The Burden of Traumatic Brain Injury, Its Causes, and Future Trend Predictions in 204 Countries and Territories (1990-2021): Results from the Global Burden of Disease Study 2021.

Background: Traumatic brain injury (TBI) is a leading cause of death and disability worldwide, with varying epidemiological trends across regions and demographics. Updated global assessments are needed to inform prevention and care strategies.

Materials and methods: Data on the age-standardized prevalence, incidence, and years lived with disability (YLDs) of TBI and its leading causes were retrieved from the Global Burden of Disease (GBD) 2021 project for 204 countries and territories, between 1990 and 2021. The counts and rates per 100,000 population, along with 95% uncertainty intervals (UIs), were presented for each estimate.

Results: In 2021, 37.92 million (37,928,494) prevalent cases of TBI were reported globally, with TBI accounting for 20.83 million (20,837,466) incident cases and 5.48 million (5,480,354) YLDs cases. The global age-standardized point prevalence, incidence, and YLD rates for TBI were 448 (95% UIs: 429.3-469.7), 259 (225.5-296.2), and 64.8 (45.7-86.7) per 100,000 population, which were 16.5%, 20.2%, 16.2% lower than in 1990, respectively. In 2021, the Kingdom of Saudi Arabia (1,218.2) had the highest age-standardized point prevalence of TBI (per 100,000). Kingdom of Saudi Arabia (680.7) had the highest age-standardized incidence of TBI (per 100,000). Syrian Arab Republic (83.5%) showed the largest increases in age-standardized point prevalence across the study period. Kingdom of Saudi Arabia (177.8) and the Republic of Madagascar (25.8) had the highest and lowest age-standardized YLD rates per 100,000, respectively. Among men, the global YLD rate of TBI increased up to age 80-84 years and then decreased with advancing age, whereas for women the rate increased up to age 90-94 years and then decreased with advancing age. Causes at the global level contributing most to the YLD rates for TBI were road injuries (21.4%), other transport injuries (13.2%), and interpersonal violence (11.4%).

Conclusion: Despite some evidence pointing to the decreasing burden of TBI, this injury remains a serious public health and social problem concerning peace and war, especially in countries of Eastern Europe and Central Europe with high-medium sociodemographic index. Our findings highlight road injuries as a key target for prevention and underscore the importance of fall prevention strategies - particularly for older adults and other vulnerable groups. Preventive strategies should concentrate on enhancing public awareness of road safety, improving laws and regulations on road traffic safety management, stabilizing impetuous and restless social emotions, stopping the war, and defending world peace to reduce the burden of TBI further.