Injuries and risk factors associated with bicycle and electric bike use in China: A systematic review and meta-analysis

Bicycles and electric bike riding have reshaped the transportation system worldwide and have significantly contributed to road traffic injuries. However, the risk factors associated with such injuries remain unclear. Therefore, this systematic review aimed to update and summarize the available evidence regarding risk factors that have been associated with bicycle and electric bike-related injuries in China. We searched for studies related to bicycles and electric bike-related injuries and deaths in China that were published in English from January 2000 to December 2020. In total, 18 studies met the inclusion criteria. Four domains of risk factors associated with such injuries were identified, including sociodemographic factors (e.g., age, sex, education level), riding behaviour (e.g., traffic rule violations, not wearing a helmet), vehicle and road factors (e.g., type of nonmotor vehicle and type of road), and temporal factors (such as commuting-hour riding or rush-hour riding). The pooled analysis showed that the mortality rate of e-bike injuries in China was 9.0% (95% confidence interval [CI]: 5.0%-13.0%). Understanding and identifying injury-related risk factors associated with bicycles and electric bike riding could provide important evidence to guide traffic safety management. More efforts are needed to reduce bicycle- and electric bike-related injuries in China. Targeted interventions, including enforcing helmet usage, requiring a driver's licence to operate scooter-style electric bikes, and establishing a data collection and safe-riding credit system, may need to be developed. Moreover, given the global phenomenon of population ageing, targeted injury prevention interventions should be developed for senior riders, who are more likely to sustain severe bicycles and electric bike-related injuries and die due to injury