OBJECTIVES To determine factors affecting the severity of motorcycle injuries, considering variables related to the individual, the environment, the vehicle, and the crash. METHODS This is a register-based retrospective cohort study. All individuals born in 1970-1972 (n = 334,070) were extracted from the Swedish Population and Housing Census of 1985 and followed up from 1988 to 2000, when aged 16-30. All subjects whose records indicated an injury as a motorcycle driver in the Swedish National Road Administration Accident Database were selected, and constituted the study population (n = 1,748). Factors related to the individual, the environment, the vehicle, and the crash were considered as exposure measures, whereas the outcome measure was the level of injury severity, based on assessments made on-site by police officers, in two categories: fatal/severe and minor. Associations between individual, environmental, vehicle and crash factors and injury severity were measured, using Chi-square, and through univariate and multivariate stepwise logistic regression. RESULTS Factors such as alcohol consumption, traffic environment, speed limit, and type of crash were significantly associated (p < 0.0001) with injury severity. More specifically, a positive suspicion of alcohol consumption, driving in a rural area, and a posted speed limit over 50 km/hour were all factors positively associated (OR > 1.0) with the likelihood of being severely injured. On modeling all the variables together through stepwise logistic regression, positive suspicion of alcohol emerged as the strongest determinant (adjusted OR = 2.7) of a severe outcome. CONCLUSIONS. Motorcycle crashes still place a heavy burden on young drivers. Increased efforts are needed to prevent alcohol-related crashes-through law enforcement and a multiplicity of policies at local and national levels.