Introduction: Traumatic brain injury (TBI) – the ‘silent epidemic’ – contributes more to death and disability worldwide than any other traumatic insult. Yet, TBI incidence and distribution across regions and socioeconomic divides remain unknown. In an effort to promote advocacy, understanding, and targeted intervention, we sought to quantify the case burden of TBI across World Health Organization (WHO) regions and World Bank (WB) income groups.

Methods: Incidence of RTI published by the Global Burden of Disease Study 2015 was used to calculate the incidence and estimated case volume of TBI for each WHO region and WB income groups. A series of meta-analyses were performed on systematically reviewed literature to derive proportions for TBI among road traffic injuries (RTI) and a ratio of RTI contributing to overall TBI.

Results: Sixty-nine million [64-74 million] individuals worldwide are estimated to sustain TBI each year. The proportion of TBI resulting from road traffic collisions was greatest in Africa and South-East Asia (both 56%) and lowest in North America (25%). The incidence of RTI was similar in South-East Asia (1.5% of population per year) and Europe (1.2%). Overall incidence of TBI per 100,000 people was greatest in North America (1,299; 95% CI [612-1,986]) and Europe (1,012; 95% CI [907-1,117]), and least in Africa (801; 95% CI [730-873]) and the Eastern Mediterranean (897; 95% CI [767-1,027]). Low- and middle-income countries (LMICs) experience nearly three times more cases of TBI than high-income countries.

Conclusions: South-East Asian and Western Pacific regions experience the greatest overall burden of TBI each year. Head injury following RTI is more common in LMICs, and the proportion of TBI secondary to RTI is likewise greatest in these countries. Meanwhile, the estimated incidence of TBI is highest in regions from where higher-quality data exist, specifically in North America and Europe.

Patient Care: A tremendous burden – approximately 69 million cases – of TBI can be expected each year. The vast majority of this burden affects populations in LMICs, where adequate healthcare resources are often either inaccessible or nonexistent. Examining the disease burden between regions and comparing against available resources allow identification of such deficits in existing healthcare coverage. More robust research, especially in LMICs where high-quality data are deficient, is essential for a targeted campaign. Ultimately, curbing the silent epidemic of TBI will require a multipronged effort toward public awareness, safety legislation and enforcement, injury prevention campaigns, healthcare capacity strengthening, and community-based efforts to promote recovery and rehabilitation.

Learning Objectives: To estimate the global incidence of traumatic brain injury To demonstrate the use of modelling to derive incidence figures from global disease databases

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