Jones, KellyTheadom, AliceStarkey, NicolaZeng, IreneAmeratunga, ShanthiBarker-Collo, SuzanneWilkinson-Meyers, LauraTe Ao, BradenHenry, NathanMcClean, Luke AChua, JenniferHaumaha, LeahKahan, MichaelChristey, GrantHardaker, NatalieJones, AmyDowell, AnthonyFeigin, ValeryBarker-Collo, SuzanneWilkinson-Meyers, LauraBerryman, KayScott, NinaMasters-Awatere, Bridgette2026-02-182026-02-182026Jones, K., Theadom, A., Starkey, N., Zeng, I., Ameratunga, S., Barker-Collo, S., Wilkinson-Meyers, L., Ao, B. T., Henry, N., McClean, L. A., Chua, J., Haumaha, L., Kahan, M., Christey, G., Hardaker, N., Jones, A., Dowell, A., & Feigin, V. (2026). A population-based study of traumatic brain injury incidence and mechanisms in New Zealand: 2021–2022 compared with 2010–2011. The Lancet Regional Health. Western Pacific, 67. https://doi.org/10.1016/j.lanwpc.2026.1017972666-6065https://hdl.handle.net/10289/17943Background: 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.enAttribution 4.0 Internationalhttp://creativecommons.org/licenses/by/4.0/Traumatic brain injuryIncidenceMechanismPopulation-basedEpidemiologyBIONIC and BIONIC2 Study GroupsJournal Article10.1016/j.lanwpc.2026.1017972666-606532 Biomedical and Clinical Sciences4206 Public Health42 Health Sciences3202 Clinical Sciences3202 Clinical sciences4203 Health services and systems4206 Public health