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Increasing Incidence of Concussion

True Epidemic or Better Recognition?

Langer, Laura BSc (Hon); Levy, Charissa MHSc; Bayley, Mark MD

The Journal of Head Trauma Rehabilitation: June 25, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/HTR.0000000000000503
Original Article: PDF Only

Objectives: To provide updated estimates of the incidence of concussion from all causes diagnosed by all physicians in a large jurisdiction, as previous studies have examined only single causes of injury or from smaller specific populations.

Design: Physician Billing and National Ambulatory Care Reporting System (NACRS) databases were used to identify all Ontario residents with a diagnosis of concussion (ICD-9 850.0 and ICD-10 S06.0) made by physicians between 2008 and 2016, excluding those with moderate to severe traumatic brain injury.

Results: In total, 1 330 336 people were diagnosed with a concussion between 2008 and 2016. The annual average was 147 815, and 79% were diagnosed in the emergency department. The average annual incidence was 1153 per 100 000 residents. Incidence varied by age, sex, and geography; children younger than 5 years had the highest incidence of concussion, more than 3600 per 100 000 individuals of that age group. Males had higher incidence than females except in older than 65 years age groups. There was a Pearson correlation (+0.669) between sustaining a concussion and living in rural locations.

Conclusion: The annual incidence of approximately 1.2% of the population is the highest rate of concussion ever reported thorough sampling methods and may represent a closer estimate of the true picture of concussion. Findings may inform future concussion treatment and healthcare planning.

Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada (Ms Langer and Dr Bayley); Toronto ABI Network, GTA Rehab Network, Toronto, Ontario, Canada (Ms Levy); and Institute of Health Policy, Management and Evaluation (Ms Levy) and Division of Physiatry (Dr Bayley), University of Toronto, Toronto, Ontario, Canada.

Corresponding Author: Laura Langer, BSc (Hon), Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto, ON M5G 2A2, Canada (

This study was supported through the provision of data from the Institute for Clinical and Evaluative Sciences (ICES) and through the funding support to ICES from an Ontario Neurotrauma Foundation (ONF) research grant. The authors acknowledge Dr Susan Jaglal, Jennifer Voth, Symron Bansal, and Refik Saskin, for their assistance and expertise with the ICES databases, and Sarah Cote and Andrew Ho, for manuscript editing assistance. The opinions, results, and conclusions reported in this article are those of the authors and are independent from the funding sources. No endorsement by ICES or ONF is intended or should be inferred.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (

The authors declare no conflicts of interest.

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