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A population-based study of traumatic brain injury incidence and mechanisms in New Zealand: 2021-2022 compared with

Kelly Jones¹, Alice Theadom², Nicola Starkey³

¹National Institute for Stroke and Applied Neurosciences, School of Community and Public Health, Auckland University of Technology, Auckland, New Zealand.

The Lancet Regional Health. Western Pacific

|February 3, 2026

Abstract

Background:

Monitoring traumatic brain injury (TBI) incidence and epidemiological patterns is important for evidence-based strategic planning, policy, prevention, and resource allocation. We revisited population-based estimates and examined patterns of TBI incidence (all ages, severities) in 2021-2022 compared with 2010-2011 in New Zealand (NZ).

Methods:

Examining an urban (Hamilton) and rural (Waikato District) region in NZ (May 2021-April 2022, unintentionally following the start of the COVID-19 pandemic), we calculated crude annual age-, sex-, ethnic-, urban/rural area- and mechanism-specific TBI incidence per 100,000 person-years with 95% Confidence Intervals (CI). Poisson regression was used to derive adjusted Risk Ratios (aRRs) to compare age-standardised rates between sex, ethnicity, and area groups. Direct standardisation was used to age-standardise rates to the world population. We calculated Incidence Rate Ratios (IRRs) with 95% CI to compare 2021-2022 with 2010-2011 age-standardised rates.

Findings:

Total TBI incidence per 100,000 person-years was 852 cases (95% CI 816-890), including 791 cases (756-828) of mild TBI, and 61 cases (52-72) of moderate to severe TBI. TBI affected males more than females (IRR 1.31, 95% CI 1.29-1.33), and urban more than rural residents (IRR 1.57, 1.43-1.73). Most TBI (61%) occurred in people aged 15-64 years and were due to falls (48%). European and Asian peoples had lower risk of TBI than Māori (aRRs 0.68, 0.31 respectively). Compared to 2010-2011, total TBI incidence and rates among Māori were stable; TBI incidence was greater among females, urban residents, and adults aged ≥34 years; and TBI due to falls significantly increased (IRR 1.20, 95% CI 1.03-1.40).

Interpretation:

Noting increased risks for underestimation due to COVID-19, findings suggest overall TBI incidence rate in NZ was similar in 2021-2022 to 2010-2011, while highlighting changes in TBI distribution. Age-, sex-, area-, ethnic-, and mechanism-specific distributions should be considered when revisiting prevention strategies to reduce TBI incidence.

Funding:

Health Research Council of New Zealand of NZ.

Keywords:

Epidemiology Incidence Mechanism Population-based Traumatic brain injury

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