Global, regional, and national burden of spinal cord injury, 1990-2019: a systematic analysis for the Global Burden of Disease Study 2019

Abstract

Background Spinal cord injury (SCI) is a major cause of health loss due to premature mortality and long-term disability. We aimed to report on the global, regional, and national incidence, prevalence, and years of life lived with disability (YLDs) for SCI from 1990 to 2019, using data from the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019. Methods Using GBD 2019 data pooled in DisMod-MR 2.1, a Bayesian meta-regression tool, we systematically derived numbers and age-standardised rate changes with 95 uncertainty intervals (95 UIs) for the incidence, prevalence, and YLDs for SCI from 1990 to 2019 for the whole world, 21 GBD regions, and 204 countries and territories. We report trends based on age, sex, year, cause of injury, and level of injury. Findings Globally, 20 center dot 6 million (95 UI 18 center dot 9 to 23 center dot 6) individuals were living with SCI in 2019. The incidence of SCI was 0 center dot 9 million (0 center dot 7 to 1 center dot 2) cases with an estimated 6 center dot 2 million (4 center dot 5 to 8 center dot 2) YLDs. SCI rates increased substantially from 1990 to 2019 for global prevalence (81 center dot 5, 74 center dot 2 to 87 center dot 1), incidence (52 center dot 7, 30 center dot 3 to 69 center dot 8), and YLDs (65 center dot 4, 56 center dot 3 to 76 center dot 0). However, global age-standardised rates per 100 000 population showed small changes in prevalence (5 center dot 8, 2 center dot 6 to 9 center dot 5), incidence (-6 center dot 1, -17 center dot 2 to 1 center dot 5), and YLDs (-1 center dot 5, -5 center dot 5 to 3 center dot 2). Data for 2019 shows that the incidence of SCI increases sharply until age 15-19 years, where it remains reasonably constant until 85 years of age and older. By contrast, prevalence and YLDs showed similar patterns to each other, with one peak at around age 45-54 years. The incidence, prevalence, and YLDs of SCI have consistently been higher in men than in women globally, with a slight and steady increase for both men and women from 1990 to 2019. Between 1990 and 2019, SCI at neck level was more common than SCI below neck level in terms of incidence (492 thousand 354 to 675 vs 417 thousand 290 to 585), prevalence (10 center dot 8 million 9 center dot 5 to 13 center dot 9 vs 9 center dot 7 million 9 center dot 2 to 10 center dot 4), and YLDs (4 center dot 2 million 3 center dot 0 to 5 center dot 8 vs 1 center dot 9 million 1 center dot 3 to 2 center dot 5). Falls (477 thousand 327 to 683 cases) and road injuries (230 thousand 122 to 389 cases) were the two leading causes of SCI globally in 2019. Interpretation Although age-standardised rates of incidence, prevalence, and YLDs for SCI changed only slightly, absolute counts increased substantially from 1990 to 2019. Geographical heterogeneity in demographic, spatial, and temporal patterns of SCI, at both the national and regional levels, should be considered by policy makers aiming to reduce the burden of SCI. Copyright (c) 2023 The Author(s). Published by Elsevier Ltd.