Motorcycle-Related Fatalities: A Systematic Review and Structured Narrative Synthesis.

Two-wheelers, including motorcycles, account for a significant portion of road traffic fatalities. Although several measures, including alcohol and helmet legislation, have been established, 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 motorcycle crashes. We conducted a systematic search across PubMed, Scopus, and Web of Science from 2014 to April 2026. The studies included were observational (cohort, case-control, and cross-sectional) and examined fatal motorcycle crashes. Data extraction centered on helmet use, substance use involvement, injury patterns, and demographic variables. Due to substantial heterogeneity, meta-analysis was not performed, and findings were synthesized using a structured narrative approach. Study quality was assessed using the Joanna Briggs Institute (JBI) methodology for systematic reviews. Sixty-five (65) studies were included, including data from across the globe. Lack of helmet use appeared to be commonly identified among fatal cases. Alcohol, as well as other substance use, prior to riding were significantly correlated with mortality. Males aged 15-45 were identified as the most vulnerable demographic group, while elderly victims also demonstrated high mortality numbers, suggesting the presence of a two-spike distribution. Motorcycle collision fatalities are a result of 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.