Background Land transport injuries and fatalities constitute a significant global public health challenge, with disproportionate burden experienced in developing countries. Safety concerns can deter people from using active modes of transport, however, differences in data collection and reporting of transport injuries across modes makes quantifying safety by mode difficult.

Objective We undertook a systematic review to investigates injury and fatality rates across different land-based transportation modes for studies that used travel related denominators to examine how travel injury and fatality rates vary by mode of transport.

Methods A systematic search of Ovid Suite of Databases, CINAHL, and TRID databases, supplemented by reference checks. Eligibility criteria required articles to include travel exposure-based data comparing injury and/or fatality rates for transport modes (including pedestrian); limited to peer-reviewed primary studies (published in English, 2000–2022).

Results Twenty-nine studies compared two or more modes and at least one travel-exposure based denominator (distance/time/trip) and were included in the analysis. Findings indicated disparities in injury and fatality rates, dependant on the combination of mode and exposure measures - including kilometres travelled, hours spent commuting or number of trips made. Out of 21 studies that compared motor vehicles (MV) and cycling fatalities using a distance-based denominator, six showed MV had higher fatality rates per billion km. Ten studies used time-based denominators for fatal injuries. Although cycling had a higher rate of fatalities in all 10 studies per million hours travelled, the non-fatal injury rates were more similar across modes when using time-based denominator. Public transport (PT) had the lowest rate of injury in three studies that included PT. Pedestrians had a lower rate of injury than cyclists, but higher than MV in all studies. Methodological challenges faced in studying exposure data are highlighted, underscoring the need for standardised metrics and improved data collection methods to facilitate accurate comparisons between modes and jurisdictions.

Conclusions The research provides valuable insights into injury and fatality rates associated with various transportation modes. It offers a foundation for evidence-based decision-making, enabling policymakers, researchers, and practitioners to design contextually relevant interventions, including infrastructure investment; ultimately fostering safer transportation environments and saving lives.