"The rapid growth of the gig economy has transformed urban labor markets in the digitalization era, particularly in the last-mile delivery industry. Despite its expansion, the working conditions and occupational risks faced by ‘last-mile workers' remain underexplored, with limited systematic evidence on their psychosocial, health, and safety challenges. Aim: This study aims to systematically review empirical evidence on the occupational risks, psychosocial outcomes, and safety of last-mile delivery workers, focusing on how working conditions, delivery modalities, and road safety issues shape their health and well-being. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published until 2025, following PRISMA guidelines. The included studies were evaluated for methodological quality using the Newcastle-Ottawa Scale (NOS) for observational studies and the CASP checklist for qualitative research. Results: A total of 32 studies, covering a total of 38,682 last-mile workers, were included. Poor working conditions (e.g., economic insecurity, algorithmic control, time pressure) were consistently associated with negative psychosocial outcomes, including stress, fatigue, burnout, and reduced mental well-being. Motorized two-wheelers were found to have higher crash and injury risks than bicycles or light vehicles, primarily due to higher speeds and greater traffic exposure. Psychosocial stressors related to algorithmic management and piece-rate pay significantly influenced safety and health-related behaviors, linking high stress and workload to riskier riding/driving practices. Conclusion: These findings highlight the need for multidimensional interventions targeting both the physical and psychosocial risks faced by last-mile workers, including safer work environments, occupational health initiatives, support for mental well-being, and more sustainable work practices."

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