Abstract
Background/Objectives: Türkiye’s registered motorcycle fleet more than doubled after the COVID-19 pandemic amid rapid growth of the platform delivery economy. In a national ecological analysis of routinely collected official statistics (2018–2025), we quantified the resulting mortality and injury burden; the injury burden is operationalised as police-recorded injured persons, a proxy for emergency care demand rather than measured hospital contacts. Methods: Rider deaths and injuries were modelled by Poisson/quasi-Poisson regression with the registered fleet as an offset (primary mortality window 2019–2025; 2018 in sensitivity analyses). Non-motorcycle deaths served as a contemporaneous comparison series, compared formally through a pooled interaction model; the insured fleet served as an alternative exposure denominator; and the care pathway, courier occupational records, province-level correlates (81 provinces), and 2030 projections were also analysed. Results: Rider deaths rose from 823 (2018) to 1334 (2025)—from 12.3% to 22.1% of all road deaths—while the fleet grew from 3.2 to 7.1 million. The fleet-adjusted mortality rate declined by about 1.7% per year (2019–2025: incidence rate ratio (IRR) 0.983, 95% confidence interval (CI) 0.971–0.995); its trend did not differ measurably from the comparison series (ratio of trends 1.011, 95% CI 0.951–1.075), and fleet growth alone predicted at least the entire rise in deaths. Injured riders more than tripled (fleet-adjusted IRR 1.071, 95% CI 1.051–1.091, for 2018–2025; 1.080, 1.058–1.103, for 2019–2025), the fatality proportion halved (2.02 to 1.01 deaths per 100 reported casualties), and roughly two-thirds to 71% of deaths in every year occurred after arrival at medical care, with death rates falling in both the scene and post-admission phases. Courier occupational accident rates rose from 13.8 to 19.1 per 1000 insured workers. Provincial fatality proportions varied five-fold, with urbanisation the only robust correlate (rate ratio (RR) 0.85 per standard deviation (SD)). Trend-based planning scenarios project 237,000–344,000 injured riders annually by 2030. Conclusions: An exposure-driven mortality surge with a steep morbidity increase is concentrating within the trauma-care pathway; priorities are exposure management, delivery-sector regulation, occupational registration, and post-crash care capacity.