Background Acute injuries in sports are still a problem and the knowledge of incidences and severity in different sports at a national level are limited.

Objective The aim of this study was to identify high-risk sports with respect to incidence of injury and severity of injuries in 35 sports.

Design A retrospective cohort study was set up based on a comprehensive database from an insurance company.

Setting Almost 90% of all athletes in Sweden (in 57/70 sports federations), in all ages and at all competitive levels, have their accident insurance in the same insurance company.

Participants All licensed athletes in 35 sports during 2009–2011.

Main outcome measurements The incidence of sport injuries as well as severe injuries (medical disability) were calculated for licensed athletes at a national level. Comparisons between sports, gender, and ages were made. Risk ratio was calculated with median injury incidence as the norm.

Results Each year approximately 12 000 injuries (in total 35 971 injuries during 2009–2011) and 1 170 000 licensed athletes were eligible for analysis. The incidence of injury was higher in team sport compared to individual sports. Individual sports with highest incidence were motorcycle/snowmobile, skating, and wrestling. Team sports with highest incidence were handball, ice hockey, and rugby. Sports with a large number of injuries were soccer, ice hockey, floor ball, and handball. Highest proportions of medical disabilities were in motorcycle and then in team sports, such as soccer, basket, handball, and floor ball. Risk ratio for motorcycle was 15 and handball 14.

Conclusions Sports with numerous acute injuries, high incidence and more severe injuries must be the target for prevention actions. This study suggests that team sports and motorcycle should be the object. Next step is to identify injury types, anatomical locations and injury mechanisms to understand how to prevent these injuries.