Background Travel practices are changing. Active transport modes such as walking and cycling are encouraged because they are beneficial to health and reduce pollution.

Methods We estimated the exposure-based fatality rates for road traffic crashes in France, on the basis of the ratio between the number of fatalities and exposure to road accident risk. Fatality data were obtained from the French national police database of road traffic casualties in the period 2007–2008. Exposure data was estimated from the latest national household travel survey (ENTD) which was conducted from April 2007 to April 2008. Three quantities of travel were computed for each mode of transport: (1) the number of trips, 2) the distance travelled and (3) the time spent travelling. Annual fatality rates were assessed by road user type, age and sex.

Results The fatality rates differed according to road user type, age and sex. The risk of being killed was 20 to 32 times higher for motorised two-wheeler users than for car occupants. For cyclists, the risk of being killed, both on the basis of time spent travelling and the number of trips was about 1.5 times higher than for car occupants. Risk for pedestrians compared to car occupants was similar according to time spent travelling, lower according to the number of trips and higher according to the distance travelled. People from the 17–20 and 21–29 age groups and those aged 70 and over had the highest rates. Males had higher rates than females, by a factor of between 2 and 3.

Conclusions When exposure is taken into account, the risks for motorised two-wheeler users are extremely high compared to other types of road user. The difference between the fatality risk of cyclists and of car occupants is much smaller (1.5 times higher); besides, there is much room for improvements in cyclist safety, for instance by increasing the use of helmets and conspicuity equipment. Traffic calming could also benefit cyclists, pedestrians and perhaps moped users.