Alcohol and substance use contribute to rising e-scooter and e-bike injuries

The numbers of e-scooter and e-bike injuries have tripled in the US since 2019, fuelled by alcohol and substance use, finds a nationwide analysis of emergency department visits, published online in the journal Injury Prevention.

And the odds of alcohol and substance use were much higher among 10-17 year old riders with these injuries than they were among older age groups, the findings show.

E-scooters and e-bikes, collectively known as micromobility devices, have become increasingly popular, thanks to their zero emissions, amid higher fuel prices and better biking infrastructure, note the researchers. 

Emerging evidence points to increasing numbers of injuries associated with their use, and the researchers wanted to explore trends in these figures and the contributory factors, with the aim of informing effective prevention strategies and enhancing safety measures.

They mined emergency department data from 100 hospitals out of more than 5000 nationwide contributing to the National Electronic Injury Surveillance System (NEISS).

They looked in particular at yearly visits, patient demographics, injury details, and alcohol/substance use associations from 2019 to 2022.

During this period, micromobility devices prompted 4020 emergency department visits out of a total of 1,331,871, of which 3700 were due to e-scooters and 320 due to e-bikes. 

This corresponds to nationwide weighted estimates of 279,990 e-scooter injuries, and 16,600 e-bike injuries nationwide. 

The smaller wheel size of e-scooters might account for the difference in injury numbers because it contributes to a higher likelihood of losing balance and sustaining injuries, suggest the researchers.

The number of emergency department visits tripled, rising from a weighted estimate of 22,835 in 2019 to 65,892 in 2022. Men sustained most of these injuries, with 80% of them involving 18-39 year olds and those of White ethnicity.

Nearly 18% of e-scooter emergency department visits and 12.5% of e-bike visits ended up with an admission to hospital. And approximately 0.4% of those injured by e-scooters died.

Most e-scooter injuries occurred on the street (72%) compared with nearly a third of e-bike injuries (nearly 31%).

Alcohol use was implicated in 327 of all the e-scooter and e-bike injuries; substance use was implicated in 116; and both alcohol and substance use were implicated in 39.

Specifically, alcohol use was reported in nearly 9% of e-scooter injuries and in 2.5% of e-bike injuries. Substance use was implicated in 3% of e-scooter injuries and just under 1% of e-bike injuries.

Men and boys were more than 2.5 times as likely to have used alcohol and more than twice as likely to have used substances as women and girls.

Alcohol was 7.5 times more likely to be implicated in the injuries sustained by 10-17 year olds, and substance use 4 times more likely in this age group than among 18–39-year olds. 

But the over 40s had 35% lower odds of alcohol-related, and 40% lower odds of substance-related, emergency department visits than 18–39 year olds. 

“Younger individuals are more likely to be intoxicated, and this impairs their mental and physical health, leading them to engage in risky activities while riding these micromobility devices that can result in injuries,” point out the researchers.

The legs and the head were the areas of the body most likely to be affected in e-scooter injuries associated with alcohol and substance misuse (29% and 19%, respectively), followed by injuries to the chest (10%), face (10%), shoulder (7%) and abdomen (6%).

The areas of the body most likely to be affected in e-bike injuries associated with alcohol and substance misuse were the legs (34%), head (18%), shoulders (12%) and face (7%).

This is an observational study, and relies on weighted estimates. The researchers also acknowledge that the data analysis was limited by its retrospective nature and lack of detailed information on the units of alcohol and substance use consumed, or helmet use. 

The NEISS database doesn’t include the mechanism of injury, nor does it provide more details on injury type, limiting the ability to draw specific conclusions on the exact cause.

Nevertheless, they conclude: “Our findings emphasise the critical and pressing issue of alcohol and substance use in relation to e-scooter and e-bike injuries.

“As these forms of transportation gain popularity, institutions, governments, healthcare practitioners and the general public must work together to develop effective risk mitigation strategies.

“By addressing this issue early, we can reduce the frequency and severity of e-scooter-related injuries and improve overall public safety.”