Increasing incidence of spondylodiscitis in England: An analysis of the national health service (NHS) hospital episode statistics from 2012 to 2021

Abstract

Background: Spondylodiscitis is a potentially life-threatening infection of the intervertebral disk and adjacent vertebral bodies, with a mortality rate of 2-20%. Given the aging population, the increase in immunosuppression, and intravenous drug use in England, the incidence of spondylodiscitis is postulated to be increasing; however, the exact epidemiological trend in England remains unknown.

Objective: The Hospital Episode Statistics (HES) database contains details of all secondary care admissions across NHS hospitals in England. This study aimed to use HES data to characterise the annual activity and longitudinal change of spondylodiscitis in England.

Methods: The HES database was interrogated for all cases of spondylodiscitis between 2012 and 2019. Data for the length of stay, waiting time, age-stratified admissions, and 'Finished Consultant Episodes' (FCEs), which correspond to a patient's hospital care under a lead clinician, were analysed.

Results: In total, 43135 FCEs for spondylodiscitis were identified between 2012 and 2022, of which 97.1% were adults. Overall admissions for spondylodiscitis have risen from 3 per 100,000 population in 2012/13 to 4.4 per 100,000 population in 2020/21. Similarly, FCEs have increased from 5.8 to 10.3 per 100,000 population, in 2012-2013 and 2020/21 respectively. The highest increase in admissions from 2012 to 2021 was recorded for those aged 70-74 (117% increase) and aged 75-59 (133% increase), among those of working age for those aged 60-64 years (91% increase).

Conclusion: Population-adjusted admissions for spondylodiscitis in England have risen by 44% between 2012 and 2021. Healthcare policymakers and providers must acknowledge the increasing burden of spondylodiscitis and make spondylodiscitis a research priority.

Keywords: Discitis; Incidence; Pyogenic; Spine infection; Spondylitis; Spondylodiscitis.

Fig. 1

A line graph showing finished consultant episodes (FCEs) and admissions per 100,000 population for spondylodiscitis (ICD-10: M46.4 ​+ ​M46.3+ M46.2) from 2012/13 to 2020/21. One FCE is a continuous period of admitted patient care under one consultant within one healthcare provider, and multiple FCEs may be counted for a single patient. At the bottom, a legend signified the assigned meaning of the line colours: dark blue is assigned for FCEs, and light blue for admissions. The x-axis shows the years from 2012/13 to 2020/21, and the y-axis shows the number (“n”) of admissions or FCEs, respectively. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 2

An area chart showing age-stratified admissions for spondylodiscitis (ICD-10: M46.4 ​+ ​M46.3+ M46.2) per 100,000 population from 2012/13 to 2020/21 for the following age groups: age 18, 19, 20–24, 25–29, 30–34, 35–39, 40–44, 45–49, 50–54, 55–59, 60–64, 65-59, 70–74, 75–79, 80–84, 85–89, 90+ years. On the x-axis is the time in years from 2012/13 to 2020/21, and on the y-axis is the number of admissions per 100,000 population for spondylodiscitis in the respective year for the respective age group. The colours are categorically chosen to represent and differentiate between the different age groups. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 3

A line chart showing sex-stratified finished consultant episodes for spondylodiscitis (ICD-10: M46.4 ​+ ​M46.3+ M46.2) from 2012/13 to 2020/21 for males and females per 100,000 population. One FCE is a continuous period of admitted patient care under one consultant within one healthcare provider, and multiple FCEs may be counted for a single patient. At the bottom, a legend signified the assigned meaning of the line colours: green is assigned for FCEs for female patients, and orange for FCEs for male patients. The x-axis shows the years from 2012/13 to 2020/21, and the y-axis shows the number (“n”) of FCEs, respectively. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)

Fig. 4

A line chart comparing mean waiting time for admission and length of stay during admission, both in days, for spondylodiscitis (ICD-10: M46.4 ​+ ​M46.3+ M46.2) from 2012/13 to 2020/21. At the bottom, a legend signified the assigned meaning of the line colours: purple is assigned for mean time waited in days, and green for mean length of stay in days. The x-axis shows the years from 2012/13 to 2020/21, and the y-axis shows the days for mean length of stay and mean time waited for admission, respectively. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)