Introduction: Indigenous Peoples are much more likely than non‑Indigenous Peoples to be seriously injured or die in motor vehicle collisions (MVCs). This study updates and extends a previous systematic review, suggesting that future research ought to incorporate social–environmental factors.

Methods: We conducted a systematic review and meta‑analysis of the published and grey literature on MVCs involving Indigenous Peoples in Canada between 2010 and 2020. We focussed on personal (e.g. driving an old vehicle) and community social–environmental–economic factors (e.g. prevalent low socioeconomic status).

Results: Eleven comparative cohorts that resulted in 23 at minimum, age‑standardised, mortality or morbidity rate outcomes were included in our meta‑analysis. Indigenous Peoples were twice as likely as non‑Indigenous Peoples to be seriously injured (rate ratio [RRpooled] = 2.18) and more than 3 times as likely to die (RRpooled = 3.40) in MVCs. Such great risks to Indigenous Peoples do not seem to have diminished over the past generation. Furthermore, such risks were greater on-reserves and in smaller, rural and remote, places.

Conclusion: Such places may lack community resources, including fewer transportation and healthcare infrastructural investments, resulting in poorer road conditions in Indigenous communities and longer delays to trauma care. This seems to add further evidence of geo‑structural violence (geographical and institutional violence) perpetrated against Indigenous Peoples in yet more structures (i.e. institutions) of Canadian society. Canada’s system of highways and roadways and its remote health‑care system represent legitimate policy targets in aiming to solve this public health problem.