Background: Road traffic accidents (RTAs) remain a leading cause of morbidity and mortality in India, disproportionately affecting young adults aged 15–39 years. Despite multiple road safety initiatives, the burden of road traffic injuries remains high, with wide variation in epidemiology, behavioral risk factors, and trauma care delivery. Understanding recent trends and determinants is essential for designing effective, evidence-based interventions.

Purpose: This systematic review aimed to synthesize contemporary evidence (2020–2025) on the epidemiology of RTAs in India, associated risk factors, injury patterns, and preventive strategies.

Methods: A systematic literature search was conducted in PubMed/MEDLINE, Embase, Google Scholar, and Indian journal repositories for studies published up to August 31, 2025, following PRISMA 2020 guidelines. Eligible studies included hospital-based observational studies, community and population surveys, forensic autopsy studies, qualitative research, surveillance reports, and relevant reviews conducted in India. Case reports and multinational studies without disaggregated Indian data were excluded. Study quality and risk of bias were assessed using the Newcastle–Ottawa Scale for observational studies and established qualitative appraisal frameworks. Due to heterogeneity in study designs and outcomes, findings were synthesized narratively.

Findings: Forty-five studies met inclusion criteria. RTAs predominantly involved males aged 21–40 years, with two-wheelers being the most commonly affected vehicles. Key risk factors included non-use of helmets and seatbelts, alcohol consumption, and speeding. Head and limb injuries were the most frequently reported injury patterns. Deficiencies in timely transport and pre-hospital care emerged as critical gaps. Qualitative evidence highlighted behavioral barriers to road safety compliance and challenges in traffic law enforcement.

Implications: RTAs continue to pose a major public health challenge in India, driven by interconnected behavioral, environmental, and systemic factors. Strengthened traffic enforcement, improved road infrastructure, and robust pre-hospital trauma care systems are urgently required. Future research should evaluate the effectiveness of targeted policy interventions and technological innovations in road safety management.