Motorized Two-Wheeled Vehicles Contribute Disproportionately to the Increase in Pandemic-Period Road Traffic Fatalities in New York State

<b>Background:</b> New York State, like many other states, experienced a significant increase in road traffic deaths during the COVID-19 pandemic that is not fully understood. Our earlier work using the Safe System framework suggests a shift in the distribution of vehicle types that may have contributed to this phenomenon. <b>Methods:</b> To further investigate this, variables from the Fatality Analysis Reporting System (FARS) were mapped onto the Safe System framework and used to examine factors associated with motorized two- and three-wheeled vehicle deaths. Two time periods were examined: pre-pandemic (1 April 2017-31 December 2019, <i>n</i> = 428) and the COVID-19 pandemic era (1 April 2020-31 December 2022, <i>n</i> = 600). A buffer pandemic transition period (1 January 2020-31 March 2020) was excluded. Percent difference, chi-square tests, and multivariable logistic regression (OR, 95% CI) were used. <b>Results:</b> Compared to pre-COVID-19, pandemic-period motorized two-wheeled deaths were 40.2% higher, helmet wearing lower (80.2% vs. 90.6%, <i>p</i> < 0.0001), urban roadway deaths higher (76.7% vs. 64.0%, <i>p</i> < 0.0001), and fully licensed drivers lower (78.4% vs. 89.9%, <i>p</i> < 0.0001), with unlicensed drivers doubling between the two periods (8.7% to 17.6%, <i>p</i> < 0.0001). Deaths associated with mopeds/motor scooters/minibikes increased 361.5% between study periods, from 3% to 10% of motorized two-wheeled deaths. Adjusted multivariable risk factors for pandemic-period death were age 30-39 years (1.601, 1.155-2.311), being unhelmeted (3.191, 2.109-4.968), being in an urban area (1.898, 1.425-2.533), being unlicensed (1.968, 1.228-33.216) and riding an off-road motorcycle (3.753. 1.391-13.063), moped or motor scooter/minibike (3.540, 1.971-6.842). <b>Conclusions:</b> Total mortality was higher in the COVID-19-era timeframe, with the increase differing significantly by vehicle type, helmet use, licensure status, and urbanization. Due to the increase in motorized two-wheeled vehicles, they should be incorporated into surveillance systems and injury prevention strategies.