Objective To investigate the proportion and the incidence of concussion associated with competitive riding or training.

Design Nationwide register-based cohort study.

Setting Nationwide medical care.

Participants All members of the Swedish Equestrian Federation (92% females) and acute injuries reported to Folksam Insurance Group during 2017–2021.

Interventions (or Assessment of Risk Factors) Sex, age groups (0–6, 7–12, 13–20, 21–40 and 41- years), type of injury, injury-mechanism, and permanent medical impairment.

Outcome Measures Reported concussions and concussions leading to long-term consequences (using 2017–2018 data).

Main Results Of the 153,017 insured members the incidence of concussions during training or competition was 1.48 per 1000 members per year. Concussions account for 16% of all reported injuries and 95% occurred during a fall. Females represented 98% of all injured and were associated with more than four times the risk of concussion than males (RR=4.3). Members aged 13–20 and 21–40 had the highest incidence. In total 3% of all injured equestrians (2017–2018) sustained a permanent medical impairment.

Conclusions Both the proportion and the incidence of concussion among equestrians were high, and to maintain a healthy and physically active population it is important to make efforts to prevent injuries. Females predominated with 98% of injured equestrians and they were also having a much higher risk. Further studies should be conducted to analyse these differences.