Torvaldsson, KalleFagher, KristinaDerman, WayneEngebretsen, LarsLindblom, HannaLopes, Alexandre DiasRunciman, PhoebeSchwellnus, Martin PeterSoligard, TorbjornSonesson, SofiSteffen, KathrinHagglund, Martin2025-10-172025-10-172025-09Torvaldsson, K., Fagher, K., Derman, W., et al. Injury and illness epidemiology in elite athletes during the Olympic, Youth Olympic and Paralympic Games: a systematic review and meta-analysis. British Journal of Sports Medicine 2025;59:1302-1314, doi : 10.1136/bjsports-2025-109980.0306-3674 (print)1473-0480 (online)10.1136/bjsports-2025-109980http://hdl.handle.net/2263/104750DATA AVAILABILITY STATEMENT : All data relevant to the study are included in the article or uploaded as supplementary information.OBJECTIVE : To systematically review and synthesise the incidence and characteristics of injuries and illnesses among athletes participating in the Olympic, Youth Olympic and Paralympic Games. DESIGN : Systematic review and meta-analysis. DATA SOURCES : PubMed, Embase, CINAHL, Scopus and Web of Science were searched up to 2 July 2024, and Google Scholar, ClinicalTrials.gov and WHO International Clinical Trials Registry Platform up to 12 December 2023. ELIGIBILITY CRITERIA FOR SELECTING STUDIES : Cohort studies conducted during the Games reporting injuries and illnesses among athletes. Risk of bias was assessed using the Joanna Briggs Institute critical appraisal tool for prevalence studies, and certainty of evidence using the Grading of Recommendations, Assessment, Development and Evaluation framework. RESULTS : 27 articles were included (10 Olympic, 4 Youth Olympic and 13 Paralympic Games). 23 articles had low, 3 moderate and 1 high risk of bias. Certainty of evidence was high to moderate for Olympic, high to low for Youth Olympic and low for Paralympic Games. Injury incidences per 1000 athlete-days were 6.5 (95% CI 5.9 to 7.2) during Olympic, 10.5 (95% CI 9.4 to 11.8) during Youth Olympic and 14.3 (95% CI 9.9 to 20.7) during Paralympic Games. Illness incidences per 1000 athlete-days were 3.6 (95% CI 2.8 to 4.7), 6.9 (95% CI 6.1 to 7.8) and 9.7 (95% CI 6.5 to 14.4), respectively. Lower limb injuries were frequent during Olympic and Youth Olympic Games, upper limb injuries during Paralympic Games and respiratory illnesses across all Games cohorts. CONCLUSIONS : Injury and illness incidences were highest in Paralympic Games, followed by Youth Olympic and Olympic Games. Incidences and patterns of injury and illness were sport and context specific, which could inform future prevention strategies.en© Author(s) (or their employer(s)) 2025. Published by BMJ Group. http://creativecommons.org/licenses/by-nc/4.0/. This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license.Olympic GamesYouth Olympic GamesParalympic GamesElite athletesInjury and illnessArticle