The lack of helmet use appeared to be linked to mortality. Alcohol use, although not frequently analyzed, was also significantly correlated with mortality. Elderly victims of male sex appear to demonstrate the highest mortality numbers. Fatalities from bicycle and e-scooter collisions result from several commonly modifiable behavioral and environmental factors. The establishment of intervention strategies, including helmet laws, substance abuse prevention, infrastructure improvements, and age- and gender-targeted education, is crucial to reducing mortality. Enhanced prehospital care and injury surveillance systems are also mandatory to improve survival outcomes.