Objectives To report the incidence and burden of concussion in elite English football; and to compare between sexes (men`s vs women`s football), activity (matches vs training) and level (international vs domestic). Methods Concussion injuries in men`s and women`s international football (2012-2022) and men`s (2013-2022) and women`s (2018-2022) English domestic football were diagnosed and recorded by club/team-based medical practitioners, alongside training and match exposure. Severity was also reported based on days lost due to concussion; subsequently, incidence and burden were calculated. Comparisons were made between sexes (men`s vs women`s football), activity (matches vs training) and level (international vs domestic) using ORs (relative to non-concussion injuries). Results 327 concussions were reported. Concussion accounted for 7% of all injuries in women`s international football, 5% in women`s domestic, 3% in men`s international, and 2% in men`s domestic. Concussions were more likely to occur in matches than training (OR 1.03-2.55), with this difference only significant for men`s and women`s domestic football. The burden was higher for matches than training (OR 1.38-1.63), except for women`s international football, which was lower in matches (OR 0.46). Concussions were more likely to occur in women`s international training than domestic (OR 1.81), and the burden was higher in international football (OR 1.10-3.93). The incidence (OR 2.09-4.65) and burden (OR 1.55-5.34) of concussion were higher in women compared with men`s football. Conclusion These data provide benchmark statistics for concussions in elite English football, enabling comparisons and assessing the efficacy of future concussion prevention strategies. Contextual factors such as sex (women>men), activity (matches>training), and level (international>domestic) influence the incidence and burden of concussion injuries.
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