People involved in e-bike accidents are more likely to have internal injuries than are those riding electric scooters or pedal-powered bicycles


A team of researchers from the NYU School of Medicine and Bellevue Hospital Center has found that people involved in e-bike accidents are more likely to have internal injuries than are those riding electric scooters or pedal-powered bicycles.

In their paper published in the journal Injury Prevention, the group describes their study of emergency room data and what it showed about powered two-wheeled transportation devices.

As the planet heats up, people around the world continue to look for ways to decrease their environmental footprint. One way involves using electric-powered, two-wheeled transportation devices like e-bikes and e-scooters instead of cars.

In this new effort, the researchers sought to better understand the risks people are taking when they switch to “cleaner” modes of transportation.

The work involved running searches on the U.S. Consumer Product Safety Commission’s National Electronic Injury Surveillance System (NEISS), which documents emergency room visit information involving both types of vehicles, as well as pedal-powered bicycles.

The researchers report that pedal-powered bicycle riding results in far more trips to the emergency room than either of the battery-powered options – this is because pedal-powered bicycle riders still far outnumber those that ride electricity-powered two-wheeled vehicles.

Over the years 2000 to 2017, there were over 9 million recorded pedal-power-related injuries in the NEISS. Over the same time period, there were 130,000 reported injuries for scooters and 3,000 for e-bikes.

The researchers also report that they found a difference in injury types for the three modes of transportation. They found that people riding e-bikes, for example, were more likely to suffer internal injuries than people riding the other two options – mostly because they can move roughly twice as fast. They also found that people riding scooters were more likely to experience accidents that resulted in concussions.

The researchers note that cities and towns are still in the process of making laws to govern such vehicles (New York Governor Cuomo recently vetoed a bill that would make riding such vehicles in the city legal) and making changes to infrastructure, such as building bike paths, to make their use safer.

They note that the number of pedestrians taken to the emergency room after being struck by such vehicles has also risen as the number of electric-powered two-wheeled vehicles rises.

In recent years, electric bicycles (e-bikes) became the best choice for daily travel of some residents in large and medium-sized cities in China due to their low price, convenience, and flexibility. Unlike in North America and Europe, e-bikes are the main traffic mode in many of China’s major cities and are used primarily for commuting rather than simply for leisure.

According to the statistics of the Chinese cycling association [1], in 2017, the total number of e-bikes in China was 250 million, the output of e-bikes was 30.97 million, and the export was 7.301 million, with an export value of $1.44 billion. In Nanning, Haikou, Kunming, Guilin, and other cities, e-bikes far outnumber bicycles; Nanning has more than 1.8 million e-bikes [2], which is known as “the city of electric bicycles”, due to it having the largest number of e-bikes in the country. Therefore, e-bikes are currently one of the most important means of commuter transportation [3].

Despite the obvious advantages, the rapid growth of e-bikes also causes a series of safety problems. Like traditional bicycles and pedestrians, e-bikes also belong to the category of vulnerable groups on the road. Due to their fast speed, e-bikes have more serious accident risks. According to the statistical annual report of China’s road traffic accidents in 2015, the number of e-bike accidents was 8.2 times larger than that of bicycle accidents and 5.4 times larger than that of pedestrian accidents [4].

From January to June 2016, the number of e-bike accidents accounted for nearly 70% of the total number of accidents in Jiangsu Province [5]. The hospital data are not optimistic either.

The hospitalization records of e-bike users in Hefei from 2009 to 2011 show that one-third of e-bike users were seriously injured [6]. According to the hospitalization records of Suzhou from October 2010 to April 2011, the number of injured e-bike users accounted for 57.2% of the rate of road traffic hospitalization [7].

In addition to the severity of accidents, the number of e-bike accidents also shows a trend of continuous growth. According to the statistical data [8], the numbers of e-bike traffic accidents in 2011 and 2016 were 10,347 and 17,747, respectively, and the number of deaths increased by 71.52% in the five years.

The numbers of e-bike injuries were 11,381 and 19,678, respectively, increasing by 72.90%. Based on the cases of injuries or casualties of two-wheeled vehicles in five cities in China from July 2011–June 2016, electric bicycle accidents were a common type of two-wheeled vehicle accidents in China, accounting for 34.79% of the total number. Among these accidents involving electric bicycles, those causing minor injuries to the riders accounted for 70.0%, while the proportion of serious injuries was 12.6%, and the proportion of deaths was 10.6% [9].

Due to the frequent occurrence and severity of e-bike accidents, cities like Guangzhou, Shenzhen, Wenzhou, and Fuzhou banned or restricted the use of e-bikes [6]. At the same time, in terms of national laws and regulations, relevant provisions were also formulated to restrain illegal behaviors.

For example, Article 70 of the regulations for the implementation of the road traffic safety law of the People’s Republic of China stipulates that “when riding a bicycle, an electric bicycle, or a tricycle and crossing a motor vehicle lane on a road, the rider should get off the vehicle and carry it. If there is no crosswalk or pedestrian crossing facilities, or if it is inconvenient to use them, the rider should go straight through after confirming safety.”

Numerous studies showed that human factors, especially the behavior of e-bike users (Figure 1), are important in most traffic accidents, as is the case with e-bikes. Figure 1 shows the keyword co-occurrence network of e-bike safety studies, in which we found that previous studies mainly focused on behavior, safety, risk, crashes, choice, and so on.

E-bike traffic violations mainly involve a violation of traffic signals, a violation of regulations on manned vehicles, a failure to drive in non-motorized lanes, adverse driving, etc. [10].

For example, Zhang et al. [11] found that the violation of traffic signals by e-bikes is one of the main causes of road traffic accidents, accounting for 54.18% of the total accident data. Cherry and Du et al. [12,13] analyzed the violations of e-bike users and found that red-light running, over-speeding, and overloading were the main causes of road traffic accidents.

Demographic variables, social cognition, and other factors of e-bike users are also closely related to the occurrence of traffic accidents.

Hu et al. [6] analyzed the influencing factors of e-bike accidents and found that age, gender, and vehicle type had a significant impact. Yao and Wu [14] established the relationship between safety attitude, risk perception, and violations of e-bike users, and the results showed that both gender and driving experience had a significant impact on e-bike accidents. Papoutsi et al. [15] analyzed the age, gender, accident time, and accident cause of e-bike users using the accident data of a hospital in Switzerland.

Guo et al. [16] found that e-bikes are more likely to be involved in red-light running than ordinary bikes. Zhou et al. [17] empirically analyzed the significant factors affecting accidents involving e-bikes and the use of license plates, and found that the use of license plates on e-bikes reduced the possibility of accidents. Guo et al. [18] found from a model comparison analysis that the cyclist’s gender, cycling behavior, type of e-bike, speed limit, and other factors had a significant impact on the severity of e-bike collisions. Based on the previous studies, the visualization of risky riding behaviors of e-bikes can be found through collaboration network analysis, as shown in Figure 2.

In Figure 2, each node represents an author or an organization, and the node sizes indicate the number of published papers. The links between nodes represent the collaborations, whereby the greater width of a link represents a closer collaboration. Specifically, the citation network among productive authors is shown in Figure 2a, the co-authorship network among productive authors is shown in Figure 2b, and the collaboration network among research institutions is shown in Figure 2c.

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Figure 1
Keyword co-occurrence network of electric bicycle (e-bike) safety studies.

With the increasing attention paid to the problems discussed above, it is urgent to better understand the risky riding behavior of e-bikes and the physiological and psychological characteristics of e-bike users, so as to reduce the accident rate and improve the safety awareness of e-bike users.

At the same time, on the basis of studies on the risky riding behavior of e-bikes, it is of great significance to improve road traffic safety and reduce traffic accidents by further analyzing the traffic accident characteristics and traffic accident causes of e-bikes.

Analysis of Characteristics of E-Bike Users

Vision and Hearing

Vision and hearing are fundamental to riding an e-bike, and they are directly related to the perception of the external environment. The level of perception has a significant impact on the safety of the road. Drunk cycling [25] reduces the visual and other sensory functions of cyclists, and the acquisition and judgment of external information are prone to errors. In addition, the mood of the drunk user is very unstable, and risky riding behaviors such as over-speeding or running a red light are easily generated.

E-bike users have differing levels of dynamic and static vision [41], based on factors such as age and physical feature. The user’s dynamic observation varies according to the speed of cycling, whereby a faster speed results in a narrower dynamic field of vision, while illusions can also occur due to differences between senses, which are important factors in causing traffic accidents. Due to its small size and low driving noise on the road, e-bikes are not easily heard or perceived by other road participants [12]; thus, there are many unsafe and uncertain factors when considering non-motor vehicle lanes and other participants. Zhao [60] studied the visual behavior of e-bike users.

Their results showed that, in different cycling environments, the distribution of eye movement time was uneven. A larger proportion of scanning time led to a shorter duration of each fixation point, while a more complex environment narrowed the user’s gaze. In the process of cycling, the following a vehicle can be considered a hazardous situation as electric bikes overtake more frequently.

Different Age Groups

The probability of traffic accidents caused by cyclists of different ages varies due to their wide-ranging physical functions. Wu et al. [61] studied user riding behavior and the relationship with age using survey data, and found that young and middle-aged people were more likely to ride through a red light than older people. They also found that small groups of riders or individual riders were more likely to run red lights, whereas middle-aged and older riders were more fearful of traffic accidents while riding, leading to more cautious behavior [62]. According to the survey data of Truong et al. [27], the average age of e-bike users is 23 years old, while that of motorcycle drivers is 30 years old.

Gender Difference

Users of different genders have different physical skills and psychological states; thus, gender difference also has an impact on the behavior of cyclists. Wu et al. [61] studied the riding behaviors of male and female cyclists through survey data, and found that the probability of male users running a red light was higher than that of female users, especially when the mopeds of male users had greater dynamic performance [41,62,63]. According to the questionnaire survey results of Yao and Wu [13], it was found that gender was significantly related to traffic accidents, whereby men were more likely to have traffic accidents than women. Truong et al. [27] also pointed out that the incidence of mobile phone use in cycling was lower in women than in men.

Reaction Ability

A slow response time and the accuracy of the response are directly related to the occurrence of traffic accidents. Wang [42] summarized the reaction processes of users as follows: external stimulus–conscious acknowledgement–response. In other words, the information obtained through the sensory system is fed back to the e-bike, followed by a certain behavioral operation after the central nervous system makes a decision.

The responsiveness is related to the cycling speed of the vehicle and the complexity of the driving environment. For example, the driving speed of an electric bicycle is faster than that of an ordinary bicycle; thus, the requirement for its responsiveness is higher than that of a bicycle user.

If the complexity of the driving environment exceeds the processing ability of the cyclists within the allowed range, their reaction ability will not keep up with the changes of the environment, and unsafe riding scenes are easily generated. Fu [64] found that, due to fatigue, drugs, pathology, and other physiological characteristics, cyclists’ consciousness level would decline, their reaction would be relatively slow, and they would be prone to drowsiness and other symptoms. The above symptoms were mainly manifested in cycling behavior with wrong riding and poor judgment.

In summary, different user riding behaviors occur due to several factors, such as gender, age, and the ability to hear and respond to outside stimuli. In cases of drinking, fatigue, illness, and drug use, the brain’s nervous system is in a state of dottiness, which slows reaction time and increases erratic behavior such as running red lights, seriously affecting the user and other participants in terms of road safety.

Psychological Factors

Due to the differences in cyclist psychology, the characteristics of each user are unique. Therefore, on the basis of understanding the general psychology of cyclists, special promotion and education should be carried out to achieve the purpose of safety. Wang [42] pointed out that a normal psychological environment is required for safe cycling. In the process of cycling, people are prone to fear, transcendence, dispersion, conformity, habit, frustration, competitiveness, and distraction, which are hidden dangers leading to traffic accidents. Fu [64] pointed out that, because the speed of e-bikes is faster than that of bicycles, cyclists tend to show exhibit behaviors such as competitiveness, transcendence, conformity, independence, and dispersion, leaving them prone to unsafe riding behaviors (such as speeding, following, running red lights, etc.).

Relationship between Different Factors and Riding Behaviors

It can be seen from the above research that e-bike riders have different personal attributes, and the road traffic infrastructure selected by the riders when riding is different, which will generate different risky riding behaviors. The different variables used and the correlations discussed in previous studies are shown in Table 2.

Table 2

Independent and dependent variables used in previous studies.

Independent VariablesDependent Variables
VisionManned by bike
HearingChatting while riding
Different age groupsListening to music while riding
Gender differenceCalling while riding
Reaction abilityRiding side by side
Psychological factorsFearOver the speed limit
TranscendenceRunning a red light
DispersionReverse driving
HabitExcessive turning speed
FrustrationDrinking and driving
CompetitivenessMotorway occupancy
DistractionNot adhering to stipulations to give way
Aircraft non-isolation beltForced overtaking
Red light durationSudden stopping or turning
Traffic sign markingFatigue riding

According to the list of independent variables and dependent variables used in previous studies [10,12,13,25,27,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64], we found that the characteristics of e-bike users, such as vision, hearing, age group, reaction ability, and psychological factors, are the main reasons affecting the risky riding behavior of cyclists, as well as red light duration and traffic sign marking. For example, Du et al. [13], Wang [42], and Zhang et al. [53] found that independent variables, such as group psychology and waiting too long for the red light, were the main risky riding behaviors related to running a red light.

Fu [64] also found that psychological factors, such as transcendence, habit, and distraction, were also the main risky riding behaviors related to over-speed, as well as gender and age. What is more, when cyclists ride on roads with inorganic non-isolation zones, they tend to illegally occupy motor vehicle lanes [55,56].

It can be seen from the above review that the risky riding behaviors of e-bikes are related to the psychological characteristics of users. The psychological characteristics related to safety risks are all caused by the weak subjective safety awareness of cyclists. Therefore, it is expected that, to prevent the occurrence of such risky cycling behaviors, it is necessary to carry out targeted psychological intervention. To sum up, cyclists’ risky riding behaviors are the main factors causing traffic accidents.

These behaviors include illegally occupying motor vehicle lanes, running red lights, and illegally carrying people or objects. In general, these risky riding behaviors are the result of a lack of knowledge about the safety features of e-bikes and the weak awareness of road traffic safety. Therefore, it is necessary to strengthen safety awareness and education to improve psychological preparedness. Furthermore, it is necessary to increase cycling skill training to improve coping ability, and to formulate relevant laws and regulations to regulate cycling behavior.Go to:

Prevention and Intervention of E-Bike Traffic Accidents

In view of the prevention and intervention of e-bike traffic accidents, previous research put forward relevant measures based mainly on four aspects: strengthening traffic management, improving laws and regulations, improving the cycling environment of e-bikes, and strengthening the safety education and training of users.

  1. In terms of strengthening traffic management, Ma [65] proposed giving priority to the development of public transportation to limit the increase of the number of e-bikes, following a study of collision experiments between e-bikes and motor vehicles and an analysis of the safety degree of e-bikes. Other suggested measures include limiting the maximum design speed of e-bikes to realize source control, carrying out cycling skill training and assessment, implementing annual inspection, and ensuring the safety of vehicles. Dong [41] proposed that, in order to more clearly identify e-bike riding on the road, reverse laser technology can be adopted on the body and license plate of the e-bike to prevent the occurrence of collision accidents. Jiang and Li [44] proposed to regulate the e-bike industry, strengthen the management of users and e-bikes, strengthen traffic management, improve road conditions, set up e-bike city management departments, and introduce relevant laws and regulations on the basis of analyzing the potential safety risks of e-bikes. Liu and Yang [51] put forward corresponding permit management and compulsory speed limit systems for e-bike users’ red-light running behavior, including (i) training, assessment, and licensing before e-bike riding, and (ii) penalties for illegal riding of e-bikes. Similarly, Shi [66,67] and Chen [68] proposed unified registration and listing for e-bikes, a standardized production of e-bikes, the implementation of a permit system, and e-bike users paying for insurance. Xu et al. [45] emphasized strengthening production management, regulating mopeds, and preventing vehicles from “exceeding the standard”. Wu et al. [69] investigated the status quo of license plate registration of e-bikes, and found that 30.58% of respondents registered their license plates, but there were still 69.42% of users who had unregistered license plates. Carole [70], on the basis of a comprehensive definition of risky riding behavior, suggested that the rapid growth in volume of electric bicycles was consistent with the high electric bicycle accident rate in China, and pointed out that relevant departments should first establish guiding principles for the prevention of traffic accidents through a forward-looking guidance strategy.
  2. In terms of improving relevant laws and regulations, Ma [65] advocated that laws should be passed to explicitly prohibit minors from riding e-bikes. Chen [68] and Wu et al. [69] proposed that users must wear hard hats to ride so as to not be fined. Shi et al. [66] and Jang and Li [44] proposed revising and increasing the traffic laws and regulations for e-bikes, forcing cyclists to change their risky riding behaviors through legal means. Truong et al. [27], through an investigation and analysis of mobile phone use of e-bike users, proposed combining existing legislation with extensive education and publicity to reduce potential death and injury caused by mobile phone use during cycling.
  3. In terms of improving the cycling environment of e-bikes, Dong [71] and Dong [41] put forward that the separation between machines and non-machines should be ensured. Gu [43] found that speed is the key to controlling user cycling safety factors; thus, measures such as vertical migration (speed humps, deceleration machines, pavement textures, raised crossings, vibrating belts), horizontal deflections (turns), road narrowing, and others (closed road width, central islands, coating surfaces, control of vehicle speed, and deceleration graphics) were suggested aimed at slowing down traffic to reduce hazards faced by electric bicycle users and other road members. Xu et al. [45] proposed improving the transportation infrastructure for e-bikes. Zhao [47] used the time–space isolation method to isolate machines driving directly and turning left at intersections, and set a no-driving area of non-motor vehicles at intersections. They suggested setting left and right turning lanes at intersections, along with special signal lights at intersections with a large number of e-bikes. At small intersections, non-motor vehicles would be required to cross sidewalks, whereby a non-motor vehicle bypass area would be set up at the intersection.
  4. In terms of strengthening user safety education and training, Wu [72], Xu et al. [45], Zhao [47], and Chen [68] proposed strengthening safety awareness and education, emphasizing the importance of road safety to consciously improve safety awareness, thereby avoiding risky riding behavior. In addition, Chen [68] pointed out that the quasi-driving mode of motor vehicles should be imitated, and the skills of cyclists should be trained to improve their ability and experience.

In addition, Wang et al. [73] found through investigation that the current phenomenon of children being carried on e-bikes is quite common, and pointed out that the safety guarantee of existing electronic bicycle seats is limited. Thus, the design strength and structure of the seats should be reasonably strengthened to ensure the personal safety of children when riding. Yuan et al. [74] analyzed 150 traffic accidents of e-bikes in Beijing, and found an increase at intersections and in motor vehicle lanes in the suburbs where the occurrence of e-bikes was high. Safety education and training should be carried out for users in the suburbs, and the design of traffic safety facilities in these areas should be strengthened at the same time. Yuan et al. [75], using statistical analysis of vulnerable road users in Beijing collisions, compared pedestrian, bicycle, and electric bicycle accident frequency, severity, and influencing factors. It was concluded that electric bicycle accidents were dependent on collision speed and position of the victim, with similarities and differences compared to the other groups. Suggestions were given for accident intervention.

All in all, scholars put forward comprehensive prevention measures for electric bicycle traffic accidents on the basis of traffic management, laws and regulations, riding conditions, and safety education and training, including uniform registration licenses, a quasi-driving system, improvement of the road and intersection traffic safety facilities, strengthening safety awareness and education, driving skill training, and more. These approaches would help improve the traffic safety consciousness of the user while safeguarding them.

More information: Charles J DiMaggio et al. Injuries associated with electric-powered bikes and scooters: analysis of US consumer product data, Injury Prevention (2019). DOI: 10.1136/injuryprev-2019-043418


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