Methodological advancements in road safety research reveal an increasing inclination toward integrating spatial approaches in hot spot identification, spatial pattern analysis, and developing spatially lagged models. Previous studies on hot spot identification and spatial pattern analysis have overlooked crash severities and the spatial autocorrelation of crashes by severity, missing valuable insights into crash patterns and underlying factors. This study investigates the spatial autocorrelation of crash severity by taking two capital cities, Addis Ababa and Berlin, as a case study and compares patterns in low and high-income countries. The study used three-year crash data from each city. It employed the average nearest neighbor distance (ANND) method to determine the significance of spatial clustering of crash data by severity, Global Moran's I to examine the statistical significance of spatial autocorrelation, and Local Moran's I to identify significant cluster locations with High-High (HH) and Low-Low (LL) crash severity values. The ANND analysis reveals a significant clustering of crashes by severity in both cities, except in Berlin's fatal crashes. However, different Global Moran's I results were obtained for the two cities, with a strong and statistically significant value for Addis Ababa compared to Berlin. The Local Moran's I result indicates that the central business district and residential areas have LL values, while the city's outskirts exhibit HH values in Addis Ababa. With some persistent HH value locations, Berlin's HH and LL grid clusters are intermingled on the city's periphery. Socio-economic factors, road user behavior and roadway factors contribute to the difference in the result. Nevertheless, it is interesting to note the similarity of significant HH value locations on the outskirts of both cities. Finally, the results are consistent with previous studies and indicate the need for further investigation in other locations.