Global, regional, and national burden of spinal cord injury, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019
Mahdi Safdarian, Eugen Trinka, Vafa Rahimi‐Movaghar, Aljoscha Thomschewski, Amirali Aali, Gdiom Gebreheat Abady, Semagn Mekonnen Abate, Foad Abd-Allah, Aidin Abedi, Denberu Eshetie Adane, Saira Afzal, Bright Opoku Ahinkorah, Sajjad Ahmad, Haroon Ahmed, Nasir Amanat, Dhanalakshmi Angappan, Jalal Arabloo, Armin Aryannejad, Seyyed Shamsadin Athari, Alok Atreya, Sina Azadnajafabad, Ahmed Y. Azzam, Hassan Babamohamadi, Palash Chandra Banik, Mainak Bardhan, Azadeh Bashiri, Alemshet Yirga Berhie, Ajay Nagesh Bhat, Julie Brown, Ana Paula Silva Champs, Periklis Charalampous, Isaac Sunday Chukwu, Kaleb Coberly, Omid Dadras, Dereje Y Yada, Xiaochen Dai, Lalit Dandona, Rakhi Dandona, Fikadu Nugusu Dessalegn, Abebaw Alemayehu Desta, Sameer Dhingra, Nancy Diao, Daniel Díaz, Mahmoud Dibas, Deepa Dongarwar, Haneil Larson Dsouza, Michael Ekholuenetale, Nevine El Nahas, Muhammed Elhadi, Sharareh Eskandarieh, Adeniyi Francis Fagbamigbe, Jawad Fares, Ali Fatehizadeh, Seyed‐Mohammad Fereshtehnejad, Florian Fischer, Richard C. Franklin, Tushar Garg, Melaku Getachew, Fariborz Ghaffarpasand, Ali Gholamrezanezhad, Milad Gholizadeh Mesgarha, Sherief Ghozy, Mahaveer Golechha, Pouya Goleij, Simon Matthew Graham, Vivek Gupta, Juanita A. Haagsma, Samer Hamidi, Netanja I. Harlianto, Mehdi Harorani, Mohammad Hasanian, Amr Hassan, Mohammed Bheser Hassen, Amir Human Hoveidaei, Farideh Iravanpour, Rana Irilouzadian, Chidozie C D Iwu, Louis Jacob, Chinwe Juliana Iwu, Nitin Joseph, Charity Ehimwenma Joshua, Jacek Jerzy Jozwiak, Vidya Kadashetti, Amit Kandel, Rami S. Kantar, Ibraheem M. Karaye, Samad Karkhah, Yousef Khader, Ejaz Ahmad Khan, Mohammad Jobair Khan, Hamid Reza Khayat Kashani, Mohammad Saeid Khonji, Moein Khormali, Grace Kim, Vijay Krishnamoorthy, Senthil Kumaran, Mohammad‐Reza Malekpour, Tuomo J Meretoja, Mohamed Kamal Mesregah, Tomislav Meštrović
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, 20·6 million (95% UI 18·9 to 23·6) individuals were living with SCI in 2019. The incidence of SCI was 0·9 million (0·7 to 1·2) cases with an estimated 6·2 million (4·5 to 8·2) YLDs. SCI rates increased substantially from 1990 to 2019 for global prevalence (81·5%, 74·2 to 87·1), incidence (52·7%, 30·3 to 69·8), and YLDs (65·4%, 56·3 to 76·0). However, global age-standardised rates per 100 000 population showed small changes in prevalence (5·8%, 2·6 to 9·5), incidence (-6·1%, -17·2 to 1·5), and YLDs (-1·5%, -5·5 to 3·2). 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 (10·8 million [9·5 to 13·9] vs 9·7 million [9·2 to 10·4]), and YLDs (4·2 million [3·0 to 5·8] vs 1·9 million [1·3 to 2·5]). 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. FUNDING: Bill & Melinda Gates Foundation.