Spinal Cord Injury: The Global Incidence, Prevalence, and Disability From the Global Burden of Disease Study 2019

Weizhong Ding, MD; Shian Hu, MD; Pengju Wang, MM; Honglei Kang, MD; Renpeng Peng, MD; Yimin Dong, MD; Feng Li, MD

Spine. 2022;47(21):1532-1540.

Abstract and Introduction

Abstract

Study Design: A retrospective cohort study.

Objective: The authors aimed to estimate the incidence, prevalence and years lived with disability (YLDs) of spinal cord injury (SCI) by location, sex, age, injury site and socio-demographic index (SDI) based on the data of the Global Burden of Disease Study (GBD) 2019.

Summary of Background Data: GBD 2019 estimates the burden of 369 diseases and injuries worldwide in 2019 and the temporal trends in the past 30 years. SCI is estimated as a result of injury from various causes.

Methods: A Bayesian meta-regression tool, DisMod-MR2.1, was used to produce the estimates. Estimated annual percentage change (EAPC) was calculated based on a linear regression mode of the age standardized rates and the calendar year to represent the temporal trends of the age standardized rates. Spearman rank order correlation was used to determine the correlation between SDI and the incidence and burden of SCI.

Results: Globally, there were 0.9 [95% uncertainty interval (UI), 0.7 to 1.2] million incident cases, 20.6 (95% UI, 18.9–23.6) million prevalent cases and 6.2 (95% UI, 4.5–8.2) million YLDs of total SCI in 2019. The ASPR increased (EAPC, 0.1; 95% confidence interval, −0.01 to 0.2), while the age standardized incidence rate (ASIR) (EAPC, −0.08; 95% UI, −0.24 to 0.09) and age standardized YLD rate (ASYR) (EAPC, −0.08; 95% confidence interval, −0.24 to 0.09) decreased. Males had higher ASIR and ASYR, and the rate of incidence, prevalence and YLD increased with age. Spinal injuries at neck level caused higher ASYR than injuries below neck level. A positive correlation existed between SDI and ASIR (ρ=0.1626, P<0.05), while a negative correlation was observed between SDI and EAPC of ASYR (ρ=−0.2421, P<0.01).

Conclusion: Conclusively, the incidence and burden of SCI has increased over the last 30 years. Males and the elderly were affected to a greater degree than females and younger individuals.

Level of Evidence: Level III.

Introduction

Spinal cord injury (SCI) can be caused by either traumatic injuries such as vertebral fractures or nontraumatic causes like infections and vascular damages.^[1] Currently, it is still difficult for patients to completely recover from severe SCI, due to the reduced growth capacity of mature neurons in the spinal cord. Consequently, patients with severe SCI will suffer perpetual loss in sensation and motion ability.^[1,2]

Patients with SCI may develop both physical and psychological dysfunctions. After SCI, the impaired vessel and muscle and dysregulated neural-endocrine factors can result in rapid and intense bone loss, leading to osteoporosis and fractures.^[3] Cognitive impairment has also been reported in patients following SCI, as a result of concurrent brain injury or other complications.^[4]

Many injuries can result in SCI, among which falls and road injuries were the leading causes in most regions.^[5] In 2016, the annual incidence rate of SCI in the United States was 54 cases per million population,^[1] and the prevalence rate was 721 to 906 per million people.^[6] In 1990, the annual cost of medical management for SCI was estimated to be 4 billion dollars in America, causing enormous burden to both patients' family and the society.^[6] Overall, the incidence and prevalence of SCI vary from nation to nation, and most surveys were conducted in developed regions.^[1] The is still a lack of up-to-date data about the epidemiology and burden of SCI and the temporal trends worldwide and in each country.

In this study, we explored the epidemiology and health burden of SCI worldwide based on the data from the Global Burden of Diseases (GBD) Study 2019. We aimed to provide a comprehensive description about the incidence, prevalence and burden of SCI. In addition, we also evaluated the association between social development and disease burden. These findings could provide a comprehensive understanding of the current burden of SCI.

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Abstract and Introduction
Methods
Results
Discussion
Conclusions
References
Sidebar

Table 1. The Full form and Explanations of Abbreviations
Abbreviations	Full Form	Explanations
YLD	Years lived with disability	The sum of years that patients lived with disability due to SCI
ASIR	Age standardized incidence rate	The incidence rate of SCI in a specific time and region after age standardization
ASPR	Age standardized prevalence rate	The prevalence rate of SCI in a specific time and region after age standardization
ASYR	Age standardized YLD rate	The YLD rate of SCI in a specific time and region after age standardization
EAPC	Estimated annual percentage change	EAPC are calculated based on a linear regression mode of the age standardized rates and the calendar year to represent temporal trends
SDI	Socio-demographic index	The sociodemographic development level of countries

Table 2. The Incidence of Spinal Cord Injuries, Spinal Cord Lesion at and Below Neck Level
Location	Spinal Injuries			Spinal Cord Lesion at Neck Level			Spinal Cord Lesion Below Neck Level
Location	Incidence Number (×1000)	ASIR per 100,000 in 2019	EAPC From 1990 to 2019	Incidence Number (×1000)	ASIR per 100,000 in 2019	EAPC From 1990 to 2019	Incidence Number (×1000)	ASIR per 100,000 in 2019	EAPC From 1990 to 2019
Global	909 (707–1156)	12 (9–15)	−0.08 (−0.24 to 0.09)	492 (354–675)	6 (5–9)	−0.09 (−0.32 to 0.14)	417 (290–585)	5 (4–7)	−0.06 (−0.2 to 0.08)
East Asia	236 (173–315)	13 (10–18)	0.7 (0.32 to 1.09)	123 (79–187)	7 (5–11)	0.72 (0.34–1.1)	113 (72–173)	6 (4–10)	0.69 (0.3–1.08)
Southeast Asia	47 (38–60)	7 (6–9)	−0.6 (−1.41 to 0.22)	26 (19–35)	4 (3–5)	−0.8 (−1.56 to −0.04)	22 (16–31)	3 (2–5)	−0.34 (−1.23 to 0.55)
Oceania	1 (0–1)	5 (4–6)	−0.37 (−1.6 to 0.87)	0 (0–0)	3 (2–4)	−0.5 (−1.63 to 0.65)	0 (0–0)	2 (2–3)	−0.21 (−1.55 to 1.15)
Central Asia	6 (5–7)	7 (6–8)	−1.26 (−2.15 to −0.35)	3 (3–4)	4 (3–5)	−1.84 (−3.1 to −0.56)	3 (2–4)	3 (2–4)	−0.18 (−0.31 to −0.05)
Central Europe	17 (14–22)	13 (11–16)	−1.08 (−1.38 to −0.77)	9 (7–12)	7 (5–9)	−1.51 (−2.01 to −1.01)	8 (6–11)	6 (5–8)	−0.5 (−0.56 to −0.44)
Eastern Europe	30 (24–38)	13 (11–16)	−0.57 (−0.83 to −0.32)	16 (12–22)	7 (5–9)	−0.59 (−0.93 to −0.25)	14 (10–19)	6 (4–8)	−0.55 (−0.73 to −0.37)
High-income Asia Pacific	33 (25–43)	12 (9–15)	−0.49 (−0.57 to −0.41)	17 (12–25)	6 (4–8)	−0.5 (−0.58 to −0.42)	16 (11–22)	6 (4–8)	−0.47 (−0.55 to −0.39)
Australasia	5 (4–6)	14 (11–17)	0.3 (0.27 to 0.34)	3 (2–4)	7 (5–10)	0.31 (0.28–0.34)	2 (2–3)	7 (5–9)	0.29 (0.26–0.33)
Western Europe	61 (46–81)	10 (8–12)	−0.36 (−0.42 to −0.3)	32 (21–47)	5 (4–7)	−0.36 (−0.43 to −0.3)	29 (20–42)	5 (3–6)	−0.36 (−0.42 to −0.29)
Southern Latin America	5 (4–6)	8 (6–9)	−0.02 (−0.07 to 0.03)	3 (2–4)	4 (3–5)	−0.05 (−0.1 to −0.01)	3 (2–3)	4 (3–5)	0.01 (−0.05 to 0.07)
High-income North America	114 (85–156)	23 (17–30)	−0.08 (−0.28 to 0.11)	59 (39–90)	12 (8–17)	−0.08 (−0.27 to 0.11)	55 (37–83)	11 (8–16)	−0.08 (−0.28 to 0.12)
Caribbean	3 (3–4)	7 (6–9)	0.99 (−1.28 to 3.31)	2 (1–2)	4 (3–5)	0.86 (−1.34 to 3.11)	2 (1–2)	3 (2–4)	1.14 (−1.2 to 3.54)
Andean Latin America	3 (2–3)	5 (4–5)	−1.05 (−1.57 to −0.53)	2 (1–2)	2 (2–3)	−1.76 (−2.58 to −0.94)	1 (1–2)	2 (2–3)	0.09 (−0.03 to 0.21)
Central Latin America	25 (20–31)	10 (8–13)	−0.12 (−0.46 to 0.23)	13 (9– 18)	5 (4–7)	−0.36 (−0.69 to −0.02)	12 (9–16)	5 (3–7)	0.17 (−0.2 to 0.53)
Tropical Latin America	33 (25–44)	14 (11–19)	−0.19 (−0.27 to −0.12)	17 (12–26)	8 (5–11)	−0.19 (−0.26 to −0.11)	16 (11–23)	7 (5–10)	−0.2 (−0.27 to −0.12)
North Africa and Middle East	53 (35–98)	9 (6–17)	2.2 (1.06–3.36)	38 (21–81)	7 (4–14)	3.27 (1.95–4.6)	15 (11–20)	3 (2–3)	−0.6 (−1.54 to 0.35)
South Asia	156 (120–201)	9 (7–12)	0.05 (−0.29 to 0.4)	86 (60–123)	5 (4–7)	0.08 (−0.26 to 0.41)	70 (48–100)	4 (3–6)	0.03 (−0.35 to 0.4)
Central sub-Saharan Africa	5 (4–8)	5 (4–6)	−2.69 (−4.88 to −0.46)	3 (2–6)	3 (2–5)	−3.39 (−6.12 to −0.59)	2 (1–3)	2 (1–3)	0.04 (−0.07 to 0.16)
Eastern sub-Saharan Africa	29 (22–38)	9 (7–12)	−2.85 (−4.19 to −1.48)	16 (11–22)	5 (3–7)	−4.03 (−5.81 to −2.22)	13 (9–20)	4 (3–6)	−0.08 (−0.17 to 0.02)
Southern Sub-Saharan Africa	7 (5–9)	9 (7–12)	−0.27 (−0.46 to −0.09)	3 (2–5)	5 (3–7)	−0.33 (−0.52 to −0.14)	3 (2–5)	4 (3–7)	−0.21 (−0.4 to −0.02)
Western Sub-Saharan Africa	38 (28–52)	11 (8–15)	0.24 (0.06–0.41)	21 (14–31)	6 (4–9)	0.15 (−0.16 to 0.45)	17 (11–28)	5 (3–9)	0.35 (0.28–0.42)