Jones, KTheadom, AStarkey, NZeng, IAmeratunga, SBarker-Collo, SWilkinson-Meyers, LAo, BTHenry, NMcClean, LAChua, JHaumaha, LKahan, MChristey, GHardaker, NJones, ADowell, AFeigin, V2026-05-192026-05-192026-01-22The Lancet Regional Health. Western Pacific, ISSN: 2666-6065 (Print); 2666-6065 (Online), Elsevier, 67, 101797-. doi: 10.1016/j.lanwpc.2026.1017972666-60652666-6065http://hdl.handle.net/10292/21115Background: 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.© 2026 The Authors. Published by Elsevier Ltd. This is an open access article distributed under the terms of the Creative Commons CC-BY license, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. You are not required to obtain permission to reuse this article.https://creativecommons.org/licenses/by/4.0/EpidemiologyIncidenceMechanismPopulation-basedTraumatic brain injuryBIONIC and BIONIC2 Study Groups32 Biomedical and Clinical Sciences4206 Public Health42 Health Sciences3202 Clinical SciencesRural HealthWomen's HealthNeurosciencesBrain DisordersHealth Disparities and Racial or Ethnic Minority Health ResearchHealth DisparitiesTraumatic Brain Injury (TBI)PreventionPhysical Injury - Accidents and Adverse EffectsMinority HealthTraumatic Head and Spine Injury2.4 Surveillance and distributionInjuries and accidents3202 Clinical sciences4203 Health services and systems4206 Public healthJournal ArticleOpenAccess10.1016/j.lanwpc.2026.101797